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Pesce A, Ramírez JM, Fabbri N, Martínez Ubieto J, Pascual Bellosta A, Arroyo A, Sánchez-Guillén L, Whitley A, Kocián P, Rosetzka K, Bona Enguita A, Ioannidis O, Bitsianis S, Symeonidis S, Anestiadou E, Teresa-Fernandéz M, Carlo Vittorio F. The EUropean PErioperative MEdical Networking (EUPEMEN) project and recommendations for perioperative care in colorectal surgery: a quality improvement study. Int J Surg 2024; 110:4796-4803. [PMID: 38742840 PMCID: PMC11325912 DOI: 10.1097/js9.0000000000001601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 04/26/2024] [Indexed: 05/16/2024]
Abstract
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.
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Affiliation(s)
- Antonio Pesce
- Department of Surgery, Azienda Unità Sanitaria Locale Ferrara, University of Ferrara, Via Valle Oppio, Lagosanto (FE), Italy
| | - Jose Manuel Ramírez
- Institute for Health Research Aragón
- Department of Surgery, Faculty of Medicine, University of Zaragoza
- Departments of Plastic Surgery
| | - Nicolò Fabbri
- Department of Surgery, Azienda Unità Sanitaria Locale Ferrara, University of Ferrara, Via Valle Oppio, Lagosanto (FE), Italy
| | - Javier Martínez Ubieto
- Institute for Health Research Aragón
- Department of Anaesthesia, Resuscitation and Pain Therapy, Miguel Servet University Hospital
- Grupo Español de Rehabilitación Multimodal (GERM), Zaragoza
| | - Ana Pascual Bellosta
- Institute for Health Research Aragón
- Department of Anaesthesia, Resuscitation and Pain Therapy, Miguel Servet University Hospital
- Grupo Español de Rehabilitación Multimodal (GERM), Zaragoza
| | - Antonio Arroyo
- Grupo Español de Rehabilitación Multimodal (GERM), Zaragoza
- Department of Surgery, Universidad Miguel Hernández Elche, Hospital General Universitario Elche, Elche, Spain
| | - Luis Sánchez-Guillén
- Grupo Español de Rehabilitación Multimodal (GERM), Zaragoza
- Department of Surgery, Universidad Miguel Hernández Elche, Hospital General Universitario Elche, Elche, Spain
| | - Adam Whitley
- Department of Surgery, University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Petr Kocián
- Department of Surgery, Second Faculty of Medicine, Charles University and Motol University Hospital
| | | | - Alejandro Bona Enguita
- Institute for Health Research Aragón
- Grupo Español de Rehabilitación Multimodal (GERM), Zaragoza
| | - Orestis Ioannidis
- Fourth Department of Surgery, Medical School, Faculty of Health Sciences, Aristotle University of Thessaloniki, General Hospital "George Papanikolaou", Thessaloniki, Greece
| | - Stefanos Bitsianis
- Fourth Department of Surgery, Medical School, Faculty of Health Sciences, Aristotle University of Thessaloniki, General Hospital "George Papanikolaou", Thessaloniki, Greece
| | - Savvas Symeonidis
- Fourth Department of Surgery, Medical School, Faculty of Health Sciences, Aristotle University of Thessaloniki, General Hospital "George Papanikolaou", Thessaloniki, Greece
| | - Elissavet Anestiadou
- Fourth Department of Surgery, Medical School, Faculty of Health Sciences, Aristotle University of Thessaloniki, General Hospital "George Papanikolaou", Thessaloniki, Greece
| | - Marta Teresa-Fernandéz
- Institute for Health Research Aragón
- Eupemen Project Coordinator, Institute for Health Research Aragón
| | - Feo Carlo Vittorio
- Department of Surgery, Azienda Unità Sanitaria Locale Ferrara, University of Ferrara, Via Valle Oppio, Lagosanto (FE), Italy
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Ferreira G, Carvalho A, Pereira MG. Relaxation intervention to improve diabetic foot ulcer healing: protocol for a pilot study with a nested qualitative study. J Wound Care 2024; 33:clxxi-clxxxi. [PMID: 38980125 DOI: 10.12968/jowc.2022.0175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/10/2024]
Abstract
OBJECTIVE A mixed-methods approach nested in a pilot three-arm randomised controlled trial (RCT) was conducted to evaluate the feasibility and acceptability of an intervention of progressive muscle relaxation with guided imagery (experimental group) compared to a neutral guided imagery placebo (active control group) and a group that did not receive any psychological intervention (passive control group). The purpose was to inform a future definitive RCT that will test its effectiveness. Qualitatively, this study examined patients and health professionals' perspectives regarding the relaxation intervention, in order to assess the acceptability and applicability of relaxation as an adjuvant therapy. METHOD Participants must have had a diagnosis of diabetes and diabetic foot disease; one or two active hard-to-heal ulcers at the time of the assessment; and clinical levels of stress or anxiety or depression. Participants were randomised and assessed at three timepoints after the first hospital consultation for hard-to-heal diabetic foot ulcer (DFU). RESULTS Rates of eligibility, recruitment, refusal, adherence to study protocol, participation in follow-up and dropout, and patients' satisfaction with the relaxation intervention were assessed as primary outcomes. Secondary outcomes were DFU healing; patients' DFU-related quality of life; physical and mental quality of life; perceived stress; emotional distress; adherence to DFU care; perceptions of DFU; as well as arterial systolic/diastolic pressure and heart rate. CONCLUSION The results of this pilot study contributed to clarification and better elucidation of the benefits of relaxation techniques regarding patients' HRQoL and DFU healing. DECLARATION OF INTEREST Funding: This study was conducted at the Psychology Research Centre (CIPsi/UM) School of Psychology, University of Minho, Portugal and supported by the Foundation for Science and Technology (FCT) through the Portuguese State Budget (UIDB/01662/2020) and by a PhD fellowship from FCT assigned to GF (SFRH/BD/131780/2017) and an FCT grant (PTDC/PSI-GER/28163/2017) assigned to MGP. The authors have no conflicts of interest to declare.
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Affiliation(s)
- Gabriela Ferreira
- Psychology Research Centre, School of Psychology, University of Minho, Braga, Portugal
| | - André Carvalho
- Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - M Graça Pereira
- Psychology Research Centre, School of Psychology, University of Minho, Braga, Portugal
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Da Silva J, Santos D, Vilaça M, Carvalho A, Carvalho R, Jesus Dantas MD, Pereira MG, Carvalho E. Impact of Psychological Distress on Physiological Indicators of Healing Prognosis in Patients with Chronic Diabetic Foot Ulcers: A Longitudinal Study. Adv Wound Care (New Rochelle) 2024; 13:308-321. [PMID: 37756373 DOI: 10.1089/wound.2023.0043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2023] Open
Affiliation(s)
- Jessica Da Silva
- PDBEB-Ph.D. Program in Experimental Biology and Biomedicine, Institute for Interdisciplinary Research, University of Coimbra, Coimbra, Portugal
- CNC-UC-Center for Neuroscience and Cell Biology, CIBB-Center for Innovative Biomedicine and Biotechnology, University of Coimbra, Coimbra, Portugal
| | - Diana Santos
- PDBEB-Ph.D. Program in Experimental Biology and Biomedicine, Institute for Interdisciplinary Research, University of Coimbra, Coimbra, Portugal
- CNC-UC-Center for Neuroscience and Cell Biology, CIBB-Center for Innovative Biomedicine and Biotechnology, University of Coimbra, Coimbra, Portugal
| | - Margarida Vilaça
- CIPsi-Psychology Research Center, School of Psychology, University of Minho, Braga, Portugal
| | - André Carvalho
- Centro Hospitalar e Universitário de Santo António, E.P.E., Unidade de Pé Diabético, Porto, Portugal
| | - Rui Carvalho
- Centro Hospitalar e Universitário de Santo António, E.P.E., Unidade de Pé Diabético, Porto, Portugal
| | - Maria de Jesus Dantas
- Centro Hospitalar do Tâmega e Sousa, E.P.E., Clínica do Pé Diabético, Penafiel, Portugal
| | - M Graça Pereira
- CIPsi-Psychology Research Center, School of Psychology, University of Minho, Braga, Portugal
| | - Eugénia Carvalho
- CNC-UC-Center for Neuroscience and Cell Biology, CIBB-Center for Innovative Biomedicine and Biotechnology, University of Coimbra, Coimbra, Portugal
- Institute for Interdisciplinary Research, University of Coimbra, Coimbra, Portugal
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Weber M, Chao M, Kaur S, Tran B, Dizdarevic A. A Look Forward and a Look Back: The Growing Role of ERAS Protocols in Orthopedic Surgery. Anesthesiol Clin 2024; 42:345-356. [PMID: 38705681 DOI: 10.1016/j.anclin.2023.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2024]
Abstract
The success of enhanced recovery after surgery (ERAS) protocols in improving patient outcomes and reducing costs in general surgery are widely recognized. ERAS guidelines have now been developed in orthopedics with the following recommendations. Preoperatively, patients should be medically optimized with a focus on smoking cessation, education, and anxiety reduction. Intraoperatively, using multimodal and regional therapies like neuraxial anesthesia and peripheral nerve blocks facilitates same-day discharge. Postoperatively, early nutrition with appropriate thromboprophylaxis and early mobilization are essential. As the evidence of their improvement in patient outcomes and satisfaction continues, these pathways will prove invaluable in optimizing patient care in orthopedics.
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Affiliation(s)
- Marissa Weber
- Department of Anesthesiology, Weill Cornell Medicine, 525 East 68th Street, Box 124, New York, NY 10065, USA.
| | - Melissa Chao
- Department of Anesthesiology and Pain Medicine, Columbia University Irving Medical Center, 622 West 168th Street, New York, NY 10032, USA
| | - Simrat Kaur
- Virginia Commonwealth University, VCU School of Medicine, VCU Department of Anesthesiology, West Hospital, 1200 East Broad Street, 7th Floor, North Wing, Box 980695, Richmond, Virginia 23298, USA
| | - Bryant Tran
- Virginia Commonwealth University, VCU School of Medicine, VCU Department of Anesthesiology, West Hospital, 1200 East Broad Street, 7th Floor, North Wing, Box 980695, Richmond, Virginia 23298, USA
| | - Anis Dizdarevic
- Department of Anesthesiology and Pain Medicine, Columbia University Irving Medical Center, 622 West 168th Street, New York, NY 10032, USA
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Xie W, Ye F, Yan X, Cao M, Ho MH, Kwok JYY, Lee JJ. Acupressure can reduce preoperative anxiety in adults with elective surgery: A systematic review and meta-analysis of randomised controlled trials. Int J Nurs Stud 2023; 145:104531. [PMID: 37321140 DOI: 10.1016/j.ijnurstu.2023.104531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 03/28/2023] [Accepted: 05/16/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND Preoperative anxiety is prevalent amongst adults with elective surgery and is associated with multiple detrimental perioperative physiological effects. Increasing studies support the effectiveness of acupressure in managing preoperative anxiety. However, the magnitude of acupressure's positive association with preoperative anxiety is still unclear due to a lack of rigorous evidence synthesis. OBJECTIVE To estimate the efficacy of acupressure on preoperative anxiety and physiological parameters amongst adults scheduled for elective surgery. DESIGN Systematic review and meta-analysis. DATA SOURCES Search terms were combined for acupressure and preoperative anxiety in PubMed, Cochrane Library, EMBASE, CINAHL, China National Knowledge Infrastructure, and WanFang Data Knowledge Service Platform to search for eligible randomised controlled trials from the inception of each database through September 2022. METHODS Pairs of researchers independently screened and extracted data from included studies. The risk of bias was assessed using the Cochrane risk of bias tool Version 2.0. Meanwhile, random-effects meta-analysis of overall effects and prespecified subgroup (i.e., surgery types, intervention providers, and acupressure stimulation tools) was conducted using Review Manager Software 5.4.1. Meta-regression was performed to explore study-level variables that may contribute to heterogeneity using STATA 16. RESULTS Of 24 eligible randomised controlled trials, there were a total of 2537 participants from 5 countries contributed to this synthesis. When comparing acupressure with usual care or placebo, acupressure showed a large effect size for preoperative anxiety (SMD = -1.30; 95%CI = -1.54 to -1.06; p < 0.001; I2 = 86%). The significant mean reduction of heart rate, and systolic and diastolic blood pressure was -4.58 BPM (95%CI = -6.70 to -2.46; I2 = 89%), -6.05 mmHg (95%CI = -8.73 to -3.37; p < 0.001; I2 = 88%), and -3.18 mmHg (95%CI = -5.09 to -1.27; p = 0.001; I2 = 78%), respectively. Exploratory subgroup analyses showed significant differences in surgery types and acupressure stimulation tools, whilst the intervention providers (i.e., healthcare professionals and self-administered) showed no statistically significant difference for acupressure therapy. None of the predefined participants and study-level characteristics moderated preoperative anxiety through meta-regression. CONCLUSION Acupressure appears efficacious as a therapy for improving preoperative anxiety and physiological parameters amongst adults with elective surgery. Self-administered acupressure, which is effective with a large effect, may be considered as an evidence-based approach to managing preoperative anxiety. Hence, this review aids in the development of acupressure in different types of elective surgeries and the improvement of the rigour of acupressure therapy.
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Affiliation(s)
- Wenxuan Xie
- School of Nursing, LKS Faculty of Medicine, University of Hong Kong, China
| | - Fen Ye
- School of Nursing, LKS Faculty of Medicine, University of Hong Kong, China
| | - Xinyi Yan
- School of Nursing, LKS Faculty of Medicine, University of Hong Kong, China
| | - Mengyao Cao
- School of Nursing, LKS Faculty of Medicine, University of Hong Kong, China
| | - Mu-Hsing Ho
- School of Nursing, LKS Faculty of Medicine, University of Hong Kong, China
| | - Jojo Yan Yan Kwok
- School of Nursing, LKS Faculty of Medicine, University of Hong Kong, China
| | - Jung Jae Lee
- School of Nursing, LKS Faculty of Medicine, University of Hong Kong, China.
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Ferreira G, Faria S, Carvalho A, Pereira MG. Relaxation intervention to improve diabetic foot ulcer healing: Results from a pilot randomized controlled study. Wound Repair Regen 2023; 31:528-541. [PMID: 37078427 DOI: 10.1111/wrr.13085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 02/02/2023] [Accepted: 04/10/2023] [Indexed: 04/21/2023]
Abstract
This pilot randomised controlled study (RCT) aimed to assess the feasibility and acceptability of a progressive muscle relaxation with guided imagery intervention (experimental group [EG]) compared to a neutral guided imagery placebo (active control group [ACG]) and standard care to diabetic foot ulcer [DFU] treatment (passive control group [PCG]), to decide on the need for a definitive RCT. Diabetic foot patients with one or two chronic DFU and significant levels of stress/anxiety/depression were recruited and assessed during a period of 6 months, at three moments. Primary outcomes: feasibility rates and satisfaction with relaxation sessions. Secondary outcomes: DFU healing score, DFU-related quality of life (DFUQoL), physical and mental HRQoL, stress and emotional distress, DFU representations, arterial blood pressure, and heart rate. A total of 146 patients completed the baseline (T0) assessment with 54 participants presenting significant distress being randomised into three groups. Patients were assessed 2 months post-intervention (T1) and 4 months after T1 (T2). Feasibility rates showed reduced values on eligibility, recruitment and inclusion in the study, although with an acceptable rate of refusal lower than 10%. On average, participants reported being satisfied with relaxation sessions and recommended them to other patients. Differences between groups showed that, at T1, PCG participants reported higher levels of stress than those from EG and ACG. Within-group differences showed improvements in stress, distress, DFUQoL and DFU extent over time only in EG and ACG. Only EG showed significant changes in DFU representations at T1. The results suggest that relaxation may be a promising coping strategy to deal with DFU distress and an important adjuvant therapy for DFU healing, supporting the implementation of a definitive RCT.
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Affiliation(s)
- Gabriela Ferreira
- School of Psychology, Department of Applied Psychology, University of Minho, Braga, Portugal
- Psychology Research Centre (CIPsi/UM), School of Psychology, University of Minho, Braga, Portugal
| | - Susana Faria
- Department of Mathematics and Applications, University of Minho, Braga, Portugal
| | - André Carvalho
- Service of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário do Porto EPE, Porto, Portugal
| | - M Graça Pereira
- School of Psychology, Department of Applied Psychology, University of Minho, Braga, Portugal
- Psychology Research Centre (CIPsi/UM), School of Psychology, University of Minho, Braga, Portugal
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Ferreira G, Bernardo AC, Carvalho A, Pereira MG. Relax to Heal? Perspectives of Patients with Diabetic Foot Ulcers and Health Professionals on Relaxation Sessions for Wound Healing. Adv Skin Wound Care 2023; 36:1-10. [PMID: 37017401 DOI: 10.1097/01.asw.0000922832.62539.a3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2023]
Abstract
OBJECTIVE To explore patients' and healthcare professionals' (HPs') perspectives on the suitability/acceptability of a relaxation intervention, its effects on patients' well-being and diabetic foot ulcer (DFU) healing, and its incorporation into the multidisciplinary management of patients with diabetic foot. METHODS This qualitative study was nested within a three-arm pilot randomized controlled trial. Patients with a chronic DFU received four relaxation sessions. Investigators then interviewed patients, physicians, and nurses involved with diabetic foot consultations. Interviews were audio-recorded, transcribed, and analyzed using thematic content analysis. RESULTS Five themes emerged from patient's interviews about the suitability/acceptability of the relaxation intervention: perceptions regarding the psychological intervention, distress, the relaxation technique, changes in the patient's life, and changes in DFU/contribution to healing. Three themes emerged from interviews with HPs: perceptions regarding relaxation, changes in the patient, and changes in DFU/healing. Regarding the feasibility of the relaxation intervention, three themes emerged for both patients and HPs: suggested modifications, stressors/difficulties, and impact of COVID-19 pandemic. The utility theme emerged only in HP interviews, with subthemes of patients' distress, psychological interventions, relaxation intervention, and integration of the psychologist in the team. CONCLUSIONS These findings provide evidence for the suitability/acceptability, feasibility, and utility of a relaxation intervention in diabetic foot consultations.
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Affiliation(s)
- Gabriela Ferreira
- At the Psychology Research Centre, School of Psychology, University of Minho, Braga, Portugal, Gabriela Ferreira, PhD, is Research Collaborator, Health & Family Research Group; and Ana Cristina Bernardo, MSc, is PhD Student in Psychology. André Carvalho, MD, PhD, is a Consultant in Endocrinology and Diabetes, at Centro Hospitalar Universitário do Porto. M. Graça Pereira, PhD, is the Coordinator of the Health, Well-being and Performance Research Lab, and the coordinator of the Health & Family Research Group in the Psychology Research Centre. She is also an Associate Professor with Habilitation in the School of Psychology, University of Minho
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Güler B, Mete S. Effects of Relaxation-Focused Nursing Program in Women with Ovarian Cancer: A Randomized Controlled Trial. Pain Manag Nurs 2023:S1524-9042(23)00074-7. [PMID: 37045690 DOI: 10.1016/j.pmn.2023.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 02/26/2023] [Accepted: 03/11/2023] [Indexed: 04/14/2023]
Abstract
BACKGROUND Surgical treatment is a major cause of hospitalization in ovarian cancer. In this process, physical problems, such as pain and changes in respiratory functions, and psychological problems, such as anxiety and stress, may develop. AIM This study aims to investigate the effects of the Relaxation-Focused Nursing Program on pain, anxiety, lung volume, level of knowledge, and nursing care satisfaction in ovarian cancer surgery. METHOD A randomized controlled trial in which participants were randomly assigned to either the experimental (preoperative relaxation exercises and education; n = 24) or control (usual nursing care; n =22) groups. The intervention consisted of practicing four sessions of relaxation exercises and education in the hospital for two days before surgery. Data were collected using the Trait and State Anxiety Inventory, Surgical Information Form, and Perioperative Assessment Form. The results were analyzed using the Friedman and Wilcoxon tests. RESULTS The findings showed significant reductions in pain (p = .045) and anxiety scores (p < .001). The level of knowledge means scores were higher in the experimental group, but there was no significant difference between mean scores of spirometer volume and care satisfaction. CONCLUSIONS The program was more effective than usual nursing care in preoperative anxiety, pain, and level of knowledge. Although there was no difference between the care satisfaction scores of the patients, the reasons for care satisfaction were different in the program. Developing and implementing care that combines stress reduction interventions and preoperative education can improve the preoperative outcomes of patients.
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Affiliation(s)
- Buse Güler
- From the Dokuz Eylul University Faculty of Nursing, İzmir, Turkey.
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Zengin Aydın L, Doğan A. The Effect of Guided Imagery on Postoperative Pain Management in Patients Undergoing Lower Extremity Surgical Operations: A Randomized Controlled Trial. Orthop Nurs 2023; 42:105-112. [PMID: 36944205 DOI: 10.1097/nor.0000000000000929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/23/2023] Open
Abstract
Guided imagery distracts patients from disturbing feelings and thoughts, positively affects emotional well-being, and reduces pain by producing pleasing mental images. This study aimed to determine the effects of guided imagery on postoperative pain management in patients undergoing lower extremity surgery. This randomized controlled study was conducted between April 2018 and May 2019. This study included 60 patients who underwent lower extremity surgery. After using guided imagery, the posttest mean Visual Analog Scale score of patients in the intervention group was found to be 2.56 (1.00 ± 6.00), whereas the posttest mean score of patients in the control group was 4.10 (3.00 ± 6.00), and the difference between the groups was statistically significant (p <.001). Guided imagery reduces short-term postoperative pain after lower extremity surgery.
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Affiliation(s)
- Leyla Zengin Aydın
- Leyla Zengin Aydin, PhD, Department of Nursing, Ataturk Faculty of Health Sciences, Dicle University, Diyarbakır, Turkey
- Aysel Doğan, PhD, Department of Nursing, Faculty of Health Sciences, Toros University, Mersin, Turkey
| | - Aysel Doğan
- Leyla Zengin Aydin, PhD, Department of Nursing, Ataturk Faculty of Health Sciences, Dicle University, Diyarbakır, Turkey
- Aysel Doğan, PhD, Department of Nursing, Faculty of Health Sciences, Toros University, Mersin, Turkey
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Stanzel A, Sierau S. Pediatric Medical Traumatic Stress (PMTS) following Surgery in Childhood and Adolescence: a Systematic Review. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2022; 15:795-809. [PMID: 35958723 PMCID: PMC9360277 DOI: 10.1007/s40653-021-00391-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/22/2021] [Indexed: 05/22/2023]
Abstract
The purpose of the present review was to systematically review, synthesize and quantify prevalence rates of subclinical and clinical psychological symptoms in children and adolescents who have undergone surgery. Systematic literature searches were conducted twofold in April 8, 2020 and March 7, 2021 in PsycInfo and PubMed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Manuscripts were screened against eligibility criteria and were included if they investigated psychological symptoms in children or adolescents (age between 1 to 21 years at the time of study) who were hospitalized for pediatric surgery. Means and standard deviations weighted by sample size were calculated. Eleven articles met inclusion criteria. The review revealed that a small but substantial number of children and adolescents are at an elevated risk for postoperative psychological symptoms and disorders. Up to 13% had symptoms consistent with a diagnosis of a posttraumatic stress disorder, 6% to 8% exhibited elevated symptoms of depression or anxiety, and about 25% showed internalizing and externalizing symptoms. This review provides preliminary evidence that children and adolescents experience significant psychological distress and posttraumatic stress symptoms after pediatric surgery. Apart from better training of clinicians, prevention, early psychological screening and psychosocial care in surgical wards of hospitals are recommended. Well-designed studies of high methodological quality are necessary to replicate existing findings and provide a broader base of evidence. Supplementary Information The online version contains supplementary material available at 10.1007/s40653-021-00391-9.
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Affiliation(s)
- Anna Stanzel
- Department of Clinical Child and Adolescent Psychology, Institute of Psychology, Leipzig University, Leipzig, Germany
| | - Susan Sierau
- Department of Clinical Child and Adolescent Psychology, Institute of Psychology, Leipzig University, Leipzig, Germany
- Department of Medical Psychology and Medical Sociology, Leipzig University, Leipzig, Germany
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Effect of Ultrasound Image-Guided Nerve Block on the Postoperative Recovery Quality of Patients with Tibial Fractures Using the Concept of Enhanced Recovery after Surgery. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:4428883. [PMID: 36045945 PMCID: PMC9424038 DOI: 10.1155/2022/4428883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 07/28/2022] [Accepted: 08/03/2022] [Indexed: 11/24/2022]
Abstract
This study was aimed at investigating the clinical effect of ultrasound-guided nerve block based on the concept of enhanced recovery after surgery (ERAS) for postoperative anesthesia in patients with tibial fractures. The noise-reduction processing was introduced in ultrasound images to adjust the ultrasound clarity of the patient. A total of 177 patients with tibial fractures in our hospital were retrospectively analyzed and divided into OG group (general anesthesia combined with nerve block, 78 cases), C1 group (simple general anesthesia, 27 cases), C2 group (ultrasound-guided nerve block combined with general anesthesia, 10 cases), and C3 group (62 cases of spinal-epidural anesthesia). The effect of anesthesia and postoperative recovery time of patients in each group were analyzed. The wake-up time of the OG group was significantly shorter than that of the other three groups (P < 0.05). The doses of propofol and remifentanil in the OG group were much lower than those in the other groups (P < 0.05). After the ultrasound image was processed with noise reduction, the image showed the lesion more clearly. The excellent and good rates of OG group, C1 group, C2 group, and C3 group were 89.86%, 62.73%, 75.37%, and 61.07%, respectively. The Ramsay sedation score and anesthesia satisfaction in the OG group were obviously higher than those in the other groups, but there was no significant difference (P > 0.05). The visual analogue scale (VAS) scores of the OG group at 12 h, 24 h, and 36 h after the surgery were 4.52 ± 0.41, 4.72 ± 0.24, and 4.81 ± 0.74, respectively, which were significantly higher than those of the other three groups (P < 0.05). On the basis of ERAS, ultrasound-guided nerve block combined with general anesthesia can improve the perioperative pain in patients with tibial fractures and significantly shorten the time for the wake-up time. In addition, it was safe and reliable, so it was worthy of clinical promotion.
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Schrempf MC, Petzold J, Petersen MA, Arndt TT, Schiele S, Vachon H, Vlasenko D, Wolf S, Anthuber M, Müller G, Sommer F. A randomised pilot trial of virtual reality-based relaxation for enhancement of perioperative well-being, mood and quality of life. Sci Rep 2022; 12:12067. [PMID: 35835944 PMCID: PMC9282619 DOI: 10.1038/s41598-022-16270-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 07/07/2022] [Indexed: 11/12/2022] Open
Abstract
A cancer diagnosis and subsequent treatment can trigger distress, negatively impact coping resources, and affect well-being as well as quality of life. The aim of this pilot study was to investigate feasibility and clinical effects of a VR intervention on quality of life, well-being and mood in cancer patients undergoing surgery compared to a non-VR intervention and a control group. 54 patients with colorectal cancer or liver metastases from colorectal cancer undergoing elective curatively intended surgery were recruited and randomised to one of two intervention groups or a control group receiving standard treatment. Participants assigned to one of the intervention groups either received a VR-based intervention twice daily or listened to music twice daily. Adherence to the intervention was 64.6% in the music group and 81.6% in the VR group. The VR intervention significantly reduced heart rate (- 1.2 bpm; 95% CI - 2.24 to - 0.22; p = 0.02) and respiratory rate (- 0.7 brpm; 95% CI - 1.08 to - 0.25; p = 0.01). Self-reported overall mood improved in both groups (VR: + 0.79 pts; 95% CI 0.37-1.21; p = 0.001; music: + 0.59 pts; 95% CI 0.22-0.97; p = 0.004). There was no difference in quality of life between the three groups. Both interventions groups reported changes in feelings. Adherence rates favoured the VR intervention over the music group. Observed clinical outcomes showed stronger intragroup effects on mood, feelings, and vital signs in the VR group. The study demonstrated feasibility of a VR intervention in cancer patients undergoing surgery and should encourage further research investigating the potential of VR interventions to positively influence well-being and mood in cancer patients.
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Affiliation(s)
- Matthias C Schrempf
- Department of General, Visceral and Transplantation Surgery, University Hospital Augsburg, Stenglinstrasse 2, 86156, Augsburg, Germany.
| | - Julian Petzold
- Department of General, Visceral and Transplantation Surgery, University Hospital Augsburg, Stenglinstrasse 2, 86156, Augsburg, Germany
| | - Morten Aa Petersen
- Palliative Care Research Unit, Department of Palliative Medicine GP, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Tim Tobias Arndt
- Department of Computational Statistics and Data Analysis, Institute of Mathematics, University of Augsburg, Augsburg, Germany
| | - Stefan Schiele
- Department of Computational Statistics and Data Analysis, Institute of Mathematics, University of Augsburg, Augsburg, Germany
| | - Hugo Vachon
- Quality of Life Department, European Organisation for Research and Treatment of Cancer, Brussels, Belgium
| | - Dmytro Vlasenko
- Department of General, Visceral and Transplantation Surgery, University Hospital Augsburg, Stenglinstrasse 2, 86156, Augsburg, Germany
| | - Sebastian Wolf
- Department of General, Visceral and Transplantation Surgery, University Hospital Augsburg, Stenglinstrasse 2, 86156, Augsburg, Germany
| | - Matthias Anthuber
- Department of General, Visceral and Transplantation Surgery, University Hospital Augsburg, Stenglinstrasse 2, 86156, Augsburg, Germany
| | - Gernot Müller
- Department of Computational Statistics and Data Analysis, Institute of Mathematics, University of Augsburg, Augsburg, Germany
| | - Florian Sommer
- Department of General, Visceral and Transplantation Surgery, University Hospital Augsburg, Stenglinstrasse 2, 86156, Augsburg, Germany
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13
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Josephs CA, Shaffer VO, Kucera WB. Impact of Mental Health on General Surgery Patients and Strategies to Improve Outcomes. Am Surg 2022:31348221109469. [PMID: 35730505 DOI: 10.1177/00031348221109469] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Mental Health Disorders (MHD) are a growing concern nationwide. The significant impact MHD have on surgical outcomes has only recently started to be understood. This literature review investigated how mental health impacts the outcomes of general surgery patients and what can be done to make improvements. Patients with schizophrenia had the poorest surgical outcomes. Mental health disorders increased post-surgical pain, hospital length of stay, complications, readmissions, and mortality. Mental health disorders decreased wound healing and quality of care. Optimizing outcomes will be best accomplished through integrating more effective perioperative screening tools and interventions. Screenings tools can incorporate artificial intelligence, MHD data, resilience and its biomarkers, and patient mental health questionnaires. Interventions include cognitive behavioral therapy, virtual reality, spirituality, pharmacology, and resilience training.
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Affiliation(s)
- Cooper A Josephs
- 364432Campbell University School of Osteopathic Medicine, Lillington, NC, USA
| | - Virginia O Shaffer
- Department of Surgery, 12239Emory University School of Medicine, Atlanta, GA, USA
| | - Walter B Kucera
- Department of Surgery, 12239Emory University School of Medicine, Atlanta, GA, USA
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14
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Daily mother-infant skin-to-skin contact and maternal mental health and postpartum healing: a randomized controlled trial. Sci Rep 2022; 12:10225. [PMID: 35715486 PMCID: PMC9205929 DOI: 10.1038/s41598-022-14148-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 06/02/2022] [Indexed: 11/09/2022] Open
Abstract
This randomized controlled trial examined the effects of a daily hour of mother-infant skin-to-skin contact (SSC) during the first five postnatal weeks, compared to care-as-usual, on maternal depressive (primary outcome), anxiety, stress, fatigue, pain, and delivery-related post-traumatic stress symptoms (PTSS). Prenatal symptom severity and touch discomfort were examined as moderators. Mothers and full-term infants were randomly allocated to SSC or care-as-usual conditions and followed during the first postnatal year. For the total group (intention-to-treat analyses), care-as-usual mothers showed an increase of anxiety symptoms from week 2 to 12, while SSC mothers displayed a stability of anxiety symptoms. Also, care-as-usual mothers showed an initial decrease in fatigue followed by an increase, while SSC mothers showed a decrease from week 2 to 12. In per-protocol analyses, including only the SSC dyads who adhered to SSC guidelines, findings on anxiety, but not fatigue, were replicated. No SSC effects were found for depressive, stress, and pain symptoms. No moderator, dose-response, or 52-week follow-up effects were found. PTSS were low with little variation; consequently, analyses were discontinued. Daily SSC in healthy mother-infant dyads may reduce anxiety and fatigue symptoms, but not depressive, stress, and pain symptoms, during the early postpartum period. Replication studies are recommended.
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15
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Weber M, Chao M, Kaur S, Tran B, Dizdarevic A. A Look Forward and a Look Back: The Growing Role of ERAS Protocols in Orthopedic Surgery. Clin Sports Med 2022; 41:345-355. [PMID: 35300845 DOI: 10.1016/j.csm.2021.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
The success of enhanced recovery after surgery (ERAS) protocols in improving patient outcomes and reducing costs in general surgery are widely recognized. ERAS guidelines have now been developed in orthopedics with the following recommendations. Preoperatively, patients should be medically optimized with a focus on smoking cessation, education, and anxiety reduction. Intraoperatively, using multimodal and regional therapies like neuraxial anesthesia and peripheral nerve blocks facilitates same-day discharge. Postoperatively, early nutrition with appropriate thromboprophylaxis and early mobilization are essential. As the evidence of their improvement in patient outcomes and satisfaction continues, these pathways will prove invaluable in optimizing patient care in orthopedics.
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Affiliation(s)
- Marissa Weber
- Department of Anesthesiology, Weill Cornell Medicine, 525 East 68th Street, Box 124, New York, NY 10065, USA.
| | - Melissa Chao
- Department of Anesthesiology and Pain Medicine, Columbia University Irving Medical Center, 622 West 168th Street, New York, NY 10032, USA
| | - Simrat Kaur
- Virginia Commonwealth University, VCU School of Medicine, VCU Department of Anesthesiology, West Hospital, 1200 East Broad Street, 7th Floor, North Wing, Box 980695, Richmond, Virginia 23298, USA
| | - Bryant Tran
- Virginia Commonwealth University, VCU School of Medicine, VCU Department of Anesthesiology, West Hospital, 1200 East Broad Street, 7th Floor, North Wing, Box 980695, Richmond, Virginia 23298, USA
| | - Anis Dizdarevic
- Department of Anesthesiology and Pain Medicine, Columbia University Irving Medical Center, 622 West 168th Street, New York, NY 10032, USA
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16
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Weis CN, Webb EK, deRoon-Cassini TA, Larson CL. Emotion Dysregulation Following Trauma: Shared Neurocircuitry of Traumatic Brain Injury and Trauma-Related Psychiatric Disorders. Biol Psychiatry 2022; 91:470-477. [PMID: 34561028 PMCID: PMC8801541 DOI: 10.1016/j.biopsych.2021.07.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 07/13/2021] [Accepted: 07/25/2021] [Indexed: 11/02/2022]
Abstract
The psychological trauma associated with events resulting in traumatic brain injury (TBI) is an important and frequently overlooked factor that may impede brain recovery and worsen mental health following TBI. Indeed, individuals with comorbid posttraumatic stress disorder (PTSD) and TBI have significantly poorer clinical outcomes than individuals with a sole diagnosis. Emotion dysregulation is a common factor leading to poor cognitive and affective outcomes following TBI. Here, we synthesize how acute postinjury molecular processes stemming from either physical or emotional trauma may adversely impact circuitry subserving emotion regulation and ultimately yield long-term system-level functional and structural changes that are common to TBI and PTSD. In the immediate aftermath of traumatic injury, glucocorticoids stimulate excess glutamatergic activity, particularly in prefrontal cortex-subcortical circuitry implicated in emotion regulation. In human neuroimaging work, assessing this same circuitry well after the acute injury, TBI and PTSD show similar impacts on prefrontal and subcortical connectivity and activation. These neural profiles indicate that emotion regulation may be a useful target for treatment and early intervention to prevent the adverse sequelae of TBI. Ultimately, the success of future TBI and PTSD early interventions depends on the fields' ability to address both the physical and emotional impact of physical injury.
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17
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Pombeiro I, Moura J, Pereira MG, Carvalho E. Stress-Reducing Psychological Interventions as Adjuvant Therapies for Diabetic Chronic Wounds. Curr Diabetes Rev 2022; 18:e060821195361. [PMID: 34365927 DOI: 10.2174/1573399817666210806112813] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 05/29/2021] [Accepted: 06/04/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Diabetic foot ulcers (DFUs) are a major complication of diabetes mellitus and a leading cause of lower limb amputation. Interventions to reduce psychological stress may have the potential to improve self-care and greatly reduce the morbidity and mortality associated with DFU. This review is focused on the consequences of psychological stress in wound healing and reflects on the effects of currently used psychological stress-reducing interventions in patients with DFU, proposing new applications for currently used stress-reduction interventions. RESULTS Stress is a natural and fundamental survival mechanism that becomes harmful when chronic. DFU is associated with high levels of anxiety and chronic psychological stress. Chronic stressinduced cortisol and adrenaline release impair wound healing, independently of the stressor. Psychological stress-reducing interventions, such as relaxation with guided imagery, biofeedback-assisted relaxation, mindfulness-based strategies, and hypnosis, can lead to a reduction in perceived stress and improve wound healing by reducing wound inflammation and pain while improving glycemic control. All stress reduction interventions also lead to pain relief and improved patient's quality of life. CONCLUSION Psychological stress-reducing interventions are promising adjuvant therapies for DFU. Their clinical application can improve self-care by tackling patient's expectations, anxieties, and fears. They can also help patients manage stress and pain while reducing wound inflammation and improving wound healing.
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Affiliation(s)
- Isadora Pombeiro
- Center for Neuroscience and Cell Biology, University of Coimbra, Coimbra, Portugal
| | - João Moura
- Center for Neuroscience and Cell Biology, University of Coimbra, Coimbra, Portugal
| | - M Graça Pereira
- School of Psychology, Department of Applied Psychology, University of Minho, Braga, Portugal
- Psychology Research Center (CIPsi), University of Minho, Braga, Portugal
| | - Eugénia Carvalho
- Center for Neuroscience and Cell Biology, University of Coimbra, Coimbra, Portugal
- Institute of Interdisciplinary Research, University of Coimbra, Coimbra, Portugal
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18
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Meyer-Arndt L, Schmitz-Hübsch T, Bellmann-Strobl J, Brandt AU, Haynes JD, Gold SM, Paul F, Weygandt M. Neural Processes of Psychological Stress and Relaxation Predict the Future Evolution of Quality of Life in Multiple Sclerosis. Front Neurol 2021; 12:753107. [PMID: 34887828 PMCID: PMC8650716 DOI: 10.3389/fneur.2021.753107] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 10/26/2021] [Indexed: 01/10/2023] Open
Abstract
Health-related quality of life (HRQoL) is an essential complementary parameter in the assessment of disease burden and treatment outcome in multiple sclerosis (MS) and can be affected by neuropsychiatric symptoms, which in turn are sensitive to psychological stress. However, until now, the impact of neurobiological stress and relaxation on HRQoL in MS has not been investigated. We thus evaluated whether the activity of neural networks triggered by mild psychological stress (elicited in an fMRI task comprising mental arithmetic with feedback) or by stress termination (i.e., relaxation) at baseline (T0) predicts HRQoL variations occurring between T0 and a follow-up visit (T1) in 28 patients using a robust regression and permutation testing. The median delay between T0 and T1 was 902 (range: 363–1,169) days. We assessed HRQoL based on the Hamburg Quality of Life Questionnaire in MS (HAQUAMS) and accounted for the impact of established HRQoL predictors and the cognitive performance of the participants. Relaxation-triggered activity of a widespread neural network predicted future variations in overall HRQoL (t = 3.68, pfamily−wise error [FWE]-corrected = 0.008). Complementary analyses showed that relaxation-triggered activity of the same network at baseline was associated with variations in the HAQUAMS mood subscale on an αFWE = 0.1 level (t = 3.37, pFWE = 0.087). Finally, stress-induced activity of a prefronto-limbic network predicted future variations in the HAQUAMS lower limb mobility subscale (t = −3.62, pFWE = 0.020). Functional neural network measures of psychological stress and relaxation contain prognostic information for future HRQoL evolution in MS independent of clinical predictors.
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Affiliation(s)
- Lil Meyer-Arndt
- Max Delbrück Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Experimental and Clinical Research Center, Berlin, Germany.,Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, NeuroCure Clinical Research Center, Berlin, Germany.,Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Neurology, Berlin, Germany
| | - Tanja Schmitz-Hübsch
- Max Delbrück Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Experimental and Clinical Research Center, Berlin, Germany.,Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, NeuroCure Clinical Research Center, Berlin, Germany
| | - Judith Bellmann-Strobl
- Max Delbrück Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Experimental and Clinical Research Center, Berlin, Germany.,Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, NeuroCure Clinical Research Center, Berlin, Germany
| | - Alexander U Brandt
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, NeuroCure Clinical Research Center, Berlin, Germany.,Department of Neurology, University of California, Irvine, Irvine, CA, United States
| | - John-Dylan Haynes
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, NeuroCure Clinical Research Center, Berlin, Germany.,Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin Center for Advanced Neuroimaging, Berlin, Germany.,Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Bernstein Center for Computational Neuroscience, Berlin, Germany
| | - Stefan M Gold
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Psychosomatic Medicine, Berlin, Germany.,Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Psychiatry and Psychotherapy, Campus Benjamin Franklin, Berlin, Germany.,Universitätsklinikum Hamburg-Eppendorf, Institute of Neuroimmunology and Multiple Sclerosis (INIMS), Center for Molecular Neurobiology Hamburg, Hamburg, Germany
| | - Friedemann Paul
- Max Delbrück Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Experimental and Clinical Research Center, Berlin, Germany.,Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, NeuroCure Clinical Research Center, Berlin, Germany.,Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Neurology, Berlin, Germany
| | - Martin Weygandt
- Max Delbrück Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Experimental and Clinical Research Center, Berlin, Germany.,Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, NeuroCure Clinical Research Center, Berlin, Germany
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19
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Del Zingaro M, Cochetti G, Maiolino G, Stivalini D, Manfredini G, Tancredi A, Felici G, Ciarletti S, Gaudio G, Rossi de Vermandois JA, Mearini E. Influence of COVID-19 pandemic on stress levels of urologic patients. Open Med (Wars) 2021; 16:1198-1205. [PMID: 34514166 PMCID: PMC8389503 DOI: 10.1515/med-2021-0289] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 03/22/2021] [Accepted: 04/12/2021] [Indexed: 01/23/2023] Open
Abstract
Introduction Several studies have shown the consequences of COVID-19 pandemic on perceived stress of different populations, but none of them analyzed urological patients who underwent elective surgery. Methods We enrolled prospectively patients who underwent elective surgery between March and October 2020. A survey on COVID-19 and the 4-item Perceived Stress Scale (PPS-4) questionnaire were administered at hospital admission. Demographic and medical history data were also collected. Uni- and multivariate analyses were performed to identify independent predictors of higher PSS-4 values (≥7). Results A total of 200 patients were enrolled. Mean PSS-4 value resulted 6.04. Patients with PSS-4 value ≥7 resulted 43.5% (87/200). In multivariate analysis, PSS-4 value ≥7 was independently associated (p < 0.05) with female gender (OR 6.42), oncological disease (OR 2.87), high (>5 in a range between 0 and 10) fear of intrahospital transmission of SARS-CoV-2 infection (OR 4.75), history of bladder instillation (OR 0.26), and current smokers (OR 0.27) Conclusion High PSS-4 values at hospital admission in urologic surgical patients are positively correlated with female gender, fear of intrahospital transmission of SARS-CoV-2 infection, and oncological disease. PSS-4 questionnaire could be useful to select patients for whom a preadmission counselling is necessary to improve the management of their high stress level.
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Affiliation(s)
- Michele Del Zingaro
- Department of Surgical and Biomedical Sciences, Division of Urology Clinic, University of Perugia, Perugia, 06129, Italy
| | - Giovanni Cochetti
- Department of Surgical and Biomedical Sciences, Division of Urology Clinic, University of Perugia, Perugia, 06129, Italy
| | - Giuseppe Maiolino
- Department of Surgical and Biomedical Sciences, Division of Urology Clinic, University of Perugia, Piazzale Giorgio Menghini 1, Perugia, 06129, Italy
| | - Davide Stivalini
- Department of Surgical and Biomedical Sciences, Division of Urology Clinic, University of Perugia, Perugia, 06129, Italy
| | - Giulia Manfredini
- Department of Surgical and Biomedical Sciences, Division of Urology Clinic, University of Perugia, Perugia, 06129, Italy
| | - Angelica Tancredi
- Department of Surgical and Biomedical Sciences, Division of Urology Clinic, University of Perugia, Perugia, 06129, Italy
| | - Graziano Felici
- Department of Surgical and Biomedical Sciences, Division of Urology Clinic, University of Perugia, Perugia, 06129, Italy
| | - Sara Ciarletti
- Department of Surgical and Biomedical Sciences, Division of Urology Clinic, University of Perugia, Perugia, 06129, Italy
| | - Gianluca Gaudio
- Department of Surgical and Biomedical Sciences, Division of Urology Clinic, University of Perugia, Perugia, 06129, Italy
| | | | - Ettore Mearini
- Department of Surgical and Biomedical Sciences, Division of Urology Clinic, University of Perugia, Perugia, 06129, Italy
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20
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Willems SH, Rao J, Bhambere S, Patel D, Biggins Y, Guite JW. Digital Solutions to Alleviate the Burden on Health Systems During a Public Health Care Crisis: COVID-19 as an Opportunity. JMIR Mhealth Uhealth 2021; 9:e25021. [PMID: 34033575 PMCID: PMC8202659 DOI: 10.2196/25021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 02/01/2021] [Accepted: 05/18/2021] [Indexed: 01/08/2023] Open
Abstract
The COVID-19 pandemic has generated unprecedented and sustained health management challenges worldwide. Health care systems continue to struggle to support the needs of the majority of infected individuals that are either asymptomatic or have mild symptoms. In addition, long-term effects in the form of long-lasting COVID-19 symptoms or widespread mental health issues aggravated by the pandemic pose a burden on health care systems worldwide. This viewpoint article considers aspects of digital health care solutions and how they can play an ongoing role in safely addressing gaps in the health care support available from initially and repeatedly overwhelmed providers and systems. Digital solutions can be readily designed to address this need and can be flexible enough to adapt to the evolving management requirements of various stakeholders to reduce COVID-19 infection rates, acute hospitalizations, and mortality. Multiplatform solutions provide a hybrid model of care, which can include mobile and online platforms accompanied by direct clinician input and feedback. Desirable components to be included are discussed, including symptom tracking, patient education, well-being support, and bidirectional communication between patients and clinicians. Customizable and scalable digital health platforms not only can be readily adapted to further meet the needs of employers and public health stakeholders during the ongoing pandemic, but also hold relevance for flexibly meeting broader care management needs into the future.
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Affiliation(s)
- Sofie H Willems
- DayToDay Health, Health Innovators Inc, Boston, MA, United States
| | - Jyotsna Rao
- DayToDay Health, Health Innovators Inc, Boston, MA, United States
| | - Sailee Bhambere
- DayToDay Health, Health Innovators Inc, Boston, MA, United States
| | - Dipu Patel
- DayToDay Health, Health Innovators Inc, Boston, MA, United States
| | - Yvonne Biggins
- DayToDay Health, Health Innovators Inc, Boston, MA, United States
| | - Jessica W Guite
- DayToDay Health, Health Innovators Inc, Boston, MA, United States.,Center for Advancement in Managing Pain, School of Nursing, The University of Connecticut, Storrs, CT, United States
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21
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Spataro EA, Olds CE, Kandathil CK, Most SP. Comparison of Reconstructive Plastic Surgery Rates and 30-Day Postoperative Complications Between Patients With and Without Psychiatric Diagnoses. Aesthet Surg J 2021; 41:NP684-NP694. [PMID: 33220052 DOI: 10.1093/asj/sjaa313] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Psychiatric comorbidity is associated with greater 30-day postoperative complication rates in various surgical specialties, but is not well characterized for reconstructive plastic surgery. OBJECTIVES The aim of this study was to compare reconstructive plastic surgery rates and 30-day postoperative complications between patients with and without psychiatric diagnoses. METHODS This was a retrospective cohort study comparing patients with and without psychiatric diagnoses. Data for January 1, 2007 to December 31, 2015 were collected from the IBM MarketScan Commercial and Medicare Supplemental Databases. Rates of reconstructive plastic surgery, demographic data, covariant diagnoses, and 30-day postoperative complications were collected. Differences between the 2 groups were assessed by multivariable logistic regression. RESULTS Among 1,019,128 patients (505,715 with psychiatric diagnoses and 513,423 without psychiatric diagnoses) assessed, reconstructive plastic surgery rates were between 4.8% and 7.0% in those with psychiatric diagnoses, compared with 1.6% in patients without psychiatric diagnoses. The greatest odds of undergoing reconstructive plastic surgery were in patients with body dysmorphic disorder (BDD) (adjusted odds ratio [aOR], 3.16; 95% confidence interval [CI], 1.76-5.67) and anxiety disorder (aOR, 3.08; 95% CI, 2.97-3.17). When assessing 1,234,206 patients (613,400 with psychiatric diagnoses and 620,806 without psychiatric diagnoses), all of whom underwent reconstructive plastic surgery, 2-fold greater odds of any 30-day postoperative complication was associated with psychiatric diagnoses (aOR, 2.01; 95% CI, 1.28-3.11), as well as greater odds of specific complications (surgical site infection, bleeding, and hospital admission). Eating disorder diagnosis was associated with the greatest odds of a complication (aOR, 4.17; 95% CI, 3.59-4.86), followed by nasal surgery (aOR, 3.65; 95% CI, 2.74-4.89), and BDD (aOR, 3.16; 95% CI, 1.76-5.67). CONCLUSIONS Diagnosis of a psychiatric condition is associated with greater rates of reconstructive plastic surgery, and 2-fold greater odds of 30-day postoperative complications. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- Emily A Spataro
- Division of Facial Plastic Surgery, Department of Otolaryngology—Head and Neck Surgery, Washington University School of Medicine, St Louis, MO, USA
| | - Cristen E Olds
- Division of Facial Plastic Surgery, Department of Otolaryngology—Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Cherian K Kandathil
- Division of Facial Plastic Surgery, Department of Otolaryngology—Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Sam P Most
- Division of Facial Plastic Surgery, Department of Otolaryngology—Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA, USA
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22
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Schrempf MC, Petzold JQ, Vachon H, Petersen MA, Gutschon J, Wolf S, Sommer F, Murnauer M, Anthuber M. Virtual reality-based relaxation for enhancement of perioperative well-being and quality of life: protocol for a randomised pilot trial. BMJ Open 2021; 11:e044193. [PMID: 33827835 PMCID: PMC8031039 DOI: 10.1136/bmjopen-2020-044193] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Patients with cancer undergoing surgery often suffer from reduced quality of life and various forms of distress. Untreated distress can negatively affect coping resources as well as surgical and oncological outcomes. A virtual reality-based stress reduction intervention may increase quality of life and well-being and reduce distress in the perioperative phase for patients with cancer. This pilot trial aims to explore the feasibility of the proposed intervention, assess patient acceptability and obtain estimates of effect to provide data for sample size calculations. METHODS AND ANALYSIS Patients with colorectal cancer and liver metastasis undergoing elective surgery will be recruited for this single-centre, randomised pilot trial with a three-arm design. A total of 54 participants will be randomised at 1:1:1 ratio to one of two intervention groups or a control receiving standard treatment. Those randomised to an intervention group will either receive perioperative virtual reality-based stress reduction exercises twice daily or listen to classical music twice daily. Primary feasibility outcomes are number and proportions of participants recruited, screened, consented and randomised. Furthermore, adherence to the intervention, compliance with the completion of the quality of life questionnaires and feasibility of implementing the trial procedures will be assessed. Secondary clinical outcomes are measurements of the effectiveness of the interventions to inform sample size calculations. ETHICS AND DISSEMINATION The study protocol, the patient information and the informed consent form have been approved by the ethics committee of the Ludwigs-Maximilians-University, Munich, Germany (Reference Number: 19-915). Study findings will be submitted for publication in peer-reviewed journals. TRIAL REGISTRATION NUMBER DRKS00020909.
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Affiliation(s)
- Matthias Christian Schrempf
- Department of General, Visceral and Transplantation Surgery, University Hospital of Augsburg, Augsburg, Germany
| | - Julian Quirin Petzold
- Department of General, Visceral and Transplantation Surgery, University Hospital of Augsburg, Augsburg, Germany
| | - Hugo Vachon
- Quality of Life Department, European Organisation for Research and Treatment of Cancer, Brussels, Belgium
| | - Morten Aagaard Petersen
- The Research Unit, Department of Palliative Medicine, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Kobenhavn, Denmark
| | - Johanna Gutschon
- Department of General, Visceral and Transplantation Surgery, University Hospital of Augsburg, Augsburg, Germany
| | - Sebastian Wolf
- Department of General, Visceral and Transplantation Surgery, University Hospital of Augsburg, Augsburg, Germany
| | - Florian Sommer
- Department of General, Visceral and Transplantation Surgery, University Hospital of Augsburg, Augsburg, Germany
| | - Marcus Murnauer
- Department of General, Visceral and Transplantation Surgery, University Hospital of Augsburg, Augsburg, Germany
| | - Matthias Anthuber
- Department of General, Visceral and Transplantation Surgery, University Hospital of Augsburg, Augsburg, Germany
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Villa G, Lanini I, Amass T, Bocciero V, Scirè Calabrisotto C, Chelazzi C, Romagnoli S, De Gaudio AR, Lauro Grotto R. Effects of psychological interventions on anxiety and pain in patients undergoing major elective abdominal surgery: a systematic review. Perioper Med (Lond) 2020; 9:38. [PMID: 33292558 PMCID: PMC7722323 DOI: 10.1186/s13741-020-00169-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Accepted: 11/09/2020] [Indexed: 02/06/2023] Open
Abstract
A maladaptive response to surgical stress might lead to postoperative complications. A multidisciplinary approach aimed at controlling the surgical stress response may reduce procedural complications and improve patients’ quality of life in the short and long term. Several studies suggest that psychological interventions may interact with the pathophysiology of surgical stress response, potentially influencing wound repair, innate and adaptive immunity, inflammation, perception of pain, and patients’ mood. The aim of this systematic review is to summarise the effects of perioperative psychological interventions on surgical pain and/or anxiety in adult patients scheduled for elective general abdominal and/or urologic surgery. We conducted a systematic review of controlled clinical trials and observational studies involving psychological interventions for adult patients scheduled for elective general abdominal and/or urologic surgery. Only studies reporting pain and/or anxiety among outcome measures were included in the systematic review. The following psychological interventions were considered: (1) relaxation techniques, (2) cognitive-behavioural therapies, (3) mindfulness, (4) narrative medicine, (5) hypnosis and (6) coping strategies. We examined 2174 papers. Among these, 9 studies were considered eligible for inclusion in this systematic review (1126 patients cumulatively): 8 are randomised controlled trials and 1 is an observational prospective pre/post study. Psychological characteristics widely influence the pathophysiological mechanisms underlying the neuroendocrine and inflammatory response to surgical stress, potentially interfering with surgical outcomes. Psychological interventions are technically feasible and realistically applicable perioperatively during abdominal and/or urologic surgery; they influence the pathophysiological mechanisms underlying maladaptive surgical stress response and might have positive effects on patients’ surgical outcomes, such as pain and anxiety.
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Affiliation(s)
- Gianluca Villa
- Department of Health Sciences, Section of Anaesthesiology, Intensive Care and Pain Medicine, University of Florence, Largo Brambilla 3, 50100, Florence, Italy. .,Department of Anaesthesia and intensive Care, Azienda Ospedaliero Universitaria Careggi, Florence, Italy.
| | - Iacopo Lanini
- Department of Health Sciences, Section of Anaesthesiology, Intensive Care and Pain Medicine, University of Florence, Largo Brambilla 3, 50100, Florence, Italy
| | - Timothy Amass
- Department of Medicine, Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado, Denver, CO, USA
| | - Vittorio Bocciero
- Department of Health Sciences, Section of Anaesthesiology, Intensive Care and Pain Medicine, University of Florence, Largo Brambilla 3, 50100, Florence, Italy
| | - Caterina Scirè Calabrisotto
- Department of Health Sciences, Section of Anaesthesiology, Intensive Care and Pain Medicine, University of Florence, Largo Brambilla 3, 50100, Florence, Italy
| | - Cosimo Chelazzi
- Department of Health Sciences, Section of Anaesthesiology, Intensive Care and Pain Medicine, University of Florence, Largo Brambilla 3, 50100, Florence, Italy.,Department of Anaesthesia and intensive Care, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Stefano Romagnoli
- Department of Health Sciences, Section of Anaesthesiology, Intensive Care and Pain Medicine, University of Florence, Largo Brambilla 3, 50100, Florence, Italy.,Department of Anaesthesia and intensive Care, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - A Raffaele De Gaudio
- Department of Health Sciences, Section of Anaesthesiology, Intensive Care and Pain Medicine, University of Florence, Largo Brambilla 3, 50100, Florence, Italy.,Department of Anaesthesia and intensive Care, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Rosapia Lauro Grotto
- Department of Health Sciences, Section of Psychology and Psychiatry, University of Florence, Largo Brambilla 3, 50100, Florence, Italy
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Guo P, Li P, Zhang X, Liu N, Wang J, Yang S, Yu L, Zhang W. The effectiveness of aromatherapy on preoperative anxiety in adults: A systematic review and meta-analysis of randomized controlled trials. Int J Nurs Stud 2020; 111:103747. [DOI: 10.1016/j.ijnurstu.2020.103747] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 08/03/2020] [Accepted: 08/06/2020] [Indexed: 01/09/2023]
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The Course of Posttraumatic Stress in Children: Examination of Symptom Trajectories and Predictive Factors Following Admission to Pediatric Intensive Care. Pediatr Crit Care Med 2020; 21:e399-e406. [PMID: 32224826 DOI: 10.1097/pcc.0000000000002316] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES This study investigated trauma symptom trajectories of children 2-16 years old following admission to pediatric intensive care and identified factors that predicted a child's trauma symptom trajectory. DESIGN Prospective longitudinal design. SETTING Two tertiary care PICUs in Brisbane, Qld, Australia. PATIENTS Children 2-16 years old admitted to PICU for longer than 8 hours. MEASUREMENTS MAIN RESULTS Maternal reported child posttraumatic stress symptoms (n = 272) on the Trauma Symptom Checklist for Young Children were used to assess posttraumatic stress symptoms up to 12 months post admission. Semiparametric group-based trajectory analyses were completed to identify patterns over time. Age, gender, length of stay, premorbid functioning, maternal perceived threat to life, and maternal acute distress were assessed as potential risk factors. Three likely trajectory groups were identified. The majority of children were resilient (83.8%); however, a significant minority experienced chronic symptoms (12.9%) or elevated stress symptoms which resolved quickly (3.3%). After controlling for other variables, maternal report of premorbid internalizing behavior significantly predicted both chronic (odds ratio, 6.3) and recovery (odds ratio, 38.0) trajectories. Maternal acute distress significantly predicted child chronic symptom trajectories (odds ratio, 5.2). CONCLUSIONS Children with elevated trauma symptoms postintensive care need timely and effective intervention. The majority of children with high levels of acute symptoms will continue to have chronic, ongoing posttraumatic stress symptoms. In addition, acute maternal distress and preexisting internalizing child behavior predict ongoing psychologic distress after discharge from the PICU. Screening in the acute period post-PICU admission may identify children likely to experience ongoing chronic posttraumatic distress symptoms and enable targeted treatment of children at risk. This is the first study to examine symptom trajectories in children following pediatric intensive care admission and includes a sample of very young children.
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Mathur A, Jarrett P, Broadbent E, Petrie KJ. Open-label Placebos for Wound Healing: A Randomized Controlled Trial. Ann Behav Med 2019; 52:902-908. [PMID: 30212845 DOI: 10.1093/abm/kax057] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Background Open-label placebos are a novel treatment option, in which participants take placebos with full knowledge that they do not contain active medicine. Open-label placebo treatments have been shown to result in patient-reported symptom improvements, but they have not been tested on objectively measurable physiological outcomes such as wound healing. Purpose The current study aimed to determine whether open-label placebos improved wound healing in punch biopsy wounds compared with no treatment. Methods In a randomized controlled trial, 70 participants (mean age 27.6 ± 10.1, 58 female) were provided with information about the beneficial effects of placebos and given a 4 mm punch biopsy wound. Participants were then randomized to either an open-label placebo intervention (two placebo tablets twice a day for 10 days) or a no-treatment control group. Wounds were photographed at 7 days and 10 days to determine reepithelialization of the wound surface. Results No significant differences were observed between the open-label placebo and control conditions in the percentage of wound area healed or for the number of participants with fully reepithelialized wounds at 7 days (placebo 7/32 wounds healed, control 10/33 wounds healed, (χ2[1, N = 65] = 0.60, p = .440, φ = 0.10) and 10 days after wounding (placebo 17/32, control 25/33 wounds healed (χ2[1, N = 65] = 3.64, p = .056, φ = 0.24). Conclusions Open-label placebo treatment does not improve the healing rate of wounds. Open-label placebos may be beneficial for subjective patient-reported outcomes but do not influence wound healing. Australian New Zealand Clinical Trials Registration ACTRN12616000411448.
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Affiliation(s)
- Ashwin Mathur
- Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
| | - Paul Jarrett
- Department of Medicine, University of Auckland, Auckland, New Zealand.,Department of Dermatology, Middlemore Hospital, Auckland, New Zealand
| | - Elizabeth Broadbent
- Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
| | - Keith J Petrie
- Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
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Ju W, Ren L, Chen J, Du Y. Efficacy of relaxation therapy as an effective nursing intervention for post-operative pain relief in patients undergoing abdominal surgery: A systematic review and meta-analysis. Exp Ther Med 2019; 18:2909-2916. [PMID: 31555379 PMCID: PMC6755420 DOI: 10.3892/etm.2019.7915] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Accepted: 08/09/2019] [Indexed: 12/22/2022] Open
Abstract
This systematic review and meta-analysis was conducted with the aim of assessing the efficacy of relaxation techniques for pain relief in patients undergoing abdominal surgery. The electronic search of the PubMed, Scopus, Cochrane Central Register of Controlled Trials (CENTRAL) and Google Scholar databases was performed for studies in the English language published up to May, 2019. A total of 12 studies were included in the review and 7 in the meta-analysis. In total, 4 relaxation techniques were utilized in the included studies: Jaw relaxation, Benson's relaxation, progressive muscle relaxation (PMR) and systematic relaxation. Of the 12 included, 10 studies demonstrated statistically significant pain relief in the relaxation group as compared to the controls. The data of 422 patients in the relaxation group and 424 patients in the control group were pooled for a meta-analysis, which indicated that patients undergoing abdominal surgery had significantly greater pain relief following relaxation therapy as compared to the controls [random: standardized mean difference (SMD), −1.15; 95% CI, −2.04 to −0.26; P<0.00001). The overall quality of the studies was not high. On the whole, despite trials demonstrating the benefits of relaxation therapy for immediate pain relief in patients post-abdominal surgery, there is lack of high-quality scientific evidence substantiating its routine use. There is a need for more robust randomized control trials (RCTs) utilizing standardized relaxation protocols to provide further evidence on this subject.
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Affiliation(s)
- Wanxia Ju
- Department of General Surgery, the Fifth Central Hospital of Tianjin, Tianjin 300450, P.R. China
| | - Lili Ren
- Department of General Surgery, the Fifth Central Hospital of Tianjin, Tianjin 300450, P.R. China
| | - Jun Chen
- Department of General Surgery, the Fifth Central Hospital of Tianjin, Tianjin 300450, P.R. China
| | - Yuman Du
- Department of General Surgery, the Fifth Central Hospital of Tianjin, Tianjin 300450, P.R. China
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Schakel L, Veldhuijzen DS, Crompvoets PI, Bosch JA, Cohen S, van Middendorp H, Joosten SA, Ottenhoff THM, Visser LG, Evers AWM. Effectiveness of Stress-Reducing Interventions on the Response to Challenges to the Immune System: A Meta-Analytic Review. PSYCHOTHERAPY AND PSYCHOSOMATICS 2019; 88:274-286. [PMID: 31387109 PMCID: PMC6878733 DOI: 10.1159/000501645] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 06/21/2019] [Indexed: 01/17/2023]
Abstract
BACKGROUND There is consistent evidence showing an interplay between psychological processes and immune function in health and disease processes. OBJECTIVES The present systematic review and meta-analysis aims to provide a concise overview of the effectiveness of stress-reducing psychological interventions on the activation of immune responses in both healthy subjects and patients. METHODS Included are 3 types of challenges: in vivo, in vitro, and psychophysiological. Such challenges are designed to mimic naturally occurring immune-related threats. RESULTS A systematic literature search was conducted using PubMed, EMBASE, and PsychInfo, resulting in 75 eligible studies. The risk of bias was assessed with the Cochrane risk-of-bias tool. Across all studies, a small-to-medium effect size was found for the effects of psychological interventions on optimization of the immune function (g = 0.33; 95% CI 0.22-0.43). While the largest effects were found for in vivo immune-related challenges (g = 0.61; 95% CI 0.34-0.88; especially on studies that incorporated skin tests and wound healing), studies incorporating psychophysiological challenges and in vitro immune-related stimulations similarly suggest more optimal immune responses among those receiving stress-reducing interventions (g = 0.28; 95% CI 0.15-0.42). CONCLUSION These findings showed substantial heterogeneity depending on the type of challenge, the study populations, and the intervention types. These data demonstrate support for the effectiveness of stress-reducing psychological interventions in improving immunity in studies that tested immune function by means of incorporating an in vivo,in vitro, or psychophysiological challenge. Future research should more consistently incorporate challenges into the study design to gather more insights in the mechanisms underlying the optimized immune function following a psychological intervention. This is also relevant for clinical practice, as psychological interventions can possibly supplement, or at least partially replace, current drug treatments in various somatic conditions to reduce side effects.
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Affiliation(s)
- Lemmy Schakel
- Health, Medical and Neuropsychology Unit, Leiden University, Leiden, The Netherlands,
- Leiden Institute for Brain and Cognition, Leiden University, Leiden, The Netherlands,
| | - Dieuwke S Veldhuijzen
- Health, Medical and Neuropsychology Unit, Leiden University, Leiden, The Netherlands
- Leiden Institute for Brain and Cognition, Leiden University, Leiden, The Netherlands
| | - Paige I Crompvoets
- Health, Medical and Neuropsychology Unit, Leiden University, Leiden, The Netherlands
| | - Jos A Bosch
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Sheldon Cohen
- Department of Psychology, Carnegie Mellon University, Pittsburgh, Pennsylvania, USA
| | - Henriët van Middendorp
- Health, Medical and Neuropsychology Unit, Leiden University, Leiden, The Netherlands
- Leiden Institute for Brain and Cognition, Leiden University, Leiden, The Netherlands
| | - Simone A Joosten
- Department of Infectious Diseases, Leiden University Medical Centre, Leiden, The Netherlands
| | - Tom H M Ottenhoff
- Department of Infectious Diseases, Leiden University Medical Centre, Leiden, The Netherlands
| | - Leo G Visser
- Department of Infectious Diseases, Leiden University Medical Centre, Leiden, The Netherlands
| | - Andrea W M Evers
- Health, Medical and Neuropsychology Unit, Leiden University, Leiden, The Netherlands
- Leiden Institute for Brain and Cognition, Leiden University, Leiden, The Netherlands
- Department of Psychiatry, Leiden University Medical Centre, Leiden, The Netherlands
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Picariello F, Chilcot J, Hudson JL. Re: Bakkum et al. "Effects of psychological stress on proteinuria in childhood steroid-sensitive nephrotic syndrome". J Psychosom Res 2019; 121:3-5. [PMID: 30987810 DOI: 10.1016/j.jpsychores.2019.04.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 04/03/2019] [Accepted: 04/06/2019] [Indexed: 11/25/2022]
Affiliation(s)
- Federica Picariello
- Health Psychology Section, Psychology Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK.
| | - Joseph Chilcot
- Health Psychology Section, Psychology Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK.
| | - Joanna L Hudson
- Health Psychology Section, Psychology Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK.
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Felix MMDS, Ferreira MBG, da Cruz LF, Barbosa MH. Relaxation Therapy with Guided Imagery for Postoperative Pain Management: An Integrative Review. Pain Manag Nurs 2019; 20:3-9. [DOI: 10.1016/j.pmn.2017.10.014] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 10/09/2017] [Accepted: 10/11/2017] [Indexed: 12/29/2022]
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Packiasabapathy S, Susheela AT, Mueller A, Patxot M, Gasangwa DV, O’Gara B, Shaefi S, Marcantonio ER, Yeh GY, Subramaniam B. Guided meditation as an adjunct to enhance postoperative recovery after cardiac surgery: study protocol for a prospective randomized controlled feasibility trial. Trials 2019; 20:39. [PMID: 30635064 PMCID: PMC6329114 DOI: 10.1186/s13063-018-3103-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Accepted: 12/04/2018] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Cardiac surgical procedures are associated with postoperative neurological complications such as cognitive decline and delirium, which can complicate recovery and impair quality of life. Perioperative depression and anxiety may be associated with increased mortality after cardiac surgeries. Surgical prehabilitation is an emerging concept that includes preoperative interventions to potentially reduce postoperative complications. While most current prehabilitation interventions focus on optimizing physical health, mind-body interventions are an area of growing interest. Preoperative mind-body interventions such as Isha Kriya meditation, may hold significant potential to improve postsurgical outcomes. METHODS This is a prospective, randomized controlled feasibility trial. A total of 40 adult patients undergoing cardiac surgery will be randomized to one of three study groups. Participants randomized to either of the two intervention groups will receive meditative intervention: (1) commencing two weeks before surgery; or (2) commencing only from the day after surgery. Meditative intervention will last for four weeks after the surgery in these groups. Participants in the third control group will receive the current standard of care with no meditative intervention. All participants will undergo assessments using neurocognitive, sleep, depression, anxiety, and pain questionnaires at various time points in the perioperative period. Blood samples will be collected at baseline, preoperatively, and postoperatively to assess for inflammatory biomarkers. The primary aim of this trial is to assess the feasibility of implementing a perioperative meditative intervention program. Other objectives include studying the effect of meditation on postoperative pain, sleep, psychological wellbeing, cognitive function, and delirium. These will be used to calculate effect size to design future studies. DISCUSSION This study serves as the first step towards understanding the feasibility of implementing a mind-body intervention as a prehabilitative intervention to improve postoperative surgical outcomes after cardiac surgery. TRIAL REGISTRATION Clinicaltrials.gov, NCT03198039 . Registered on 23 June 2017.
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Affiliation(s)
- Senthil Packiasabapathy
- Department of Anesthesia, Critical Care and Pain Medicine, Indiana University School of Medicine, 340 W 10th St #6200, Indianapolis, IN 46202 USA
| | - Ammu T. Susheela
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215 USA
- Harvard Medical School, 25 Shattuck St, Boston, MA 02115 USA
| | - Ariel Mueller
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215 USA
- Harvard Medical School, 25 Shattuck St, Boston, MA 02115 USA
| | - Melissa Patxot
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215 USA
| | - Doris-Vanessa Gasangwa
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215 USA
| | - Brian O’Gara
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215 USA
- Harvard Medical School, 25 Shattuck St, Boston, MA 02115 USA
| | - Shahzad Shaefi
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215 USA
- Harvard Medical School, 25 Shattuck St, Boston, MA 02115 USA
| | - Edward R. Marcantonio
- Harvard Medical School, 25 Shattuck St, Boston, MA 02115 USA
- Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215 USA
| | - Gloria Y. Yeh
- Harvard Medical School, 25 Shattuck St, Boston, MA 02115 USA
- Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215 USA
| | - Balachundhar Subramaniam
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215 USA
- Harvard Medical School, 25 Shattuck St, Boston, MA 02115 USA
- Beth Israel Deaconess Medical Center, 375 Longwood Avenue, W/MASCO-414, Boston, MA 02215 USA
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Szeverenyi C, Kekecs Z, Johnson A, Elkins G, Csernatony Z, Varga K. The Use of Adjunct Psychosocial Interventions Can Decrease Postoperative Pain and Improve the Quality of Clinical Care in Orthopedic Surgery: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. THE JOURNAL OF PAIN 2018; 19:1231-1252. [DOI: 10.1016/j.jpain.2018.05.006] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Revised: 04/15/2018] [Accepted: 05/14/2018] [Indexed: 01/03/2023]
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Geers NC, Zegel M, Huybregts JGJ, Niessen FB. The Influence of Preoperative Interventions on Postoperative Surgical Wound Healing in Patients Without Risk Factors: A Systematic Review. Aesthet Surg J 2018; 38:1237-1249. [PMID: 29596560 DOI: 10.1093/asj/sjy074] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Poor wound healing and scar formation remain critical problems in daily surgical practice. Generally, most attention is paid to intra- and postoperative interventions to improve wound healing after surgery, while preoperative interventions remain unsatisfactorily explored. OBJECTIVES In this systematic review, the available literature on the beneficial effects of preoperative interventions on wound healing and scar formation have been summarized and compared. METHODS A comprehensive and systematic search has been conducted in MEDLINE, Pubmed, Embase, Web of Science, and Cochrane, supplemented by reference and citation tracking. All preoperative interventions and all clinically relevant outcome parameters have been considered for inclusion, due to the expected limited availability of literature. RESULTS A total of 13 studies were included, which were all randomized trials. No cohort studies or retrospective studies have been identified. All studies described different preoperative interventions and outcome parameters and could hence not be pooled and compared. Eight studies showed significantly better wound healing after a preoperative intervention. The individual studies have been summarized in this review. CONCLUSIONS This systemic review shows that preoperative interventions can be beneficial in improving wound healing and scar formation. In selected cases, wound healing was found to benefit from a higher preoperative body temperature, topical vitamin E application, and low patient stress levels. LEVEL OF EVIDENCE 2
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Affiliation(s)
- Nikki C Geers
- Department of Plastic Surgery, VU University Medical Center, Amsterdam, The Netherlands
| | - Maurits Zegel
- Department of Cardio-Thoracic Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Jeroen G J Huybregts
- Department of Neurosurgery, Leiden University Medical Center & Haaglanden Medical Center, Leiden/The Hague, The Netherlands
| | - Frank B Niessen
- Department of Plastic Surgery, VU University Medical Center, Amsterdam, The Netherlands
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Refai M, Andolfi M, Gentili P, Pelusi G, Manzotti F, Sabbatini A. Enhanced recovery after thoracic surgery: patient information and care-plans. J Thorac Dis 2018; 10:S512-S516. [PMID: 29629197 DOI: 10.21037/jtd.2017.12.87] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Many studies have confirmed that the implementation of enhanced recovery after surgery (ERAS) protocols has the advantages of reducing the potential complications after thoracic surgery and the length of hospital stay. The ERAS program involves a multidisciplinary team, aimed at integrating evidence-based knowledge into clinical practice in order to reduce the patient's stress response to the surgical procedure and improve the response to stress, guaranteeing a combination of better outcomes and cost savings. All this would not be possible without the improvement of minimally invasive surgical techniques, progression of anesthesia, pain control, and careful patient preparation. In this setting, a preoperative personal counselling may play a key role to reduce stress, fear or anxiety and improve the morbidity of patients, enabling them to achieve functional and psychological compensatory mechanisms more quickly. Preoperative patient counselling, performed using verbal, written or multimedia materials, is crucial in order to achieve the goal of the ERAS project: making the patient a potentially active participant and the main character of his recovery, able to positively impact himself throughout the surgical and healing process. This report is aimed at evaluating patient information and care-plans in thoracic surgery, reviewing the available evidence on ERAS pathways, and demonstrating our ideal program as discussed and shared among the Italian Thoracic Surgery Units accredited in the video-assisted thoracic surgery (VATS) group.
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Affiliation(s)
- Majed Refai
- Division of Thoracic Surgery, Ospedali Riuniti Ancona, Ancona, Italy.,Section of Minimally Invasive Thoracic Surgery, Ospedali Riuniti Ancona, Ancona, Italy
| | - Marco Andolfi
- Division of Thoracic Surgery, Ospedali Riuniti Ancona, Ancona, Italy
| | - Paolo Gentili
- Anesthesia and Intensive Care Unit, Ospedali Riuniti Ancona, Ancona, Italy
| | - Gilda Pelusi
- School of Nursing and Midwifery Sciences, Università Politecnica delle Marche (UNIVPM), Ancona, Italy
| | | | - Armando Sabbatini
- Division of Thoracic Surgery, Ospedali Riuniti Ancona, Ancona, Italy
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Farag P, Behzadi A. Investigating the Relationship Between Religiosity and Psychological Distress Among Surgical Inpatients: A Pilot Study. JOURNAL OF RELIGION AND HEALTH 2018; 57:291-310. [PMID: 28755090 DOI: 10.1007/s10943-017-0459-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Psychological distress may hinder recovery following surgery. Studies examining the relationship between psychological distress and religiosity in the acute post-operative setting are lacking. The present study investigated this relationship, evaluated protocol design, and explored coping mechanisms. Psychological distress of surgical inpatients was assessed using the Hospital Anxiety and Depression Scale (HADS) and Rotterdam Symptom Checklist (RSCL). Religiosity was assessed using the Santa Clara Strength of Religious Faith Questionnaire. Correlations were obtained using Minitab software. Qualitative analysis identified coping mechanisms. Of eligible inpatients, 13/54 were recruited. No significant correlation was found between religiosity and psychological distress. The RSCL had a strong correlation with HADS (R = 0.82, p = 0.001). Assessment of distress was >2 min faster using RSCL compared to HADS. Relationships with pets, friends or family, and God emerged as the most common coping mechanism. Given study limitations, no conclusion was drawn regarding the relationship between religiosity and psychological distress. Weaknesses in study protocol were identified, and recommendations were outlined to facilitate the definitive study. This includes use of RSCL instead of HADS. Further study is warranted to explore how to strengthen relationships for inpatients.
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Affiliation(s)
- Peter Farag
- Mississauga Academy of Medicine, University of Toronto, Toronto, Canada.
| | - Abdollah Behzadi
- Department of Surgery, Trillium Health Partners, Mississauga, Canada
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Meesters A, den Bosch-Meevissen YMCI, Weijzen CAH, Buurman WA, Losen M, Schepers J, Thissen MRTM, Alberts HJEM, Schalkwijk CG, Peters ML. The effect of Mindfulness-Based Stress Reduction on wound healing: a preliminary study. J Behav Med 2017; 41:385-397. [PMID: 29159589 DOI: 10.1007/s10865-017-9901-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 11/06/2017] [Indexed: 01/24/2023]
Abstract
Psychological factors have been shown to influence the process of wound healing. This study examined the effect of Mindfulness-Based Stress Reduction (MBSR) on the speed of wound healing. The local production of pro-inflammatory cytokines and growth factors was studied as potential underlying mechanism. Forty-nine adults were randomly allocated to a waiting-list control group (n = 26) or an 8-week MBSR group (n = 23). Pre- and post-intervention/waiting period assessment for both groups consisted of questionnaires. Standardized skin wounds were induced on the forearm using a suction blister method. Primary outcomes were skin permeability and reduction in wound size monitored once a day at day 3, 4, 5, 6, 7, and 10 after injury. Secondary outcomes were cytokines and growth factors and were measured in wound exudates obtained at 3, 6, and 22 h after wounding. Although there was no overall condition effect on skin permeability or wound size, post hoc analyses indicated that larger increases in mindfulness were related to greater reductions in skin permeability 3 and 4 days after wound induction. In addition, MBSR was associated with lower levels of interleukin (IL)-8 and placental growth factor in the wound fluid 22 h after wound induction. These outcomes suggest that increasing mindfulness by MBSR might have beneficial effects on early stages of wound healing. Trial Registration NTR3652, http://www.trialregister.nl.
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Affiliation(s)
- Astrid Meesters
- Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands.
| | - Yvo M C In den Bosch-Meevissen
- Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
| | - Chantal A H Weijzen
- Department of Family Medicine, Faculty of Health, Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
| | - Wim A Buurman
- Department of Psychiatry and Neuropsychology, Faculty of Health, Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
| | - Mario Losen
- Department of Psychiatry and Neuropsychology, Faculty of Health, Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
| | - Jan Schepers
- Department of Methodology and Statistics, Faculty of Psychology and Neuroscience, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
| | - Monique R T M Thissen
- Department of Dermatology, Maastricht University Medical Centre+, P. Debyelaan 25, 6202 AZ, Maastricht, The Netherlands.,GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Universiteitssingel 40, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
| | - Hugo J E M Alberts
- Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
| | - Casper G Schalkwijk
- Department of Internal Medicine, Faculty of Health, Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
| | - Madelon L Peters
- Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
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Thorell A, MacCormick AD, Awad S, Reynolds N, Roulin D, Demartines N, Vignaud M, Alvarez A, Singh PM, Lobo DN. Guidelines for Perioperative Care in Bariatric Surgery: Enhanced Recovery After Surgery (ERAS) Society Recommendations. World J Surg 2017; 40:2065-83. [PMID: 26943657 DOI: 10.1007/s00268-016-3492-3] [Citation(s) in RCA: 338] [Impact Index Per Article: 48.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND During the last two decades, an increasing number of bariatric surgical procedures have been performed worldwide. There is no consensus regarding optimal perioperative care in bariatric surgery. This review aims to present such a consensus and to provide graded recommendations for elements in an evidence-based "enhanced" perioperative protocol. METHODS The English-language literature between January 1966 and January 2015 was searched, with particular attention paid to meta-analyses, randomised controlled trials and large prospective cohort studies. Selected studies were examined, reviewed and graded. After critical appraisal of these studies, the group of authors reached a consensus recommendation. RESULTS Although for some elements, recommendations are extrapolated from non-bariatric settings (mainly colorectal), most recommendations are based on good-quality trials or meta-analyses of good-quality trials. CONCLUSIONS A comprehensive evidence-based consensus was reached and is presented in this review by the enhanced recovery after surgery (ERAS) Society. The guidelines were endorsed by the International Association for Surgical Metabolism and Nutrition (IASMEN) and based on the evidence available in the literature for each of the elements of the multimodal perioperative care pathway for patients undergoing bariatric surgery.
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Affiliation(s)
- A Thorell
- Karolinska Institutet, Department of Clinical Sciences, Danderyds Hospital & Department of Surgery, Ersta Hospital, 116 91, Stockholm, Sweden.
| | - A D MacCormick
- Department of Surgery, University of Auckland, Auckland, New Zealand.,Department of Surgery, Counties Manukau Health, Auckland, New Zealand
| | - S Awad
- The East-Midlands Bariatric & Metabolic Institute, Derby Teaching Hospitals NHS Foundation Trust, Royal Derby Hospital, Derby, DE22 3NE, UK.,School of Clinical Sciences, University of Nottingham, Nottingham, NG7 2UH, UK
| | - N Reynolds
- The East-Midlands Bariatric & Metabolic Institute, Derby Teaching Hospitals NHS Foundation Trust, Royal Derby Hospital, Derby, DE22 3NE, UK
| | - D Roulin
- Department of Visceral Surgery, University Hospital CHUV, Lausanne, Switzerland
| | - N Demartines
- Department of Visceral Surgery, University Hospital CHUV, Lausanne, Switzerland
| | - M Vignaud
- Département d'anesthésie reanimation Service de chirurgie digestive, CHU estaing 1, place Lucie et Raymond Aubrac, Clermont Ferrand, France
| | - A Alvarez
- Department of Anesthesia, Hospital Italiano de Buenos Aires, Buenos Aires University, 1179, Buenos Aires, Argentina
| | - P M Singh
- Department of Anesthesia, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - D N Lobo
- Gastrointestinal Surgery, National Institute for Health Research Nottingham Digestive Diseases Biomedical Research Unit, Nottingham University Hospitals and University of Nottingham, Queen's Medical Centre, Nottingham, NG7 2UH, UK
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Predicting delayed discharge in a multimodal Enhanced Recovery Pathway. Am J Surg 2017; 214:604-609. [DOI: 10.1016/j.amjsurg.2017.06.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 04/24/2017] [Accepted: 06/18/2017] [Indexed: 12/12/2022]
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Hagan JE, Pollmann D, Schack T. Exploring temporal patterning of psychological skills usage during the week leading up to competition: Lessons for developing intervention programmes. PLoS One 2017; 12:e0181814. [PMID: 28786998 PMCID: PMC5546585 DOI: 10.1371/journal.pone.0181814] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Accepted: 07/05/2017] [Indexed: 11/18/2022] Open
Abstract
Background and purpose Although sport psychology literature focuses on psychological skills use to promote proficiency, it is still puzzling that current research has focused on psychological skills use only during competition. There remains a scarcity of empirical evidence to support the timing, and content of psychological skill application during the time preceding competition. This study examined the extent to which psychological skills usage are dynamic or stable over a 7-day pre-competitive period and whether any natural learning experiences might have accounted for the acquisition of these skills across gender and skill level. Methods and results Ninety elite and sub-elite table tennis players completed the Test of Performance Strategies (TOPS) at three different periods (7 days, 2 days, 1 hour) before competition. A MANOVA repeated measures with follow-up analyses revealed significant multivariate main effects for only skill level and time-to-competition with no interactions. Specifically, elite (international) athletes reported more usage than sub-elite (national) counterparts for self-talk, imagery and relaxation respectively. Time-to-competition effects showed imagery use decreased steadily across the three time points while reported usage of relaxation were almost at the same level on two time points (7 days and 1 hour) but decreased 2 days before competition. Conclusions Findings suggest an implementation of formalized and periodized psychological skills training programs over continuous training cycles. This may foster a positive long-term athletes’ psychological state prior to the onset of competition.
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Affiliation(s)
- John Elvis Hagan
- "Neurocognition and Action - Biomechanics"- Research Group, Faculty of Psychology and Sport Sciences, Bielefeld University, Bielefeld, Germany
- Center of Excellence "Cognitive Interaction Technology" CITEC, Bielefeld, Germany
- * E-mail:
| | - Dietmar Pollmann
- "Neurocognition and Action - Biomechanics"- Research Group, Faculty of Psychology and Sport Sciences, Bielefeld University, Bielefeld, Germany
| | - Thomas Schack
- "Neurocognition and Action - Biomechanics"- Research Group, Faculty of Psychology and Sport Sciences, Bielefeld University, Bielefeld, Germany
- Center of Excellence "Cognitive Interaction Technology" CITEC, Bielefeld, Germany
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Sutherland AE, Bennett NC, Herst PM. Psychological stress affects the severity of radiation-induced acute skin reactions in breast cancer patients. Eur J Cancer Care (Engl) 2017; 26. [PMID: 28707369 DOI: 10.1111/ecc.12737] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/08/2017] [Indexed: 01/25/2023]
Abstract
Psychological stress exacerbates many pathological conditions including inflammatory skin conditions. The effect of psychological stress on acute radiation-induced skin reactions has not been documented before. Here, we aimed to explore if psychological stress could aggravate skin reaction severity in breast cancer patients. We conducted a secondary analysis of patient data obtained during a randomised, controlled clinical trial for acute radiation-induced skin reaction severity in 78 breast cancer patients. Patients were assessed three times a week during treatment. Skin reaction severity was measured using the modified Radiation-Induced Skin Reaction Assessment Scale (RISRAS) and Radiation Therapy Oncology Group grades. Stress levels were determined using a 5-point LIKERT scale to rate physical well-being, managing stress levels, house, family, work and other commitments. A total of 20 patients (26%) of the 78-patient cohort were considered stressed. Skin reaction severity in stressed patients was twice that of non-stressed patients (p < 0.001) and stressed patients were five times more likely to develop moist desquamation. Our results show that psychological stress aggravates skin reaction severity during radiation therapy. This research needs to be validated in a more rigorous manner by incorporating a validated scale such as the Distress Thermometer and Impact Thermometer in future skin trials.
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Affiliation(s)
- A E Sutherland
- Radiation Oncology Department, Southern Blood and Cancer Centre, Dunedin Hospital, Dunedin, New Zealand
| | - N C Bennett
- Radiation Oncology Department, Southern Blood and Cancer Centre, Dunedin Hospital, Dunedin, New Zealand
| | - P M Herst
- Department of Radiation Therapy, University of Otago, Wellington, New Zealand
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Cooijmans KHM, Beijers R, Rovers AC, de Weerth C. Effectiveness of skin-to-skin contact versus care-as-usual in mothers and their full-term infants: study protocol for a parallel-group randomized controlled trial. BMC Pediatr 2017; 17:154. [PMID: 28683833 PMCID: PMC5501342 DOI: 10.1186/s12887-017-0906-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Accepted: 06/28/2017] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Twenty-to-forty percent of women experience postpartum depressive symptoms, which can affect both the mother and infant. In preterm infants, daily skin-to-skin contact (SSC) between the mother and her infant has been shown to decrease maternal postpartum depressive symptoms. In full-term infants, only two studies investigated SSC effects on maternal depressive symptoms and found similar results. Research in preterm infants also showed that SSC improves other mental and physical health outcomes of the mother and the infant, and improves the quality of mother-infant relationship. This randomized controlled trial will investigate the effects of a SSC intervention on maternal postpartum depressive symptoms and additional outcomes in mothers and their full-term infants. Moreover, two potential underlying mechanisms for the relation between SSC and the maternal and infant outcomes will be examined, namely maternal oxytocin concentrations and infant intestinal microbiota. METHODS/DESIGN Design: A parallel-group randomized controlled trial. PARTICIPANTS 116 mothers and their full-term infants. INTERVENTION Mothers in the SSC condition will be requested to provide daily at least one continuous hour of SSC to their infant. The intervention starts immediately after birth and lasts for 5 weeks. Mothers in the control condition will not be requested to provide SSC. Maternal and infant outcomes will be measured at 2 weeks, 5 weeks, 12 weeks and 1 year after birth. PRIMARY OUTCOME maternal postpartum depressive symptoms. Secondary maternal outcomes: mental health (anxiety, stress, traumatic stress following child birth, sleep quality), physical health (physical recovery from the delivery, health, breastfeeding, physiological stress), mother-infant relationship (mother-infant bond, quality of maternal caregiving behavior). Secondary infant outcomes: behavior (fussing and crying, sleep quality), physical health (growth and health, physiological stress), general development (regulation capacities, social-emotional capacities, language, cognitive and motor capacities). Secondary underlying mechanisms: maternal oxytocin concentrations, infant intestinal microbiota. DISCUSSION As a simple and cost-effective intervention, SSC may benefit both the mother and her full-term infant in the short-and long-term. Additionally, if SSC is shown to be effective in low-risk mother-infant dyads, then thought could be given to developing programs in high-risk samples and using SSC in a preventive manner. TRIAL REGISTRATION NTR5697 ; Registered on March 13, 2016.
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Affiliation(s)
- Kelly H. M. Cooijmans
- Department of Developmental Psychology, Behavioural Science Institute, Radboud University, P.O. Box 9140, 6500 HE Nijmegen, The Netherlands
| | - Roseriet Beijers
- Department of Developmental Psychology, Behavioural Science Institute, Radboud University, P.O. Box 9140, 6500 HE Nijmegen, The Netherlands
| | - Anne C. Rovers
- Department of Developmental Psychology, Behavioural Science Institute, Radboud University, P.O. Box 9140, 6500 HE Nijmegen, The Netherlands
| | - Carolina de Weerth
- Department of Developmental Psychology, Behavioural Science Institute, Radboud University, P.O. Box 9140, 6500 HE Nijmegen, The Netherlands
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Robinson H, Norton S, Jarrett P, Broadbent E. The effects of psychological interventions on wound healing: A systematic review of randomized trials. Br J Health Psychol 2017; 22:805-835. [PMID: 28670818 DOI: 10.1111/bjhp.12257] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 05/28/2017] [Indexed: 01/31/2023]
Abstract
PURPOSE Psychological stress has been shown to delay wound healing. Several trials have investigated whether psychological interventions can improve wound healing, but to date, this evidence base has not been systematically synthesized. The objective was to conduct a systematic review of randomized controlled trials in humans investigating whether psychological interventions can enhance wound healing. METHODS A systematic review was performed using PsychINFO, CINAHL, Web of Science, and MEDLINE. The searches included all papers published in English up until September 2016. The reference lists of relevant papers were screened manually to identify further review articles or relevant studies. Nineteen studies met inclusion criteria and were included in the review. RESULTS Fifteen of nineteen studies were of high methodological quality. Six studies were conducted with acute experimentally created wounds, five studies with surgical patients, two studies with burn wounds, two studies with fracture wounds, and four studies were conducted with ulcer wounds. Post-intervention standardized mean differences (SMD) between groups across all intervention types ranged from 0.13 to 3.21, favouring improved healing, particularly for surgical patients and for relaxation interventions. However, there was some evidence for publication bias suggesting negative studies may not have been reported. Due to the heterogeneity of wound types, population types, and intervention types, it is difficult to pool effect sizes across studies. CONCLUSIONS Current evidence suggests that psychological interventions may aid wound healing. Although promising, more research is needed to assess the efficacy of each intervention on different wound types. Statement of contribution What is already known on this subject? Psychological stress negatively affects wound healing. A number of studies have investigated whether psychological interventions can improve healing. However, no systematic reviews have been conducted. What does this study add? Synthesis and review of 19 trials conducted on psychological interventions and wound healing. Most evidence supports improved healing, particularly for surgical wounds and relaxation interventions. More research is needed on different intervention types with clinical wounds and into mechanisms of action.
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Affiliation(s)
- Hayley Robinson
- Department of Psychological Medicine, The University of Auckland, New Zealand
| | - Sam Norton
- Department of Health Psychology, King's College London, UK
| | - Paul Jarrett
- Department of Medicine, The University of Auckland, New Zealand
| | - Elizabeth Broadbent
- Department of Psychological Medicine, The University of Auckland, New Zealand
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Howland LC, Jallo N, Connelly CD, Pickler RH. Feasibility of a Relaxation Guided Imagery Intervention to Reduce Maternal Stress in the NICU. J Obstet Gynecol Neonatal Nurs 2017; 46:532-543. [DOI: 10.1016/j.jogn.2017.03.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2017] [Indexed: 10/19/2022] Open
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Diener E, Pressman SD, Hunter J, Delgadillo-Chase D. If, Why, and When Subjective Well-Being Influences Health, and Future Needed Research. Appl Psychol Health Well Being 2017; 9:133-167. [PMID: 28707767 DOI: 10.1111/aphw.12090] [Citation(s) in RCA: 194] [Impact Index Per Article: 27.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
We review evidence on whether subjective well-being (SWB) can influence health, why it might do so, and what we know about the conditions where this is more or less likely to occur. This review also explores how various methodological approaches inform the study of the connections between subjective well-being and health and longevity outcomes. Our review of this growing literature indicates areas where data are substantial and where much more research is needed. We conclude that SWB can sometimes influence health, and review a number of reasons why it does so. A key open question is when it does and does not do so-in terms of populations likely to be affected, types of SWB that are most influential (including which might be harmful), and types of health and illnesses that are most likely to be affected. We also describe additional types of research that are now much needed in this burgeoning area of interest, for example, cross-cultural studies, animal research, and experimental interventions designed to raise long-term SWB and assess the effects on physical health. This research area is characterised both by potentially extremely important findings, and also by pivotal research issues and questions.
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Affiliation(s)
- Ed Diener
- University of Virginia and University of Utah and the Gallup Organization, USA
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Abstract
OBJECTIVE The aim of the study was to investigate the impact of stress, illness perceptions, and behaviors on healing of venous leg ulcers. METHODS A prospective observational study of 63 individuals for 24 weeks investigated possible psychosocial predictors of healing. There were two indices of healing: rate of change in ulcer area and number of weeks to heal. Psychological variables were assessed at baseline using self-report measures (Perceived Stress Scale, Hospital Anxiety and Depression Scale, Revised Illness Perception Questionnaire, adapted Summary of Diabetes Self-Care Activities, Adherence Questionnaire, and Short-Form Health Survey). RESULTS Controlling for sociodemographic and clinical variables, for the 24 weeks, a slower rate of change in ulcer area was predicted by greater stress (standardized β = -0.61, p = .008), depression (standardized β = -0.51, p = .039), and holding negative perceptions or beliefs about the ulcer (standardized β = -1.4, p = .045). By 24 weeks, 69% of ulcers had closed. A more negative emotional response to the ulcer at baseline (i.e., emotional representation of the ulcer) was associated with a greater number of weeks to heal (hazard ratio [HR] = 0.63, 95% confidence interval [CI] = 0.41-0.95, p = .028). Higher educational attainment (HR = 3.22, 95% CI = 1.37-7.55, p = .007) and better adherence to compression bandaging (HR = 1.41, 95% CI = 1.06-1.88, p = .019) were associated with fewer weeks to heal. No other psychosocial variable (stress, perceptions about the ulcer, health behaviors) predicted weeks to heal. CONCLUSIONS Alongside ulcer-related predictors, psychological and sociodemographic factors were associated with healing. Future research should explore mediating mechanisms underlying these associations and develop interventions to target these variables.
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Psychotherapeut(in) in der Herzchirurgie. ZEITSCHRIFT FUR HERZ THORAX UND GEFASSCHIRURGIE 2017. [DOI: 10.1007/s00398-017-0154-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Prentice C, McKillop D, French D. How financial strain affects health: Evidence from the Dutch National Bank Household Survey. Soc Sci Med 2017; 178:127-135. [PMID: 28214723 DOI: 10.1016/j.socscimed.2017.02.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Revised: 12/19/2016] [Accepted: 02/03/2017] [Indexed: 01/25/2023]
Abstract
The mechanisms by which financial strain affects health are not well understood. In this paper, we conduct a longitudinal mediation analysis of the Dutch National Bank Household Survey. To quantify the relative importance of biological and nonbiological pathways from financial strain to health, we consider smoking, heavy drinking and being overweight as plausible behavioural responses to financial strain but find that only 4.9% of the response of self-reported health to financial strain is mediated by these behaviours. Further analysis indicates that although financial strain increases impulsivity this has little effect on unhealthy behaviours. Economic stresses therefore appear to be distinct from other forms of stress in the relatively minor influence of nonbiological pathways to ill-health.
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Affiliation(s)
- Carla Prentice
- Queen's Management School, Queen's University Belfast, Northern Ireland, UK
| | - Donal McKillop
- Queen's Management School, Queen's University Belfast, Northern Ireland, UK
| | - Declan French
- Queen's Management School, Queen's University Belfast, Northern Ireland, UK.
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Utility of recorded guided imagery and relaxing music in reducing patient pain and anxiety, and surgeon anxiety, during cutaneous surgical procedures: A single-blinded randomized controlled trial. J Am Acad Dermatol 2016; 75:585-589. [DOI: 10.1016/j.jaad.2016.02.1143] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Revised: 02/03/2016] [Accepted: 02/07/2016] [Indexed: 11/21/2022]
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McClurkin SL, Smith CD. The Duration of Self-Selected Music Needed to Reduce Preoperative Anxiety. J Perianesth Nurs 2016; 31:196-208. [DOI: 10.1016/j.jopan.2014.05.017] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Revised: 03/31/2014] [Accepted: 05/29/2014] [Indexed: 10/22/2022]
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Powell R, Scott NW, Manyande A, Bruce J, Vögele C, Byrne‐Davis LMT, Unsworth M, Osmer C, Johnston M. Psychological preparation and postoperative outcomes for adults undergoing surgery under general anaesthesia. Cochrane Database Syst Rev 2016; 2016:CD008646. [PMID: 27228096 PMCID: PMC8687603 DOI: 10.1002/14651858.cd008646.pub2] [Citation(s) in RCA: 103] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND In a review and meta-analysis conducted in 1993, psychological preparation was found to be beneficial for a range of outcome variables including pain, behavioural recovery, length of stay and negative affect. Since this review, more detailed bibliographic searching has become possible, additional studies testing psychological preparation for surgery have been completed and hospital procedures have changed. The present review examines whether psychological preparation (procedural information, sensory information, cognitive intervention, relaxation, hypnosis and emotion-focused intervention) has impact on the outcomes of postoperative pain, behavioural recovery, length of stay and negative affect. OBJECTIVES To review the effects of psychological preparation on postoperative outcomes in adults undergoing elective surgery under general anaesthetic. SEARCH METHODS We searched the Cochrane Register of Controlled Trials (CENTRAL 2014, Issue 5), MEDLINE (OVID SP) (1950 to May 2014), EMBASE (OVID SP) (1982 to May 2014), PsycINFO (OVID SP) (1982 to May 2014), CINAHL (EBESCOhost) (1980 to May 2014), Dissertation Abstracts (to May 2014) and Web of Science (1946 to May 2014). We searched reference lists of relevant studies and contacted authors to identify unpublished studies. We reran the searches in July 2015 and placed the 38 studies of interest in the `awaiting classification' section of this review. SELECTION CRITERIA We included randomized controlled trials of adult participants (aged 16 or older) undergoing elective surgery under general anaesthesia. We excluded studies focusing on patient groups with clinically diagnosed psychological morbidity. We did not limit the search by language or publication status. We included studies testing a preoperative psychological intervention that included at least one of these seven techniques: procedural information; sensory information; behavioural instruction; cognitive intervention; relaxation techniques; hypnosis; emotion-focused intervention. We included studies that examined any one of our postoperative outcome measures (pain, behavioural recovery, length of stay, negative affect) within one month post-surgery. DATA COLLECTION AND ANALYSIS One author checked titles and abstracts to exclude obviously irrelevant studies. We obtained full reports of apparently relevant studies; two authors fully screened these. Two authors independently extracted data and resolved discrepancies by discussion.Where possible we used random-effects meta-analyses to combine the results from individual studies. For length of stay we pooled mean differences. For pain and negative affect we used a standardized effect size (the standardized mean difference (SMD), or Hedges' g) to combine data from different outcome measures. If data were not available in a form suitable for meta-analysis we performed a narrative review. MAIN RESULTS Searches identified 5116 unique papers; we retrieved 827 for full screening. In this review, we included 105 studies from 115 papers, in which 10,302 participants were randomized. Mainly as a result of updating the search in July 2015, 38 papers are awaiting classification. Sixty-one of the 105 studies measured the outcome pain, 14 behavioural recovery, 58 length of stay and 49 negative affect. Participants underwent a wide range of surgical procedures, and a range of psychological components were used in interventions, frequently in combination. In the 105 studies, appropriate data were provided for the meta-analysis of 38 studies measuring the outcome postoperative pain (2713 participants), 36 for length of stay (3313 participants) and 31 for negative affect (2496 participants). We narratively reviewed the remaining studies (including the 14 studies with 1441 participants addressing behavioural recovery). When pooling the results for all types of intervention there was low quality evidence that psychological preparation techniques were associated with lower postoperative pain (SMD -0.20, 95% confidence interval (CI) -0.35 to -0.06), length of stay (mean difference -0.52 days, 95% CI -0.82 to -0.22) and negative affect (SMD -0.35, 95% CI -0.54 to -0.16) compared with controls. Results tended to be similar for all categories of intervention, although there was no evidence that behavioural instruction reduced the outcome pain. However, caution must be exercised when interpreting the results because of heterogeneity in the types of surgery, interventions and outcomes. Narratively reviewed evidence for the outcome behavioural recovery provided very low quality evidence that psychological preparation, in particular behavioural instruction, may have potential to improve behavioural recovery outcomes, but no clear conclusions could be reached.Generally, the evidence suffered from poor reporting, meaning that few studies could be classified as having low risk of bias. Overall,we rated the quality of evidence for each outcome as 'low' because of the high level of heterogeneity in meta-analysed studies and the unclear risk of bias. In addition, for the outcome behavioural recovery, too few studies used robust measures and reported suitable data for meta-analysis, so we rated the quality of evidence as `very low'. AUTHORS' CONCLUSIONS The evidence suggested that psychological preparation may be beneficial for the outcomes postoperative pain, behavioural recovery, negative affect and length of stay, and is unlikely to be harmful. However, at present, the strength of evidence is insufficient to reach firm conclusions on the role of psychological preparation for surgery. Further analyses are needed to explore the heterogeneity in the data, to identify more specifically when intervention techniques are of benefit. As the current evidence quality is low or very low, there is a need for well-conducted and clearly reported research.
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Affiliation(s)
- Rachael Powell
- University of ManchesterSchool of Psychological Sciences and Manchester Centre for Health PsychologyCoupland 1 BuildingOxford RoadManchesterUKM13 9PL
| | - Neil W Scott
- University of AberdeenMedical Statistics TeamPolwarth BuildingForesterhillAberdeenScotlandUKAB 25 2 ZD
| | - Anne Manyande
- University of West LondonSchool of Human and Social SciencesBoston Manor RoadBrentfordLondonUKTW8 9GA
| | - Julie Bruce
- University of WarwickWarwick Clinical Trials UnitGibbet Hill RdCoventryUKCV4 7AL
| | - Claus Vögele
- University of LuxembourgInstitute for Health and Behaviour, Research Unit INSIDERoute de Diekirch ‐ B.P. 2Esch‐sur‐AlzetteLuxembourgL‐4366
| | - Lucie MT Byrne‐Davis
- University of ManchesterManchester Medical SchoolStopford BuildingOxford RoadManchesterUKM13 9PT
| | - Mary Unsworth
- School of Life and Health Sciences, Aston UniversityPsychologyAston TriangleBirminghamUKB4 7ET
| | | | - Marie Johnston
- University of AberdeenInstitute of Applied Health SciencesHealth Sciences Building, 2nd floorForesterhillAberdeenScotlandUKAB25 2ZD
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