Psychological aspects in day-case surgery

Non-Pharmacological Psychotropic Measures for Surgery Under Local Anaesthesia

PURPOSE

surgery under local anaesthesia can be a stressful experience for patients. The aim of this study was to determine the influence of a non-pharmacological psychotropic measures (NPTM) on the anxiety and stress levels of individuals undergoing ophthalmic surgery. This is the first study to use a bilateral haptic NPTM for this purpose.

METHODS

In this clinical interventional case-control study, we assessed objective and subjective stress parameters immediately pre- and postoperatively. We randomly assigned patients to one of two groups: an intervention group with NPTM (n = 70) and a control group (n = 68).

RESULTS

When comparing objective parameters (heart rate, blood pressure, and sweat secretion), there were no significant differences between the two groups pre- and postoperatively (p ≥ 0.05). Subjectively, 79% of patients in the intervention group perceived a positive effect from the NPTM (p < 0.01). Patients undergoing eye surgery for the first time described a positive effect significantly more often (p = 0.027).

CONCLUSIONS

Our study results show that subjectively perceived anxiety and stress during eye surgery is significantly improved by using a bimanual NPTM. The majority of the patients experienced a positive effect on their wellbeing, particularly those undergoing eye surgery for the first time, although there was also a positive effect for patients who had previously undergone eye surgery. While the haptic NPTM used in this study has a positive impact on patients' perception of ophthalmic surgery, all patients undergoing surgery under local anaesthesia may benefit from this approach.

Anxiety and associated factors among medical and surgical patients in Ethiopia: A systematic review and meta-analysis

BACKGROUND

Individuals diagnosed with chronic medical conditions and patients appointed to undergo surgery face various degrees of anxiety as a result of doubts related to the outcome of surgery, and the psycho-socioeconomic costs of the medical illness. This can affect the treatment process and even the outcome of patients with medical and surgical cases. Though different studies were conducted on anxiety and associated factors among medical and surgical patients in Ethiopia, the findings were found to be inconsistent and had a wide discrepancy. So, this systematic review and meta-analysis estimated the pooled effect size of anxiety among this population and guides to plan appropriate intervention at a national level.

METHODS

Studies conducted on anxiety and associated factors among medical and surgical patients in Ethiopia were included. Data was extracted using Microsoft Excel and analyzed using STATA version 11. The random-effects model was used to estimate the pooled effect size of anxiety and its determinants with 95% confidence intervals. Funnel plots and Egger's regression tests were employed to check publication bias. Sub-group and sensitivity analyses were also conducted.

RESULTS

The pooled prevalence of anxiety among medical and surgical patients in Ethiopia was found to be 48.82% with a 95% CI (42.66, 54.99). Being female[OR = 2.84(2.02, 4.01)], fear of death [OR = 2.93(1.57, 5.50)], and history of surgery[OR = 0.42(0.27, 0.065)], among surgical patients and being female[OR = 2.35(1.94, 2.850], having poor social support[OR = 2.22(1.62, 3.05)], perceived stigma[OR = 4.25(1.97, 9.18)] and family history of mental illness[OR = 1.86(1.21, 2.86)] among medical patients were significantly associated with anxiety in this systematic review and meta-analysis.

CONCLUSION AND RECOMMENDATION

The pooled prevalence of anxiety among medical and surgical patients in Ethiopia was found to be high. Therefore, it would be good for professionals to screen patients for anxiety besides managing their medical or surgical cases to detect them early and address them.

The effect of informative video before the procedure on anxiety levels in patients who will have ureteral stent removal under local anesthesia

OBJECTIVE

Our objective was to assess the impact of video-animated information on the anxiety levels of patients undergoing ureteral stent removal under local anesthesia.

METHOD

The study was designed as a randomized prospective trial. The one group received only verbal and written information before the surgery, while the other group received video-animated information in addition to the written and verbal instructions. The patients' anxiety levels were assessed using the STAI-S and STAI-T questionnaires, while their pain scores were evaluated using VAS scores. Tolerability and satisfaction scores were also evaluated on a 5-point Likert scale.

RESULTS

The video-group (Group 1) consisted of 74 patients, while the non-video group (Group 2) consisted of 82 patients. The mean pre-information STAI-T score was 34.4 ± 3.7 in Group 1 and 35.2 ± 3 in the Group 2 (p = 0.113). In the video group, pre-information STAI-S scores was 34.8 ± 3.3 and post-information STAI-S scores was 33.8 ± 3 (p < 0.001). In the non-video group, pre-information STAI-S score was 35.6 ± 2.6 and post-information STAI-S score was 35.5 ± 2.7 (p = 0.260). The mean VAS score of Group 1 is 5.7 ± 1.2 and Group 2 is 5.7 ± 1.4 (p = 0.608). The mean tolerability scores of Group 1 and Group 2 were 3.7 ± 0.9 and 2.7 ± 1, respectively. The mean satisfaction scores of Group 1 and Group 2 were 4.1 ± 0.9 and 2.6 ± 1, respectively. Both tolerability score and satisfaction score improved statistically significantly after video information (p < 0.001).

CONCLUSION

Providing video-animated information in addition to written and verbal information before removing the ureteral stent reduces patients' preoperative anxiety. Furthermore, patient tolerance and satisfaction are higher when informative videos are included.

Preoperative anxiety after face-to-face patient assessment versus preanaesthesia telemedicine (PANTEM) in adults: a randomised clinical trial

Preanaesthesia consultation is performed to assess and optimise patient-specific risk factors before surgery, to inform patients about anaesthesia techniques and to obtain consent. Aside from face-to-face visits, telephone consultation is increasingly being used clinically. Concentration on the content and avoidance of confounding factors could lead to improved patient preparation. We hypothesised that patients receiving a telemedical intervention have less anxiety. Patients scheduled for elective surgery were randomised into two groups according to the consultation performed face-to-face (FTF) or via telephone (TEL). Before consultation (< 48 h) and 1-2 h prior to surgery, both groups had to fill in the State-Trait Anxiety Inventory (STAI). A total of 271 patients were randomised and 130 were analysed. There were no significant intergroup differences in mean state anxiety (STAI-S) before and after the intervention. Patients' positive feedback on telemedical consultation urges future studies on its effect on satisfaction and quality of life.

Effectiveness of septoplasty compared to medical management in adults with obstruction associated with a deviated nasal septum: the NAIROS RCT

Background

The indications for septoplasty are practice-based, rather than evidence-based. In addition, internationally accepted guidelines for the management of nasal obstruction associated with nasal septal deviation are lacking.

Objective

The objective was to determine the clinical effectiveness and cost-effectiveness of septoplasty, with or without turbinate reduction, compared with medical management, in the management of nasal obstruction associated with a deviated nasal septum.

Design

This was a multicentre randomised controlled trial comparing septoplasty, with or without turbinate reduction, with defined medical management; it incorporated a mixed-methods process evaluation and an economic evaluation.

Setting

The trial was set in 17 NHS secondary care hospitals in the UK.

Participants

A total of 378 eligible participants aged > 18 years were recruited.

Interventions

Participants were randomised on a 1: 1 basis and stratified by baseline severity and gender to either (1) septoplasty, with or without turbinate surgery (n = 188) or (2) medical management with intranasal steroid spray and saline spray (n = 190).

Main outcome measures

The primary outcome was the Sino-nasal Outcome Test-22 items score at 6 months (patient-reported outcome). The secondary outcomes were as follows: patient-reported outcomes - Nasal Obstruction Symptom Evaluation score at 6 and 12 months, Sino-nasal Outcome Test-22 items subscales at 12 months, Double Ordinal Airway Subjective Scale at 6 and 12 months, the Short Form questionnaire-36 items and costs; objective measurements - peak nasal inspiratory flow and rhinospirometry. The number of adverse events experienced was also recorded. A within-trial economic evaluation from an NHS and Personal Social Services perspective estimated the incremental cost per (1) improvement (of ≥ 9 points) in Sino-nasal Outcome Test-22 items score, (2) adverse event avoided and (3) quality-adjusted life-year gained at 12 months. An economic model estimated the incremental cost per quality-adjusted life-year gained at 24 and 36 months. A mixed-methods process evaluation was undertaken to understand/address recruitment issues and examine the acceptability of trial processes and treatment arms.

Results

At the 6-month time point, 307 participants provided primary outcome data (septoplasty, n = 152; medical management, n = 155). An intention-to-treat analysis revealed a greater and more sustained improvement in the primary outcome measure in the surgical arm. The 6-month mean Sino-nasal Outcome Test-22 items scores were -20.0 points lower (better) for participants randomised to septoplasty than for those randomised to medical management [the score for the septoplasty arm was 19.9 and the score for the medical management arm was 39.5 (95% confidence interval -23.6 to -16.4; p < 0.0001)]. This was confirmed by sensitivity analyses and through the analysis of secondary outcomes. Outcomes were statistically significantly related to baseline severity, but not to gender or turbinate reduction. In the surgical and medical management arms, 132 and 95 adverse events occurred, respectively; 14 serious adverse events occurred in the surgical arm and nine in the medical management arm. On average, septoplasty was more costly and more effective in improving Sino-nasal Outcome Test-22 items scores and quality-adjusted life-years than medical management, but incurred a larger number of adverse events. Septoplasty had a 15% probability of being considered cost-effective at 12 months at a £20,000 willingness-to-pay threshold for an additional quality-adjusted life-year. This probability increased to 99% and 100% at 24 and 36 months, respectively.

Limitations

COVID-19 had an impact on participant-facing data collection from March 2020.

Conclusions

Septoplasty, with or without turbinate reduction, is more effective than medical management with a nasal steroid and saline spray. Baseline severity predicts the degree of improvement in symptoms. Septoplasty has a low probability of cost-effectiveness at 12 months, but may be considered cost-effective at 24 months. Future work should focus on developing a septoplasty patient decision aid.

Trial registration

This trial is registered as ISRCTN16168569 and EudraCT 2017-000893-12.

Funding

This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: 14/226/07) and is published in full in Health Technology Assessment; Vol. 28, No. 10. See the NIHR Funding and Awards website for further award information.

"We hear and we fear" - Insights of 1203 Women on Personnel Conversations During Cesarean Delivery

OBJECTIVE

To assess the preferences of women undergoing cesarean delivery regarding intraoperative conversations among healthcare personnel.

METHODS

This cross-sectional study was conducted by distribution of an open anonymous questionnaire on social media platforms during March 2022, targeting respondents with a history of cesarean delivery. The primary outcome was patients' experience of "being disturbed by professional and casual conversations of the personnel", rated on a 1-5 Likert scale.

RESULTS

1203 participants completed the questionnaire, with 97.6% reporting intraoperative conversations among personnel. Casual conversations were perceived as "disturbing" by more respondents vs. professional talk (33.4% vs. 27.6%, respectively, p = 0.0077). Logistic regression analysis revealed associations between feeling disturbed and higher intraoperative stress and pain - adjusted Odds Ratio (OR) 3.1, 95% confidence interval (CI) 2.1-4.5, and OR 2.7, 95%CI 1.8-4.0, respectively, for professional conversations; OR 3.0, 95%CI 2.0-4.4, and OR 1.7, 95%CI 1.1-2.7, respectively, for casual conversations. Feeling disturbed by professional conversations was also associated with urgent vs. elective operations (OR 2.0, 95%CI 1.4-3.0). Direct personnel-patient communication was associated with significantly lower stress levels (60.8% vs. 72.5% in the remaining cohort, p < 0.001).

DISCUSSION

Intraoperative conversations of the personnel occur during vast majority of cesarean deliveries. Given that a substantial proportion of patients find these conversations disturbing, it is advisable to conduct a preliminary assessment of maternal preferences. This proactive step can help tailor communication strategies to individual patient comfort and preferences, ultimately enhancing the birthing experience and maternal well-being.

Effect of pre-admission "quasi-collective" education on health education for patients with ophthalmic day surgery

BACKGROUND

Day surgery is a new surgical model in which patients complete the admission, surgery, and discharge on the same day.

OBJECTIVE

The present study aimed to explore the effect of pre-admission "quasi-collective" health education for patients with ophthalmic day surgery.

METHODS

For this study, a total of 200 patients undergoing ophthalmic day surgery from February 2019 to December 2019 were enrolled as the research subjects. The patients were divided randomly into the observation group and the control group, with 100 cases in each group. For the control group, conventional health education was conducted after admission. On the day of admission, the admission education and peri-operative health education were performed. For the observation group, pre-admission health education was provided to the patients, and detailed education on the admission instructions, pre-operative precautions, and simulation of the intra-operative process were given by the medical staff. On the day of admission, the understanding of the education was evaluated, and any weaknesses in the health education were addressed. The anxiety status, method of handwashing, method of administering the drug to the eye, preoperative preparations, intra-operative training, preoperative medication, diet guidance, and postoperative care were compared between the two groups of patients.

RESULTS

Before discharge, there were significant differences in the anxiety scores, impact, and satisfaction of health education between the two groups of patients, all of which were statistically significant (P< 0.05).

CONCLUSION

The pre-admission "quasi-collective" health education for patients undergoing day surgery in ophthalmology was better than conventional health education.

Watching a movie or listening to music is effective in managing perioperative anxiety and pain: a randomised controlled trial

PURPOSE

Despite the use of perioperative anxiolytics and pain medication, surgery can be a stressful and painful experience. Providing patients with distractions using video and/or audio tools in addition to medication may be helpful. To date, no studies have compared different distraction modalities in a same-day surgical setting in adults. This study aims to determine whether audio-visual distraction with video glasses (AVD) is more effective in reducing anxiety and pain compared to audio distraction (AD) in conscious patients undergoing orthopaedic surgery. It was hypothesised that AVD, being the more immersive modality, would be more effective than AD on the outcome parameters.

METHODS

Fifty patients undergoing orthopaedic surgery with local and/or regional anaesthesia in a clinical day-care setting were randomly assigned to receive either fixed-scenery AVD or patient-choice AD with music. Primary outcome was anxiety, as measured by the Dutch version of the Spielberger State-Trait Anxiety Inventory-6 (STAI-6) prior to and 15 min after the intervention. Secondary outcomes were pain (Numeric Rating Scale Pain [NRS-P]), systolic and diastolic blood pressure, heart rate and patient satisfaction.

RESULTS

Within each group, there was a significant reduction in anxiety (p = 0.028 for AVD, p < 0.001 for AD). In contrast to our hypothesis, listening to music without watching a video (AD group) reduced anxiety significantly more than experiencing full AVD (p = 0.018). The mean pain score did not change significantly within either user group, nor did pain scores differ between user groups.

CONCLUSION

In conscious patients undergoing surgery, watching a movie (using video glasses and a headphone set) and listening to music (using only a headphone set) are able to significantly reduce anxiety. AVD, although believed to provide higher levels of distraction, did not prove to be superior to AD. The clinical relevance of this study highlights the potential benefits of AVD or AD modalities in improving the surgical experience for conscious patients. Further research is required to examine the influence of freedom of choice in content on the aforementioned outcomes. To estimate the true value of higher immersion levels, different distraction modalities (e.g. AVD versus virtual reality) featuring the exact same scenery or content need to be compared.

LEVEL OF EVIDENCE

Level I.

Effectiveness of a digital vs face-to-face preoperative assessment: A randomized, noninferiority clinical trial

STUDY OBJECTIVE

Digitalizing the preoperative assessment clinic can be a solution to keep up with the growing demand for surgery. It remains unclear if a digital preoperative assessment clinic is as safe, and effective in terms of patient health outcomes and experience compared to face-to-face consultations. This study aimed to compare quality of recovery and mental state in patients undergoing a digital preoperative assessment versus regular face-to-face consultations.

DESIGN

This was a single centre, randomized (1:1), parallel, open-label, noninferiority trial.

SETTING

The preoperative clinic and preoperative unit of an urban secondary care hospital.

PATIENTS

All adult, Dutch speaking, ASA I-IV patients with access to an online computer who required surgery.

INTERVENTIONS

Digital preoperative screening, consisting of an electronic screening questionnaire and web-based platform with personalized information and recommendations related to the procedure, or face-to-face screening, consisting of two 20-min in-hospital consultations.

MEASUREMENTS

The primary endpoint was quality of recovery, measured 48 h after surgery. The analysis followed a per-protocol principle, and only patients who underwent the intended screening were included in the analysis. The noninferiority margin was set at -6. The trial was registered at ClinicalTrials.gov, NCT05535205, during the study on 09/08/2022, before analysing results.

MAIN RESULTS

Between March 1, 2021 and 30 august 2021, 480 patients were assessed for eligibility. 400 patients were randomly assigned to the digital group (n = 200) or face-to-face group (n = 201), of which respectively 117 and 124 patients were eventually included in the primary analysis. The mean quality of recovery score of patients undergoing digital screening (158) was non-inferior to that of patients undergoing face-to-face screening (155), with a mean difference of 3·2 points and a 97.5% lower confidence limit of -2.1 points. There were no adverse events.

CONCLUSIONS

A digital preoperative screening is not inferior to face-to-face consultations in patients undergoing predominantly low to moderate risk surgery. Given its potential to reduce physician workload, reallocate healthcare resources, and lower healthcare costs, a digital preoperative screening may be a better choice for preoperative assessments.

Outpatient Spine Surgery in Poland: A Survey on Popularity, Challenges, and Future Perspectives

Objective

This study aimed to investigate the popularity of outpatient spine surgery in Poland, identify factors influencing its adoption, and assess its benefits, challenges, and impact on patient outcomes and healthcare costs. Additionally, the study proposes strategies to improve outpatient spine surgery adoption and ensure its safe implementation in Poland.

Materials and Methods

An electronic survey was distributed to members of the Polish Spine Surgery Society and the Polish Neurosurgery Society. Data were analyzed using Matlab R2020b statistical software, employing descriptive statistics to summarize the responses.

Results

The survey indicated that 67% of respondents provide spinal procedures commercially, with 58% performing them on an outpatient basis, showing the growing role of the private sector in providing spinal surgery services in Poland. Root nerve blocks and joint blocks were the most common outpatient procedures, followed by microdiscectomy, endoscopic discectomy, and L-S spinal fusion. The public NHF was the most common payer for outpatient procedures.

Conclusion

Outpatient spine surgery in Poland is not yet widespread, but improvements can be made to reduce hospital stays and enhance recovery. Changes in reimbursement systems to cover outpatient procedures and addressing physicians' liability concerns, particularly by emphasizing the NO-fault system, are essential. With proper support, outpatient spine surgery could become a valuable addition to Poland's healthcare system.

Does Immediate Postoperative Early Ambulation Affect Clinical Results of Full-Endoscopic Lumbar Discectomy? A Historical Control Study of Daytime Operation with a 8-Hour Hospital Stay versus Inpatient Operation

OBJECTIVE

Full-endoscopic lumbar discectomy (FELD) is a popular operation for the treatment of lumbar disc herniation (LDH) and day surgery mode is increasingly popular. However, only a few studies have reported about day surgery patients undergoing Percutaneous endoscopic lumbar discectomy (PELD). This retrospective study was to evaluate and analyze the clinical outcomes of patients undergoing FELD for LDH as day surgery versus inpatient surgery.

METHODS

From January 2020 to January 2022, a retrospective analysis of LDH patients treated with FELD either in day surgery unit (within 8-h hospital stay) or inpatient unit was carried out. All these patients were followed-up for at least 12 months, and were categorized into a FELD-I (inpatient surgery) group or a FELD-D (day surgery) group, according to where the surgical procedures were performed. We assessed and compared the postoperative stand and walk time, postoperative hospitalization stays, time of return to work, modified MacNab criteria, willingness to recommend surgery, complications, revision rate, as well as the visual analogue scale (VAS) and the Oswestry disability index score (ODI). Student t-test was used for continuous variables and chi-square test or Fisher's exact test was used for categorical variables.

RESULTS

There was no statistically significant difference in demographic data and baseline characteristics between two groups. And no significant differences were found in MacNab criteria between two groups. Postoperative VAS and ODI scores at one-day postoperation and final follow-up both improved significantly in both groups, as compared to the preoperative data (p < 0.001). However, no significant difference was found between the two groups on the pre, postoperative, or the last follow-up score for VAS and ODI (p > 0.05). The postoperative first ambulation time and postoperative hospital stays was much longer in FELD-I group than FELD-D group (p < 0.001). However, there were no significant differences in the perioperative complications, revision rate as well as satisfaction rate between two groups (p > 0.05). The overall time of return to work of young patients (<60 years-old) in the FELD-D group was significantly shorter than that in the FELD-I group (p = 0.001). Patients in the FELD-D group were more likely to recommend this kind of surgical model.

CONCLUSION

These data suggest that FELD-D can be effectively performed as day surgery (within 8 h hospital stay). Early ambulation after FELD-D did not affect the clinical outcomes and the revision rates. Day surgery patients are more likely to recommend this surgery mode to other patients and younger patients may be able to return to work earlier.

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

BACKGROUND

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

OBJECTIVE

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

METHOD

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

STUDY OUTCOMES

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

CONCLUSION

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

TRIAL REGISTRATION

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

Ambulatory outpatient venous surgery service: An examination of patient satisfaction and experiences

Background

This study aimed to ascertain patients’ experience of the out-patient venous service being provided,; identify the level of patient satisfaction with the service and identify areas for further improvement and development.

Method

A prospective descriptive quantitative study. A questionnaire was distributed to all patients who used the service between June 2017 and March 2018. A total of 195 questionnaires was distributed with 162 valid questionnaires returned; response rate of 83%.

Results

This study found high satisfaction levels with endovenous ablation procedures, with concomitant phlebectomy, in the ambulatory outpatient setting and patient experiences of the service are overwhelmingly positive.

Conclusion

Study findings support the management of ambulatory outpatient varicose vein endovenous ablation procedures as a feasible alternative to day surgery theatre settings and is the blueprint for future management of varicose vein surgery in Ireland.

Prevalence and factors associated with preoperative anxiety among patients undergoing surgery in low-income and middle-income countries: a systematic review and meta-analysis

OBJECTIVES

This review aimed to determine the pooled prevalence of preoperative anxiety and its associated factors among patients undergoing surgery in low/middle-income countries (LMICs).

METHODS

We searched PubMed, SCOPUS, CINAHL, Embase and PsychINFO to identify peer-reviewed studies on the prevalence and factors associated with preoperative anxiety among patients undergoing surgery using predefined eligibility criteria. Studies were pooled to estimate the prevalence of preoperative anxiety using a random-effect meta-analysis model. Heterogeneity was assessed using I² statistics. Funnel plot asymmetry and Egger's regression tests were used to check for publication bias.

RESULT

Our search identified 2110 studies, of which 27 studies from 12 countries with 5575 participants were included in the final meta-analysis. Of the total 27 studies, 11 used the State-Trait Anxiety Inventory to screen anxiety, followed by the Amsterdam Preoperative Anxiety and Information scale, used by four studies. The pooled prevalence of preoperative anxiety among patients undergoing surgery in LMICs was 55.7% (95% CI 48.60 to 62.93). Our subgroup analysis found that a higher pooled prevalence of preoperative anxiety was found among female surgical patients (59.36%, 95% CI 48.16 to 70.52, I2=95.43, p<0.001) and studies conducted in Asia (62.59%, 95% CI 48.65 to 76.53, I2=97.48, p<0.001).

CONCLUSION

Our meta-analysis indicated that around one in two patients undergoing surgery in LMICs suffer from preoperative anxiety, which needs due attention. Routine screening of preoperative anxiety symptoms among patients scheduled for surgery is vital.

PROSPERO REGISTRATION NUMBER

CRD42020161934.

Quality of Life During Treatment for Cervicofacial Non-melanoma Skin Cancer

Non-melanoma skin cancer (NMSC), despite its low mortality, can impose a significant psychological burden on patients. The aim of the present study is to examine the evolution of the quality of life (QOL) in patients with cervicofacial NMSC during treatment. This prospective cohort study was conducted to a group of patients with cervicofacial NMSC, confirmed by skin biopsy. These patients completed the Skin Cancer Index questionnaire at the time of diagnosis and at 1 week, 1 month and 6 months after treatment began. Data for these patients' demographic characteristics and variables related to the type of tumour, the treatment received and the evolution of the condition were recorded. The study group was composed of 220 patients. At the time of diagnosis, the overall mean score for QOL was 54.1 (SD 21.9); for the social appearance component, it was 76.7 (SD 26.2), and for the emotional component, it was 23 (SD 25.1). Six months after treatment began, the overall mean score was 61 (SD19.1), that for social appearance, 85 (SD 20.6), and that for the emotional component, 27.4 (SD 26.6). All the differences were statistically significant (p < 0.05). The results obtained show that during the treatment period, it is at the time of diagnosis when patients with cervicofacial NMSC undergo the greatest deterioration in their QOL. In comparison with the findings obtained in previous studies, our population obtained lower overall scores in the questionnaires and less improvement during follow-up.

Outpatients' perception of their preoperative information regarding their health literacy skills and their preoperative anxiety level: Protocol for a prospective multicenter cross-sectional study

Despite the benefits related to ambulatory surgery such as cost reduction due to lack of accommodation and patient satisfaction due to early home return, it may not lead to these expected benefits. Indeed, this kind of practice can increase responsibility for the person being treated and his or her relatives. It is therefore essential to inform them as well as possible to obtain their adherence to the proposed care protocol. Nevertheless, patients' failures to comply with preoperative instructions or the non-attendance of the patient may result in late cancellation of the scheduled surgery. In order to reduce this kind of dysfunction, the Assistance Publique-Hôpitaux de Paris (APHP) uses a reminder system by Short Message Service (SMS).This study is a descriptive cross-sectional multicenter study that focuses on outpatients' lived experiences of their preoperative preparation and information. It aims to collect patients' perceptions of their ability to follow preoperative instructions received by SMS the day before an operation performed for ambulatory surgery, according to their level of health literacy (HL) and preoperative anxiety. Indeed, poor communication between patients and doctors can contribute to preoperative anxiety, while low health literacy (LHL) can lead to poor understanding of preoperative preparation instructions. Therefore, it seems important to take these 2 criteria into account in this study. This research is designed to interview outpatients undergoing ambulatory surgery in the establishments of APHP. A self-questionnaire will be used for this purpose. The choice of this institution is justified by its decision to use in all care units the reminder of preoperative instructions by SMS.The main outcome is the perception of outpatients with LHL skills regarding preoperative information provided by doctors.French ethics review committee (Comité d'Ethique de la Recherche) of the University of Paris has approved the study protocol (IRB 00012020-14). Results from this study will be disseminated through oral communications and a scientific article in an international peer-reviewed journal.This protocol is registered on researchregistry.com (researchregistry5834). This version number is 1.1 Protocol dated July 22, 2020.

Day-case catheterless and drainless minimal-access pyeloplasty in adults: A single-center experience of 13 years

OBJECTIVES

To analyze our practice of drainless and catheterless day-case minimal-access pyeloplasty with regard to feasibility, safety and long-term outcomes.

METHODS

Patients undergoing minimal-access pyeloplasty (laparoscopic, with or without robotic assistance) in a single center between 2007 and 2020 were included in this retrospective observational study. Patient demographics and the success rate of day-case discharge along with postoperative outcomes were analyzed.

RESULTS

A total of 129 patients underwent minimal-access pyeloplasty in this time period, of whom 116 met the inclusion criteria. The mean patient age was 48 years. A total of 65% of the patients (n = 75) were discharged on the same day and 88% (n = 101) were discharged within 23 h of surgery. Of the 14 patients with a hospital stay of >24 h, pain was the most common reason (60%) for delayed discharge. The overall subjective (pain-free status) and objective (unobstructed drainage) success rates were 91% and 86%, respectively.

CONCLUSION

This study demonstrates that routine drains or urethral catheters are not necessary in minimal-access pyeloplasty, and their omission could facilitate early recovery and day-case discharge without compromising long-term surgical outcomes. Large randomized controlled studies are required to prospectively evaluate outcomes.

One-month recovery profile and prevalence and predictors of quality of recovery after painful day case surgery: Secondary analysis of a randomized controlled trial

Background/Objectives

This study aimed to study one-month recovery profile and to identify predictors of Quality of Recovery (QOR) after painful day surgery and investigate the influence of pain therapy on QOR.

Methods/Design

This is a secondary analysis of a single-centre, randomised controlled trial of 200 patients undergoing ambulatory haemorrhoid surgery, arthroscopic shoulder or knee surgery, or inguinal hernia repair between January 2016 and March 2017. Primary endpoints were one-month recovery profile and prevalence of poor/good QOR measured by the Functional Recovery Index (FRI), the Global Surgical Recovery index and the EuroQol questionnaire at postoperative day (POD) 1 to 4, 7, 14 and 28. Multiple logistic regression analysis was performed to determine predictors of QOR at POD 7, 14, and 28. Differences in QOR between pain treatment groups were analysed using the Mann-Whitney U test.

Results

Four weeks after haemorrhoid surgery, inguinal hernia repair, arthroscopic knee and arthroscopic shoulder surgery, good QOR was present in 71%, 76%, 57% and 24% respectively. Poor QOR was present in 5%, 0%, 7% and 29%, respectively. At POD 7 and POD 28, predictors for poor/intermediate QOR were type of surgery and a high postoperative pain level at POD 4. Male gender was another predictor at POD 7. Female gender and having a paid job were also predictors at POD 28. Type of surgery and long term fear of surgery were predictors at POD 14. No significant differences in total FRI scores were found between the two different pain treatment groups.

Conclusions

The present study shows a procedure-specific variation in recovery profile in the 4-week period after painful day surgery. The best predictors for short-term (POD 7) and long-term (POD 28) poor/intermediate QOR were a high postoperative pain level at POD 4 and type of surgery. Different pain treatment regimens did not result in differences in recovery profile.

Trial registration

European Union Clinical Trials Register 2015-003987-35.

Desenhos de Crianças Submetidas a Cirurgias Eletivas

Resumo O presente artigo tem por objetivo investigar as memórias que as crianças têm sobre a cirurgia a qual foram submetidas. Participaram desta pesquisa 80 crianças com idade entre 6 e 12 anos, internadas num hospital infantil para a realização de cirurgia eletiva de pequeno porte, divididas em quatro grupos de intervenção. Foram utilizados desenhos como forma de instrumento de coleta de dados. A pesquisa ocorreu em duas etapas: na primeira, cada grupo recebeu a sua preparação no hospital, e na segunda, cerca de quinze dias após a cirurgia. Pôde-se constatar, após uma análise dos desenhos, que todos os grupos retrataram a condição de hospitalização e cirurgia, e trouxeram detalhes sobre os aspectos relacionados a esta temática.

PREPARE: PreoPerative Anxiety REduction. One-Year Feasibility RCT on a Brief Psychological Intervention for Pancreatic Cancer Patients Prior to Major Surgery

Introduction

The aim of the present paper is to establish feasibility and required power of a one-session psychological intervention devoted to increasing patient's self-efficacy and awareness in dealing with anxiety symptoms before major pancreatic cancer surgery.

Methods

Parallel assignment RCT. All consenting patients listed for pancreatic major surgery during day-hospital visits (T0) between June 2017-June 2018 were assigned randomly in blocks of ten to a psychological intervention vs usual care group to be held the day before surgery (T1). The psychological intervention provided the patient the opportunity to increase self-efficacy in dealing with anxiety by talking with a psychologist about personal concerns and learning mindfulness based techniques to cope with anxiety.

Results

400 patients were randomized into the experimental vs. usual care group. 49 and 65, respectively, completed baseline and post-intervention measures. The dropout rate between day-hospital (T0) and pre-surgery intervention (T1) was high (74.5%) due to several management and organization pitfalls. The main outcome, perceived self-efficacy in managing anxiety, showed a significant increase in the intervention group compared to the control group (p < 0.001), and was related to a reduction in state anxiety (p < 0.001). The intervention group perceived also lower emotional pain (p = 0.03). A power analysis was performed to define the appropriate sample size in a definitive RCT.

Conclusion

Beneath the complexity in retaining patients along their trajectory in pancreatic surgery department, when they had the opportunity to follow a brief psychological intervention, most of them adhered, showing a significant reduction in preoperative emotional distress and less emotional pain perception after surgery. Even if results need caution because of the high attrition rate, we can infer that our psychological intervention has the potential to be proposed in surgical setting, being short, easy to learn and applicable to a wide range of patients.

Clinical Trial Registration

The trial was registered on ClinicalTrials.gov (identifier: NCT03408002). The full protocol is available from the last author.

Defining Quality in Hand Surgery From the Patient's Perspective: A Qualitative Analysis

PURPOSE

Quality measures are used to evaluate health care delivery. They are traditionally developed from the physician and health system viewpoint. This approach can lead to quality measures that promote care that may be misaligned with patient values and preferences. We completed an exploratory, qualitative study to identify how patients with hand problems define high-quality care. Our purpose was to develop a better understanding of the surgery and recovery experience of hand surgery patients, specifically focusing on knowledge gaps, experience, and the surgical process.

METHODS

A steering committee (n = 10) of patients who had previously undergone hand surgery reviewed and revised an open-ended survey. Ninety-nine patients who had undergone hand surgery at 2 tertiary care institutions completed the open-ended, structured questionnaire during their 6- to 8-week postoperative clinic visit. Two reviewers completed a thematic analysis to generate subcodes and codes to identify themes in high-quality care from the patient's perspective.

RESULTS

We identified 4 themes of high-quality care: (1) Being prepared and informed for the process of surgery, (2) Regaining hand function without pain or complication, (3) Patients and caregivers negotiating the physical and psychological challenges of recovery, and (4) Financial and logistical burdens of undergoing hand surgery.

CONCLUSIONS

Multiple areas that patients identify as representing high-quality care are not reflected in current quality measures for hand surgery. The patient-derived themes of high-quality care can inform future patient-centered quality measure development.

CLINICAL RELEVANCE

Efforts to improve health care delivery may have the greatest impact by addressing areas of care that are most valued by patients. Such areas include patient education, system navigation, the recovery process, and cost.

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

BACKGROUND

Too much or too little information during patient education can increase patient anxiety. Needs-based patient education helps to determine the appropriate amount of information required to provide education based on patient needs. This study aimed to compare needs-based patient education with traditional patient education in reducing preoperative anxiety.

METHODS

This was a prospective, multicenter, single-blind, randomized controlled trial with a 1:1 allocation ratio. Patients undergoing day surgery were randomized into a study group (needs-based education) or a control group (traditional education). The primary outcome was patient anxiety. Secondary outcomes were patient satisfaction and time spent in patient education. Patients completed questionnaires to evaluate their anxiety and satisfaction before patient education, after patient education, and after surgery.

RESULTS

In total, 450 patients were randomized and analyzed (study group n = 225, control group n = 225). Comparisons before education, after education, and after surgery showed that there was a significant decrease in patient anxiety and an increase in satisfaction in both groups (p < 0.001). The comparison between needs-based education and traditional education showed a greater decrease in anxiety (7.09 ± 7.02 vs. 5.33 ± 7.70, p = 0.001) and greater increase in satisfaction (21.1 ± 16.0 vs. 16.0 ± 21.6, p < 0.001) in the needs-based group. The needs-based group also had significantly less education time than the traditional group (171.8 ± 87.59 vs. 236.32 ± 101.27 s, p < 0.001).

CONCLUSION

Needs-based patient education is more effective in decreasing anxiety, increasing patient satisfaction, and reducing time spent in education compared with traditional patient education.

TRIAL REGISTRATION

ClinicalTrials.gov, number NCT03003091.

Effect of video-based education on anxiety and satisfaction of patients undergoing spinal anesthesia

Background

Providing sufficient information during a preanesthetic interview may help improve patient understanding and decrease anxiety related to spinal anesthesia. We investigated the effect of video-based education on anxiety and satisfaction in patients about to undergo spinal anesthesia.

Methods

A total of 198 patients scheduled for minor elective surgery under spinal anesthesia were prospectively enrolled. The State-Trait Anxiety Inventory (State-Trait Anxiety Inventory/State and State-Trait Anxiety Inventory/Trait) questionnaires and visual analog scale were used to measure anxiety levels before the standard anesthesia evaluation was initiated. Then, 100 patients in Group 1 received written, verbal, and video-based education, whereas 98 patients in Group 2 received only written and verbal instructions regarding spinal anesthesia. Then all participants completed the State-Trait Anxiety Inventory/State and visual analog scale to evaluate anxiety. Finally, a 5-point Likert scale was used to measure satisfaction during postoperative period.

Results

No differences were found in the State-Trait Anxiety Inventory/State, State-Trait Anxiety Inventory/Trait, or visual analog scale scores between the two groups before the information period. The State-Trait Anxiety Inventory/State scores evaluating anxiety during the post-information period were differed in both groups and they found as 36.5 ± 10.0 in Group 1 and 39.6 ± 8.6 in Group 2 (p = 0.033). The 5-point Likert scale scores to measure satisfaction were stated as 4.5 ± 0.6 in Group 1 and 3.5 ± 1.2 in Group 2 (p < 0.001).

Conclusions

Providing video-based information during the preanesthetic interview alleviated anxiety and increased satisfaction in patients undergoing spinal anesthesia.

Prognostic model for psychological outcomes in ambulatory surgery patients: A prospective study using a structural equation modeling framework

INTRODUCTION

Surgical procedures are increasingly carried out in a day-case setting. Along with this increase, psychological outcomes have become prominent. The objective was to evaluate prospectively the prognostic effects of sociodemographic, medical, and psychological variables assessed before day-case surgery on psychological outcomes after surgery.

METHODS

The study was carried out between October 2010 and September 2011. We analyzed 398 mixed patients, from a randomized controlled trial, undergoing day-case surgery at a university medical center. Structural equation modeling was used to jointly study presurgical prognostic variables relating to sociodemographics (age, sex, nationality, marital status, having children, religion, educational level, employment), medical status (BMI, heart rate), and psychological status associated with anxiety (State-Trait Anxiety Inventory (STAI), Hospital Anxiety and Depression Scale (HADS-A)), fatigue (Multidimensional Fatigue Inventory (MFI)), aggression (State-Trait Anger Scale (STAS)), depressive moods (HADS-D), self-esteem, and self-efficacy. We studied psychological outcomes on day 7 after surgery, including anxiety, fatigue, depressive moods, and aggression regulation.

RESULTS

The final prognostic model comprised the following variables: anxiety (STAI, HADS-A), fatigue (MFI), depression (HADS-D), aggression (STAS), self-efficacy, sex, and having children. The corresponding psychological variables as assessed at baseline were prominent (i.e. standardized regression coefficients ≥ 0.20), with STAI-Trait score being the strongest predictor overall. STAI-State (adjusted R2 = 0.44), STAI-Trait (0.66), HADS-A (0.45) and STAS-Trait (0.54) were best predicted.

CONCLUSION

We provide a prognostic model that adequately predicts multiple postoperative outcomes in day-case surgery. Consequently, this enables timely identification of vulnerable patients who may require additional medical or psychological preventive treatment or-in a worst-case scenario-could be unselected for day-case surgery.

Prospective randomised controlled trial of written supplement to verbal communication of results to patients at the time of flexible cystoscopy

PURPOSE

This trial assessed if written information on procedural findings and subsequent treatment improved understanding and reduced anxiety among patients undergoing day case flexible cystoscopy (FC).

METHODS

Participants completed pre- and post-procedure questionnaires self-rating anxiety and feeling well informed on 5-point Likert scales. Supplemental written information was provided after FC to half the patients on a standardized template, according to randomized allocation. Comparisons between the groups were undertaken using the Wilcoxon test.

RESULTS

Two hundred patients were recruited, with 171 evaluable questionnaires (83 from written group). The distribution of age, sex and prior FC, as well as the pre-procedure self-assessment of anxiety and understanding, was similar between the two groups. Patients receiving written information reported feeling better informed, with median (range) Likert score of 5 (4-5) compared to 4 (1-5) out of 5 (p < 0.0001) and less anxious (score 1 [1-4] compared to 2 [1-5] out of 5, p < 0.005), although all except four patients had an accurate understanding of the information provided (p = NS).

CONCLUSIONS

Written information at the time of FC leads to patients feeling better informed and less anxious, although verbal information alone appears to lead to an adequate understanding.

CLINICAL TRIAL REGISTRATION NUMBER

ACTRN12616000288426.

Nurses' Perceptions of Patient Care Continuity in Day Surgery

PURPOSE

The increase in day surgery has brought about a significant change in patient care and care continuity. The purpose of this study was to analyze nurses' perceptions of the realization of continuity of care in day surgery. Continuity of care is examined from the perspectives of time, flow, co-ordination flow, caring relationship flow, and information flow.

DESIGN

Descriptive study.

METHODS

A questionnaire including demographics and questions about continuity of care was completed by 83 of the 120 eligible nurses (response rate, 69%) in one hospital district in Finland.

FINDINGS

According to the nurses, continuity of patient care is mostly well realized. On the day of surgery, information flow was the domain that was best realized. In the opinion of the nurses, continuity of care was least realized at home before surgery and at home during the period after surgery.

CONCLUSIONS

Based on nurses' perceptions, continuity of care was relatively well realized.

Evaluation of Stress Scores Throughout Radiological Biopsies

BACKGROUND

Ultrasound-guided biopsy procedures are the most prominent methods that increase the trauma, stress and anxiety experienced by the patients.

OBJECTIVES

Our goal was to examine the level of stress in patients waiting for radiologic biopsy procedures and determine the stress and anxiety level arising from waiting for a biopsy procedure.

PATIENTS AND METHODS

This prospective study included 35 female and 65 male patients who were admitted to the interventional radiology department of Kartal Dr. Lütfi Kirdar training and research hospital, Istanbul between the years 2014 and 2015. They filled out the adult resilience scale consisting of 33 items. Patients who were undergoing invasive radiologic interventions were grouped according to their phenotypic characteristics, education level (low, intermediate, and high), and biopsy features (including biopsy localization: neck, thorax, abdomen, and bone; and the number of procedures performed, 1 or more than 1). Before the biopsy, they were also asked to complete the depression-anxiety-stress scale (DASS 42), state-trait anxiety inventory scale (STAI-I), and continuous anxiety scale STAI-II. A total of 80 patients were biopsied (20 thyroid and parathyroid, 20 thorax, 20 liver and kidney, and 20 bone biopsies). The association between education levels (primary- secondary, high school and postgraduate) and the number of biopsies (1 and more than 1) with the level of anxiety and stress were evaluated using the above-mentioned scales.

RESULTS

Evaluation of sociodemographic and statistical characteristics of the patients showed that patients with biopsy in the neck region were moderately and severely depressed and stressed. In addition, the ratio of severe and extremely severe anxiety scores was significantly high. While the STAI-I and II scores were lined up as neck > bone > thorax > abdomen, STAI-I was higher in neck biopsies compared to thorax and abdomen biopsies. Regarding STAI-I and II scales, patients with neck biopsy had the highest anxiety score.

CONCLUSION

We believe that active briefing of patients who need to undergo neck and bone biopsies and have high anxiety score by healthcare personnel is an effective method to control psychological mood and increase the efficiency of treatment.

Preoperative anxiety in ambulatory surgery: The impact of an empathic patient-centered approach on psychological and clinical outcomes

OBJECTIVE

This study aims to evaluate the influence of an empathic patient-centered approach on preoperative anxiety and surgical outcomes in ambulatory surgery patients.

METHODS

A sample of 104 patients undergoing general ambulatory surgery was randomly assigned to the intervention (IG) and the control (CG) groups. Before surgery, the IG received personalized information through an empathic patient-centered interview. The CG received standardized information on surgical procedures. Anxiety was assessed before and after the preoperative interview and after the surgery. Wound healing, post-surgical recovery and satisfaction with the quality of preoperative information were assessed after the surgery.

RESULTS

The two groups were identical at baseline regarding anxiety, socio-demographic and clinical characteristics. After the patient-centered intervention, the IG showed lower levels of preoperative anxiety (p<0.001) and pain (p<0.001), better surgery recovery (p<0.01) and higher levels of daily activity (p<0.001) and of satisfaction with the information received (p<0.01) than the CG. The IG also showed better wound healing (tissue type, p<0.01; local pain, p<0.01).

CONCLUSION

An empathic patient-centered intervention can reduce preoperative anxiety and increase surgical recovery, wound healing and patient satisfaction.

PRACTICE IMPLICATIONS

This approach is applicable in pre-surgical interviews and can potentially be used in the routine care of various surgical contexts.

A drain- and catheter-free enhanced recovery protocol to achieve discharge within 23 hours of laparoscopic pyeloplasty surgery: Is this feasible and safe?

Objective:

The objective of this article is to review the outcomes of our updated single-centre extended experience of an innovative enhanced recovery pathway to perform catheter- and drain-free laparoscopic pyeloplasties, achieving safe discharge within 23 hours of surgery.

Patients and methods:

We conducted a retrospective review of patients who underwent a standard trans-peritoneal laparoscopic pyeloplasty repair over an antegrade stent in our centre by a single surgeon, between 1 September 2007 and 1 February 2015. Patients who had a urinary catheter and/or peri-nephric drain inserted intraoperatively and were not planned for day-case discharge were excluded. Data were collected for duration of in-patient stay, readmission rates and reasons for these. Successful outcome was deemed both in subjective improvement of patient symptoms and/or objective improvement in post-operative MAG-3 renogram curve.

Results:

Fifty-eight patients were included. A total of 74% ( n = 43) were successfully discharged as day-case, and four of these were readmitted. Fifteen patients required in-patient stay, of whom two were readmitted. Successful outcome was recorded in 93% ( n = 54).

Conclusion:

The insertion of a drain and catheter are not essential in laparoscopic pyeloplasty. Avoidance of unnecessary tubes facilitates day-case surgery with no adverse effect on outcome. At our institute all patients are now offered the enhanced recovery protocol for laparoscopic pyeloplasty with resulting benefits both to patients and the local health economy.

Prevalence and Predictors of Quality of Recovery at Home After Day Surgery

Traditionally, major complications and unanticipated admission/readmission rates were used to assess outcome after day surgery. However, in view of the relative absence of major complications the quality of recovery (QOR) should be considered one of the principal endpoints after day surgery. In our study, the level of QOR is defined by a combination of the Global Surgical Recovery (GSR) Index and the Quality of Life (QOL). The aim of this study was to analyze prevalence and predictors of QOR after day surgery on the fourth postoperative day. Elective patients scheduled for day surgery from November 2008 to April 2010 were enrolled in a prospective cohort study. Outcome parameters were measured by using questionnaire packages at 2 time points: 1 week preoperatively and 4 days postoperatively. Primary outcome parameter is the QOR and is defined as good if the GSR index >80% as well as the postoperative QOL is unchanged or improved as compared with baseline. QOR is defined as poor if both the GSR index ≤ 80% and if the postoperative QOL is decreased as compared with baseline. QOR is defined as intermediate in all other cases. Three logistic regression analyses were performed to determine predictors for poor QOR after day surgery. A total of 1118 patients were included. A good QOR was noted in 17.3% of patients, an intermediate QOR in 34.8%, and a poor QOR in 47.8% 4 days after day surgery. The best predictor for poor QOR after day surgery was type of surgery. Other predictors were younger age, work status, and longer duration of surgery. A history of previous surgery, expected pain (by the patient) and high long-term surgical fear were significant predictors of poor QOR in only 1 of 3 prediction models. The QOR at home 4 days after day surgery was poor in the majority of patients and showed a significant procedure-specific variation. Patients at risk for poor QOR can be identified during the preoperative period based on type of surgery, age, work status, and the duration of the surgery.

Iranian families' experience of receiving support during their patients' surgical process: qualitative study

BACKGROUND

The time spent waiting through the surgery of a loved one is stressful for family members because of their worries regarding the procedure and potential outcomes. In Iran, the attention and support of healthcare professionals focus almost exclusively on the patient. No studies have explored the related support experiences of family members. Understanding these experiences may facilitate the development by healthcare professionals of support strategies to alleviate the surgery-related stresses of patients' family members.

PURPOSE

This study elucidates the support experiences of the Iranian families of patients undergoing surgery.

METHODS

A qualitative design using a content analysis approach was used to gather and analyze the support experiences of 16 Iranian families awaiting the conclusion of their relative's surgical operation. The study was conducted at a university medical center hospital in an urban area in Iran. After employing a purposive sampling method to select participants, semistructured interviews were used to collect data.

RESULTS

Data analysis led to the development of two main themes: "interaction:" and "physical proximity." One significant finding was the role of productive interactions among family members to facilitate the passing of time and to provide a buffer. These interactions may take place among family members as well as among other companions.

CONCLUSIONS

The findings of this study may be used to guide nursing practices and may help change nursing attitudes toward the family members of surgical patients. By better understanding the experience of families, nurses may improve their professional actions and reduce the stress experienced by family members while waiting for the conclusion of surgery.

Continuity of care in day surgical care - perspective of patients

BACKGROUND

The realisation of continuity in day surgical care is analysed in this study. The term 'continuity of care' is used to refer to healthcare processes that take place in time (time flow) and require coordination (coordination flow), rapport (caring relationship flow) and information (information flow). Patients undergoing laparoscopic cholecystectomy or inguinal hernia day surgery are ideal candidates for studying the continuity of care, as the diseases are very common and the treatment protocol is mainly the same in different institutions, in addition to which the procedure is elective and most patients have a predictable clinical course.

AIM

The aim of the study was to describe, from the day surgery patients' own perspective, how continuity of care was realised at different phases of the treatment, prior to the day of surgery, on the day of surgery and after it.

METHOD

The study population consisted of 203 day surgical patients 10/2009-12/2010 (N = 350, response rate 58%). A questionnaire was developed for this study.

RESULTS

Based on the results, the continuity of care was well realised as a rule. Continuity is improved by the fact that patients know the nurse who will look after them in the hospital before the day of surgery and have a chance to meet the nurse even after the operation. Meeting the surgeon who performed the operation afterwards also improves patients' perception of continuation of care.

CONCLUSIONS

Continuity of care may be improved by ensuring that the patient meets caring staff prior to the day of operation and after the procedure. An important topic for further research would be how continuation of care is realised in the case of other patient groups (e.g. in internal medicine). On the other hand, realisation of continuation of care should also be studied from the viewpoint of those taking part in patient care in order to find similarities/differences between patients' perceptions and professionals' views. Studying interventions aimed to promote continuity of care, for example in patient guidance, would also be of great importance.

Subjectively reported symptoms in patients with persistent atrial fibrillation and emotional distress

Background: Patients with atrial fibrillation (AF) are characterized by emotional distress and poor quality of life. Little is known about the relation between emotional distress and subjectively reported AF symptoms. Our aims were to compare emotional distress levels in AF patients with distress levels in the general population and to examine the cross-sectional and prospective relationship between subjective AF symptom reports and emotional distress around electrical cardioversion (ECV).

Methods: At baseline, this study included 118 patients with persistent AF planned for ECV (aged 68 ± 10 years, 60% men) in which depression (BDI), anxiety (STAI), Type D personality (DS14), perceived stress (PSS-10), and AF symptoms (ATSSS) were assessed. The prospective substudy included 52 patients. Objective AF status was determined by ECG.

Results: AF patients experienced significantly higher levels of anxiety (p < 0.001) and depression (p < 0.001) than age and gender matched persons from the general population. Linear regression analyses showed that AF patients with higher depression levels reported significantly more AF symptoms (β = 0.44; p < 0.0005) and reported symptoms to occur with a higher frequency (β = 0.51; p < 0.0005) during the AF episode, independent of age, sex, cardiac disease, BMI, and physical activity. At 4 weeks follow-up, 56% of all patients had maintained sinus rhythm. Repeated Measures Linear mixed modeling showed that these patients reported fewer AF symptoms and a lower frequency of AF symptoms pre and post-ECV (p = 0.04). Also, the course of the number and frequency of reported symptoms was significantly associated with the change in depression over that same time period (p < 0.0005).

Conclusion: Patients with persistent AF are characterized by emotional distress. Distressed AF patients, particularly the depressed, report more AF symptoms before and after ECV. These findings call for increased attention of clinicians to emotional distress in this patient population.

Preparação psicológica de pacientes submetidos a procedimentos cirúrgicos

Este trabalho tem por objetivo identificar, entre artigos publicados em periódicos indexados pelo PubMed/MedLine, informações sobre as principais modalidades e efeitos de intervenção psicossocial em procedimentos pré e pós-operatórios com pacientes adultos, bem como, apontar algumas lacunas na produção científica acerca do tema. Foram selecionados 32 artigos, sendo oito teórico-conceituais e 24 empíricos, dos quais um era estudo de caso, nove se referiam à avaliação específica de efeitos de preparação psicológica e 14 tratavam de temas associados ao contexto de preparação psicológica e cuidados cirúrgicos. As intervenções psicológicas foram divididas em oito categorias, baseadas em características funcionais das respectivas intervenções. Verificou-se uma deficiência de estudos na área de atuação específica da Psicologia, sendo os profissionais de enfermagem e medicina os que mais produziram estudos sobre o tema. Constatou-se, também, a ausência de protocolos sistematizados de intervenção psicológica relacionados a procedimentos cirúrgicos.

The power of words: sources of anxiety in patients undergoing local anaesthetic plastic surgery

INTRODUCTION

With local or regional anaesthesia being employed for more as well as more complex surgical procedures, an increasing number of patients remain fully conscious during their operation. This is generally perceived as being advantageous to the patient as less time is spent in hospital and the side effects of general anaesthesia are avoided. However, there is no direct measure of the patient experience during 'awake surgery', in particular of which aspects of the process may be distressing.

METHODS

Seventy patients undergoing day case plastic surgery under local anaesthesia were asked to complete a short questionnaire immediately following their operation. This was designed to identify specific factors likely to either increase or reduce anxiety during surgery. The questionnaire was initially validated on a pilot group of ten patients.

RESULTS

Unsurprisingly, painful stimuli such as injections were identified as potential stressors. More interestingly, the data highlighted that some commonly used surgical terms such as 'knife' and 'scalpel' provoke considerable anxiety in the conscious patient. This varied according to age and sex with younger and female patients being most vulnerable. Other events identified as potential stressors, such as casual conversations and movements among theatre staff, were actually shown to be non-stressful and, in some cases, stress relieving.

CONCLUSIONS

Technical jargon used by surgical staff can elevate anxiety levels among patients who are awake for their operation. Careful consideration of the words we use may reduce this, particularly in female patients.