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Ng SX, Wang W, Shen Q, Toh ZA, He HG. The effectiveness of preoperative education interventions on improving perioperative outcomes of adult patients undergoing cardiac surgery: a systematic review and meta-analysis. Eur J Cardiovasc Nurs 2021; 21:521-536. [PMID: 34964470 DOI: 10.1093/eurjcn/zvab123] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 09/25/2021] [Accepted: 12/09/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND Cardiac surgeries pose as an emotional experience for patients. Preoperative education is known to positively alter people's perceptions, emotions, and mitigate surgical distress. However, this intervention's effectiveness in improving perioperative outcomes among patients undergoing cardiac surgery lacked rigorous statistical synthesis and remains inconclusive. AIMS The aim was to synthesize the effectiveness of preoperative education on improving perioperative outcomes [anxiety, depression, knowledge, pain intensity, pain interference with daily activities, postoperative complications, length of hospitalization, length of intensive care unit (ICU) stay, satisfaction with the intervention and care, and health-related quality of life] among patients undergoing cardiac surgery. METHODS This systematic review and meta-analysis conducted a comprehensive search of nine electronic databases (PubMed, EMBASE, Scopus, MEDLINE, CINAHL, Cochrane CENTRAL, Web of Science, PsycINFO, and ERIC) and grey literature for randomized controlled trials examining the preoperative educational interventional effects on patients undergoing cardiac surgery from inception to 31 December 2020. The studies' quality was evaluated using Cochrane Risk-of-Bias Tool 1 (RoB1). Meta-analyses via RevMan 5.4 software synthesized interventional effects. RESULTS Twenty-two trials involving 3167 participants were included. Preoperative education had large significant effects on reducing post-intervention preoperative anxiety (P = 0.02), length of ICU stay (P = 0.02), and improving knowledge (P < 0.00001), but small significant effect sizes on lowering postoperative anxiety (P < 0.0001), depression (P = 0.03), and enhancing satisfaction (P = 0.04). CONCLUSIONS This review indicates the feasibility of preoperative education in clinical use to enhance health outcomes of patients undergoing cardiac surgery. Future studies need to explore knowledge outcomes in-depth and more innovative technologies in preoperative education delivery.
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Affiliation(s)
- Si Xian Ng
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 2, Clinical Research Centre, Block MD11, 10 Medical Drive, Singapore 117597, Singapore.,National University Health System, NUHS Tower Block, 1E Kent Ridge Rd, Singapore 119228, Singapore
| | - Wenru Wang
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 2, Clinical Research Centre, Block MD11, 10 Medical Drive, Singapore 117597, Singapore.,National University Health System, NUHS Tower Block, 1E Kent Ridge Rd, Singapore 119228, Singapore
| | - Qu Shen
- Department of Nursing, School of Medicine, Xiamen University, Room 220, Alice Lee Building, Xiang An South Road, Xiang An District, Xiamen 361102, Fujian Province, China
| | - Zheng An Toh
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 2, Clinical Research Centre, Block MD11, 10 Medical Drive, Singapore 117597, Singapore.,National University Health System, NUHS Tower Block, 1E Kent Ridge Rd, Singapore 119228, Singapore
| | - Hong-Gu He
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 2, Clinical Research Centre, Block MD11, 10 Medical Drive, Singapore 117597, Singapore.,National University Health System, NUHS Tower Block, 1E Kent Ridge Rd, Singapore 119228, Singapore
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Xavier IBM, Biscarra VB, Piccoli ÂB, Rodrigues CG, Hirakata VN, Moraes MAPD, Pellanda LC. Nursing Guidelines on Cardiac Surgery and Parents' Anxiety: Randomized Clinical Trial. Braz J Cardiovasc Surg 2020; 35:437-444. [PMID: 32864921 PMCID: PMC7454628 DOI: 10.21470/1678-9741-2019-0345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Objective The preparation of parents of children who should undergo cardiac surgery requires special treatment such as the explanations about the event. This study aims to compare the effects of standardized nursing guidelines with routine institutional orientation on the anxiety of parents of children undergoing cardiac surgery. Methods Randomized clinical trial. The sample consisted of parents of children who underwent cardiac surgery from December 2010 to April 2011. Twenty-two parents were randomized to the intervention group (IG) and received the standard nursing guidelines and 22 participated in the control group (CG) and received the routine guidelines from the institution. Anxiety was assessed by the State-Trait Anxiety Inventory (STAI) applied in the preoperative period, between 12 and 20 hours before surgery and before receiving standard or institutional guidelines and 48 hours after surgery. The analysis of variance (ANOVA) for repeated measures was performed to evaluate the differences between the variations in STAI scores between the groups during the studied period. The level of significance was 0.05. Results There were no significant differences in baseline anxiety scores between groups with regard to trait anxiety as well as state anxiety: STAI-trait (CG 42.6±4.9 vs. IG 41.4±6.0, P=0.48); STAI-state (CG 42.3±5.7 vs. IG 45.6±8.3, P=0.18). Likewise, the variation in score after 48 hours was similar between groups (STAI-trait P=0.77; STAI-state P=0.61). Conclusion There were no significant differences in the parents’ anxiety levels when comparing the two types of guidelines: the standard nursing and the institutional orientation.
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Affiliation(s)
| | - Virginia Borne Biscarra
- Instituto de Cardiologia/Fundação Universitária de Cardiologia - IC/FUC, Porto Alegre, RS, Brazil
| | - Ângela Bein Piccoli
- Instituto de Cardiologia/Fundação Universitária de Cardiologia - IC/FUC, Porto Alegre, RS, Brazil
| | | | | | | | - Lucia Campos Pellanda
- Instituto de Cardiologia/Fundação Universitária de Cardiologia - IC/FUC, Porto Alegre, RS, Brazil.,Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brazil
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Lai VKW, Ho KM, Wong WT, Leung P, Gomersall CD, Underwood MJ, Joynt GM, Lee A. Effect of preoperative education and ICU tour on patient and family satisfaction and anxiety in the intensive care unit after elective cardiac surgery: a randomised controlled trial. BMJ Qual Saf 2020; 30:228-235. [PMID: 32321777 DOI: 10.1136/bmjqs-2019-010667] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 04/01/2020] [Accepted: 04/06/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND Preoperative education may help participants to psychologically prepare themselves for surgery, but the outcomes of such preparation have rarely been assessed in patients requiring postoperative care in the intensive care unit (ICU) as well as in family members. OBJECTIVE To assess the effect of a preoperative multifaceted education intervention on patient and family satisfaction levels in the ICU and measures of perioperative patients' anxiety and depression. TRIAL DESIGN Single-centre, two-armed, parallel, superiority, randomised controlled trial. Healthcare professionals in ICU and outcome assessor were blinded to treatment allocation. PARTICIPANTS 100 elective coronary artery bypass grafting±valve surgery patients and their family members. INTERVENTIONS Preoperative education comprising of a video and ICU tour in addition to standard care (treatment), versus standard care (control). OUTCOMES Patient and family satisfaction levels with ICU using validated PS-ICU23 and FS-ICU24 questionnaires (0-100), respectively; change in perioperative anxiety and depression scores between 1 day presurgery and 3 days postsurgery. RESULTS Among 100 (50 treatment, 50 control) patients and 98 (49 treatment, 49 control) family members, 94 (48 treatment, 46 control) patients and 94 (47 treatment, 47 control) family members completed the trial. Preoperative education was associated with higher overall patient (mean difference (MD) 6.7, 95% CI 0.2 to 13.2) and family (MD 10.0, 95% CI 3.8 to 16.3) satisfaction scores. There was a weak association between preoperative education and a reduction in patient's anxiety scores over time (MD -1.7, 95% CI -3.5 to 0.0). However, there was no evidence of a treatment effect on patient's depression scores over time (MD -0.6, 95% CI -2.3 to 1.2). CONCLUSION Providing comprehensive preoperative information about ICU to elective cardiac surgical patients improved patient and family satisfaction levels and may decrease patients' anxiety levels. TRIAL REGISTRATION NUMBER ChiCTR-IOR-15006971.
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Affiliation(s)
- Veronica Ka Wai Lai
- Department of Anaesthesia and Intensive Care, Chinese University of Hong Kong, Shatin, New Territories, Hong Kong
| | - Ka Man Ho
- Department of Anaesthesia and Intensive Care, Prince of Wales Hospital, Shatin, New Territories, Hong Kong
| | - Wai Tat Wong
- Department of Anaesthesia and Intensive Care, Chinese University of Hong Kong, Shatin, New Territories, Hong Kong
| | - Patricia Leung
- Department of Anaesthesia and Intensive Care, Chinese University of Hong Kong, Shatin, New Territories, Hong Kong
| | - Charles David Gomersall
- Department of Anaesthesia and Intensive Care, Chinese University of Hong Kong, Shatin, New Territories, Hong Kong
| | - Malcolm John Underwood
- Division of Cardiothoracic Surgery, Department of Surgery, Chinese University of Hong Kong, Shatin, New Territories, Hong Kong
| | - Gavin Matthew Joynt
- Department of Anaesthesia and Intensive Care, Chinese University of Hong Kong, Shatin, New Territories, Hong Kong
| | - Anna Lee
- Department of Anaesthesia and Intensive Care, Chinese University of Hong Kong, Shatin, New Territories, Hong Kong
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Amini K, Alihossaini Z, Ghahremani Z. Randomized Clinical Trial Comparison of the Effect of Verbal Education and Education Booklet on Preoperative Anxiety. J Perianesth Nurs 2018; 34:289-296. [PMID: 30385098 DOI: 10.1016/j.jopan.2018.06.101] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Revised: 05/25/2018] [Accepted: 06/07/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE Comparing the effect of verbal education and education booklet on preoperative anxiety. DESIGN This study was a randomized clinical trial. METHODS Sixty patients were randomly allocated into three groups: control, booklet, and verbal education. The data were collected using Spielberger's State-Trait Anxiety Inventory before and after intervention. SPSS (version 20; IBM, Armonk, NY) with analysis of variance and the dependent t test were used for analysis. FINDINGS After intervention, there was a significant difference between the mean scores of state anxiety scale among the intervention groups (booklet and verbal) with the control group (P < .05). The mean difference between the two intervention groups (booklet and verbal) was not significant (P > .05). CONCLUSIONS According to the results, and given that nurses work under time pressure in Iran and other societies, it is concluded that well-designed education booklets can be used to reduce the preoperative anxiety.
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Chivukula U, Hariharan M, Rana S, Thomas M, Andrew A. Enhancing Hospital Well-being and Minimizing Intensive Care Unit Trauma: Cushioning Effects of Psychosocial Care. Indian J Crit Care Med 2017; 21:640-645. [PMID: 29142374 PMCID: PMC5672668 DOI: 10.4103/ijccm.ijccm_468_14] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
CONTEXT Hospitalization has the potential to induce hospital anxiety, while admission in the Intensive Care Unit (ICU) is found to surpass the anxiety and result in what is termed as "ICU Trauma." AIMS This study aimed to determine the impact of psychosocial care and quality of ICU on ICU trauma and hospital well-being in patients who underwent coronary artery bypass grafting (CABG). SETTINGS AND DESIGN This correlational study involved 250 CABG patients, who were recruited from five major corporate hospitals. PARTICIPANTS AND METHODS The ICU Psychosocial Care Scale, Hospital Wellbeing Scale, and ICU Trauma Scale were used. Each of the participants was assessed individually. The ICU Practices Checklist was used to assess the environment of the ICU in the hospital. STATISTICAL ANALYSIS USED Descriptive statistics, correlation, and simple and multiple linear regression analyses were done. RESULTS The results revealed the significant contribution of psychosocial care in ICU in enhancing hospital well-being as well as minimizing ICU trauma of patients who underwent CABG. The results of multiple regressions clearly indicated that psychosocial care was a powerful predictor of hospital well-being and ICU trauma. CONCLUSIONS Although psychosocial care was not a component of hospital well-being and had a negative correlation with ICU trauma, it contributed significantly with a cushioning effect to minimize trauma and helped enhance the feelings and experiences of well-being among patients in ICU.
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Affiliation(s)
- Usha Chivukula
- Centre for Health Psychology, University of Hyderabad, Hyderabad, Telangana, India
| | - Meena Hariharan
- Centre for Health Psychology, University of Hyderabad, Hyderabad, Telangana, India
| | - Suvashisa Rana
- Centre for Health Psychology, University of Hyderabad, Hyderabad, Telangana, India
| | - Marlyn Thomas
- Centre for Health Psychology, University of Hyderabad, Hyderabad, Telangana, India
| | - Asher Andrew
- Centre for Health Psychology, University of Hyderabad, Hyderabad, Telangana, India
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Ziehm S, Rosendahl J, Barth J, Strauss BM, Mehnert A, Koranyi S. Psychological interventions for acute pain after open heart surgery. Cochrane Database Syst Rev 2017; 7:CD009984. [PMID: 28701028 PMCID: PMC6432747 DOI: 10.1002/14651858.cd009984.pub3] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND This is an update of a Cochrane review previously published in 2014. Acute postoperative pain is one of the most disturbing complaints in open heart surgery, and is associated with a risk of negative consequences. Several trials investigated the effects of psychological interventions to reduce acute postoperative pain and improve the course of physical and psychological recovery of participants undergoing open heart surgery. OBJECTIVES To compare the efficacy of psychological interventions as an adjunct to standard care versus standard care alone or standard care plus attention control in adults undergoing open heart surgery for pain, pain medication, psychological distress, mobility, and time to extubation. SEARCH METHODS For this update, we searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, Web of Science, and PsycINFO for eligible studies up to February 2017. We used the 'related articles' and 'cited by' options of eligible studies to identify additional relevant studies. We checked lists of references of relevant articles and previous reviews. We searched the ProQuest Dissertations and Theses Full Text Database, ClinicalTrials and the WHO International Clinical Trials Registry Platform to identify any unpublished material or ongoing trials. We also contacted the authors of primary studies to identify any unpublished material. In addition, we wrote to all leading heart centres in Germany, Switzerland, and Austria to check whether they were aware of any ongoing trials. SELECTION CRITERIA Randomised controlled trials comparing psychological interventions as an adjunct to standard care versus standard care alone or standard care plus attention in adults undergoing open heart surgery. DATA COLLECTION AND ANALYSIS Two review authors (SZ and SK) independently assessed trials for eligibility, estimated the risk of bias and extracted all data. We calculated effect sizes for each comparison (Hedges' g) and meta-analysed data using a random-effects model. We assessed the evidence using GRADE and created 'Summary of findings' tables. MAIN RESULTS We added six studies to this update. Overall, we included 23 studies (2669 participants).For the majority of outcomes (two-thirds), we could not perform a meta-analysis since outcomes were not measured, or data were provided by one trial only.No study reported data on the number of participants with pain intensity reduction of at least 50% from baseline. Only one study reported data on the number of participants below 30/100 mm on the Visual Analogue Scale (VAS) in pain intensity (very low-quality evidence). Psychological interventions did not reduce pain intensity in the short-term interval (g 0.39, 95% CI -0.18 to 0.96, 2 studies, 104 participants, low-quality evidence), medium-term interval (g -0.02, 95% CI -0.24 to 0.20, 4 studies, 413 participants, moderate-quality evidence) or in the long-term interval (g 0.05, 95% CI -0.20 to 0.30, 2 studies, 200 participants, moderate-quality evidence).No study reported data on median time to re-medication or on number of participants re-medicated. Only two studies provided data on postoperative analgesic use in the short-term interval, showing that psychological interventions did not reduce the use of analgesic medication (g 1.18, 95% CI -2.03 to 4.39, 2 studies, 104 participants, low-quality evidence). Studies revealed that psychological interventions reduced mental distress in the medium-term (g 0.37, 95% CI 0.13 to 0.60, 13 studies, 1388 participants, moderate-quality evidence) and likewise in the long-term interval (g 0.32, 95% CI 0.10 to 0.53, 14 studies, 1586 participants, moderate-quality evidence). Psychological interventions did not improve mobility in the medium-term interval (g 0.23, 95% CI -0.22 to 0.67, 3 studies, 444 participants, low-quality evidence), nor in the long-term interval (g 0.09, 95% CI -0.10 to 0.28, 4 studies, 458 participants, moderate-quality evidence). Only two studies reported data on time to extubation, indicating that psychological interventions reduced the time to extubation (g 0.56, 95% CI 0.08 to 1.03, 2 studies, 154 participants, low-quality evidence).Overall, the very low to moderate quality of the body of evidence on the efficacy of psychological interventions for acute pain after open heart surgery cannot be regarded as sufficient to draw robust conclusions.Most 'Risk of bias' assessments were low or unclear. We judged selection bias (random sequence generation) and attrition bias to be mostly low risk for included studies. However, we judged the risk of selection bias (allocation concealment), performance bias, detection bias and reporting bias to be mostly unclear. AUTHORS' CONCLUSIONS In line with the conclusions of our previous review, there is a lack of evidence to support or refute psychological interventions in order to reduce postoperative pain in participants undergoing open heart surgery. We found moderate-quality evidence that psychological interventions reduced mental distress in participants undergoing open heart surgery. Given the small numbers of studies, it is not possible to draw robust conclusions on the efficacy of psychological interventions on outcomes such as analgesic use, mobility, and time to extubation respectively on adverse events or harms of psychological interventions.
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Affiliation(s)
- Susanne Ziehm
- University Hospital of LeipzigInstitute of Medical Psychology and Medical SoziologyPhilipp‐Rosenthal‐Straße 55LeipzigSaxonyGermany4103
| | - Jenny Rosendahl
- University Hospital of JenaInstitute of Psychosocial Medicine and PsychotherapyStoystrasse 3JenaThuringiaGermany07743
| | - Jürgen Barth
- UniversityHospital and University of ZurichInstitute for Complementary and Integrative MedicineSonneggstrasse 6ZurichSwitzerlandCH‐8091
| | - Bernhard M Strauss
- University Hospital of JenaInstitute of Psychosocial Medicine and PsychotherapyStoystrasse 3JenaThuringiaGermany07743
| | - Anja Mehnert
- University Hospital of LeipzigInstitute of Medical Psychology and Medical SoziologyPhilipp‐Rosenthal‐Straße 55LeipzigSaxonyGermany4103
| | - Susan Koranyi
- University Hospital of LeipzigInstitute of Medical Psychology and Medical SoziologyPhilipp‐Rosenthal‐Straße 55LeipzigSaxonyGermany4103
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Heilmann C, Stotz U, Burbaum C, Feuchtinger J, Leonhart R, Siepe M, Beyersdorf F, Fritzsche K. Short-term intervention to reduce anxiety before coronary artery bypass surgery--a randomised controlled trial. J Clin Nurs 2016; 25:351-61. [PMID: 26818362 DOI: 10.1111/jocn.13055] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2015] [Indexed: 12/19/2022]
Abstract
AIMS AND OBJECTIVES The aim of this study was to evaluate an intervention with individualised information and emotional support before coronary artery bypass grafting in a controlled randomised trial. BACKGROUND Anxiety is a typical phenomenon in patients who are to undergo cardiac surgery. Preoperative anxiety has been shown to correlate to adverse postoperative outcomes. Emotional support could be an effective measure to reduce preoperative anxiety. DESIGN AND METHODS Patients with planned first coronary artery bypass grafting were randomised into an intervention group (n = 139) and a control group (n = 114). The patients of the control group were routinely informed as usual. The patients of the intervention group received a dialogue with individualised information and emotional support one day before surgery in addition to standard care. This intervention of ~30 minutes was based on a supportive psychotherapy model and was delivered by trained nurses. The primary outcome was the change in anxiety before operation. The secondary outcomes consisted of changes in postoperative anxiety, time on intensive care unit and in-hospital mortality. RESULTS Significantly reduced anxiety was found in the intervention group patients compared to control patients before coronary artery bypass grafting (p < 0·001) and five days after surgery (p < 0·001). Both groups did not differ in in-hospital mortality and duration of stay in the intensive care unit. CONCLUSIONS Our short-term psychosocial intervention in patients undergoing coronary artery bypass grafting had a beneficial effect on reducing pre- and postoperative anxiety that was better than routine information alone. RELEVANCE TO CLINICAL PRACTICE These results advocate training for nurses and physicians to provide emotional support to patients before coronary artery bypass grafting.
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Affiliation(s)
- Claudia Heilmann
- Department of Cardiovascular Surgery, Heart Center, University of Freiburg, Freiburg, Germany
| | - Ulrike Stotz
- Department of Psychosomatic Medicine and Psychotherapy, Medical Center, University of Freiburg, Freiburg, Germany
| | | | - Johanna Feuchtinger
- Quality and Development in Nursing Care, Medical Center, University of Freiburg, Freiburg, Germany
| | - Rainer Leonhart
- Institute of Psychology, University of Freiburg, Freiburg, Germany
| | - Matthias Siepe
- Department of Cardiovascular Surgery, Heart Center, University of Freiburg, Freiburg, Germany
| | - Friedhelm Beyersdorf
- Department of Cardiovascular Surgery, Heart Center, University of Freiburg, Freiburg, Germany
| | - Kurt Fritzsche
- Department of Psychosomatic Medicine and Psychotherapy, Medical Center, University of Freiburg, Freiburg, Germany
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Koranyi S, Barth J, Trelle S, Strauss BM, Rosendahl J. Psychological interventions for acute pain after open heart surgery. Cochrane Database Syst Rev 2014:CD009984. [PMID: 24861376 DOI: 10.1002/14651858.cd009984.pub2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Acute postoperative pain is one of the most disturbing complaints in open heart surgery, and is associated with a risk of negative consequences. Several trials investigated the effects of psychological interventions to reduce acute postoperative pain and improve the course of physical and psychological recovery of participants undergoing open heart surgery. OBJECTIVES To compare the efficacy of psychological interventions as an adjunct to standard care versus standard care alone or standard care plus attention in adults undergoing open heart surgery on pain, pain medication, mental distress, mobility, and time to extubation. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2013, Issue 8), MEDLINE (1946 to September 2013), EMBASE (1980 to September 2013), Web of Science (all years to September 2013), and PsycINFO (all years to September 2013) for eligible studies. We used the 'related articles' and 'cited by' options of eligible studies to identify additional relevant studies. We also checked lists of references of relevant articles and previous reviews. We also searched the ProQuest Dissertations and Theses Full Text Database (all years to September 2013) and contacted the authors of primary studies to identify any unpublished material. SELECTION CRITERIA Randomised controlled trials comparing psychological interventions as an adjunct to standard care versus standard care alone or standard care plus attention in adults undergoing open heart surgery. DATA COLLECTION AND ANALYSIS Two review authors (SK and JR) independently assessed trials for eligibility, estimated the risk of bias and extracted all data. We calculated effect sizes for each comparison (Hedges' g) and meta-analysed data using a random-effects model. MAIN RESULTS Nineteen trials were included (2164 participants).No study reported data on the number of participants with pain intensity reduction of at least 50% from baseline. Only one study reported data on the number of participants below 30/100 mm on the Visual Analogue Scale (VAS) in pain intensity. Psychological interventions have no beneficial effects in reducing pain intensity measured with continuous scales in the medium-term interval (g -0.02, 95% CI -0.24 to 0.20, 4 studies, 413 participants, moderate quality evidence) nor in the long-term interval (g 0.12, 95% CI -0.09 to 0.33, 3 studies, 280 participants, low quality evidence).No study reported data on median time to remedication or on number of participants remedicated. Only one study provided data on postoperative analgesic use. Studies reporting data on mental distress in the medium-term interval revealed a small beneficial effect of psychological interventions (g 0.36, 95% CI 0.10 to 0.62, 12 studies, 1144 participants, low quality evidence). Likewise, a small beneficial effect of psychological interventions on mental distress was obtained in the long-term interval (g 0.28, 95% CI 0.05 to 0.51, 11 studies, 1320 participants, low quality evidence). There were no beneficial effects of psychological interventions on mobility in the medium-term interval (g 0.23, 95% CI -0.22 to 0.67, 3 studies, 444 participants, low quality evidence) nor in the long-term interval (g 0.29, 95% CI -0.14 to 0.71, 4 studies, 423 participants, low quality evidence). Only one study reported data on time to extubation. AUTHORS' CONCLUSIONS For the majority of outcomes (two-thirds) we could not perform a meta-analysis since outcomes were not measured, or data were provided by one trial only. Psychological interventions have no beneficial effects on reducing postoperative pain intensity or enhancing mobility. There is low quality evidence that psychological interventions reduce postoperative mental distress. Due to limitations in methodological quality, a small number of studies, and large heterogeneity, we rated the quality of the body of evidence as low. Future trials should measure crucial outcomes (e.g. number of participants with pain intensity reduction of at least 50% from baseline) and should focus to enhance the quality of the body of evidence in general. Altogether, the current evidence does not clearly support the use of psychological interventions to reduce pain in participants undergoing open heart surgery.
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Affiliation(s)
- Susan Koranyi
- Institute of Psychosocial Medicine and Psychotherapy, University Hospital of Jena, Stoystrasse 3, Jena, Thuringia, Germany, 07743
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Rosendahl J, Tigges-Limmer K, Gummert J, Dziewas R, Albes JM, Strauss B. Bypass surgery with psychological and spiritual support (the BY.PASS Study): results of a pragmatic trial based on patients' preference. PSYCHOTHERAPY AND PSYCHOSOMATICS 2013; 82:35-44. [PMID: 23147203 DOI: 10.1159/000339170] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2011] [Accepted: 04/22/2012] [Indexed: 11/19/2022]
Abstract
BACKGROUND Some general hospitals within the German health system provide supportive interventions, psychological as well as spiritual, to their patients. It remains to be proven if these interventions are effective when used in routine clinical practice. AIM To evaluate the effectiveness of psychological and spiritual interventions on improving recovery following bypass surgery. METHODS The BY.PASS study is a pragmatic, patient preference trial (ISRCTN 07297983). Adult patients scheduled for elective coronary bypass surgery were enrolled. Patients were assigned to study conditions according to their personal preference: preference for psychological interventions, for spiritual interventions or for no intervention. Patients who were open for any kind of intervention were randomly assigned either to psychological or spiritual interventions. During a control period, patients were asked about their preference, but did not receive any interventions. Primary outcomes of the study were in-hospital morbidity and early mortality. Psychological measures served as secondary outcomes. RESULTS A total of 847 patients were enrolled. Patients of the control (n = 260) and the intervention group (n = 269) who explicitly wanted to have interventions were compared. No significant treatment effects either for morbidity (d = 0.08, 95% CI -0.09 to 0.25), or for mortality (OR = 1.81; 95% CI 0.50-6.57) could be found. A reduction of negative mood resulted from both interventions. CONCLUSIONS Although the effects observed were small, the study can serve as a basis to discuss methodological as well as theoretical aspects of a pragmatic trial, based upon patients' preferences.
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Affiliation(s)
- Jenny Rosendahl
- Institute of Psychosocial Medicine and Psychotherapy, Jena University Hospital - Friedrich Schiller University, Jena, Germany. jenny.rosendahl @ med.uni-jena.de
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Rosendahl J, Tigges-Limmer K, Gummert J, Dziewas R, Albes J, Strauß B. Wunsch nach psychologischer Begleitung bei kardiochirurgischen Patienten. ZEITSCHRIFT FUR HERZ THORAX UND GEFASSCHIRURGIE 2011. [DOI: 10.1007/s00398-011-0837-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
AIMS AND OBJECTIVES To critically review evidence on the effects of psychological support during intensive care unit (ICU) treatment on adult ICU patients' psychological and physiological outcomes. Evidence from intervention studies on imagery and relaxation has been included, as well. BACKGROUND Stress and negative emotions may have both immediate, as well as long-term effects on ICU patients' psychological and physical well-being, and they are linked to delayed physical recovery. DESIGN, METHODS: A narrative critical review methodology was employed. Databases searched included Medline, CINAHL, PubMed, PsychInfo and the Cochrane Library. Experimental, quasi-experimental or pretest-posttest peer-reviewed intervention studies published since 1970 were included. RESULTS Fourteen studies: seven on nurse led relaxation, three on guided imagery, one on nurse-patient interaction, two on physician-patient interaction and one correlational study on perceived social support were included. The results suggest significant improvements in patients' outcomes: improved vital signs, decrease in pain ratings, anxiety, rate of complications and length of stay, and improved sleep and patient satisfaction. Eight studies employed randomized experimental, four quasi-experimental and two descriptive correlational designs. Two studies explored effects on patients' sleep, and two on procedure-related pain. CONCLUSIONS The literature is limited in exploring the effects of nurse-patient interactions. The amount and quality of psychosocial support in the ICU, as well as imagery and relaxation techniques, are linked to short-term and long-term patients' outcomes. RELEVANCE TO CLINICAL PRACTICE ICU nurses need to engage in psychological support in a systematic way, and to acknowledge the high priority of support interventions.
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Affiliation(s)
- Elizabeth D E Papathanassoglou
- Department of Nursing, Cyprus University of Technology, Siakoleion Centre for Health Studies, 2252 Latsia, Nicosia, Cyprus.
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13
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Albert NM, Gillinov AM, Lytle BW, Feng J, Cwynar R, Blackstone EH. A randomized trial of massage therapy after heart surgery. Heart Lung 2009; 38:480-90. [DOI: 10.1016/j.hrtlng.2009.03.001] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2008] [Revised: 01/22/2009] [Accepted: 03/10/2009] [Indexed: 11/24/2022]
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Abstract
Acute pain is a predominant feature of the perioperative experience for the majority of patients. This paper aims to describe the adverse effects of poorly controlled acute, postoperative pain and provides an overview of the organisational aspects involved in pain management in hospitals. Following this there will be an examination of the role information giving has in improving the patient's perioperative experience. Pharmacological and non-pharmacological interventions to prevent or reduce pain will also be described and because of its importance in setting the standard for logical prescribing in pain, the Analgesic Ladder, devised by the World Health Organisation (WHO 1986) will be given special consideration. Finally, the importance of pain assessment and re-assessment will be discussed.
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Affiliation(s)
- Lorraine McMain
- Belfast City Hospital, Belfast Health and Social Care Trust.
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Höhener D, Blumenthal S, Borgeat A. Sedation and regional anaesthesia in the adult patient. Br J Anaesth 2008; 100:8-16. [PMID: 18070783 DOI: 10.1093/bja/aem342] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
This review discusses sedation for regional anaesthesia in the adult population. The first section deals with general aspects of sedation and shows that the majority of patients receiving sedation for regional anaesthesia are satisfied and would choose it again. Methods of assessing the level of sedation are discussed with emphasis on clinical measures. The pharmacology of the drugs involved in sedation is discussed, with propofol and remifentanil appearing to be the combination of choice for sedation in regional anaesthesia. The techniques for administering sedation are discussed and replacement of the traditional repeated boluses or continuous infusion with pharmacokinetic and patient-controlled systems is supported. Patient satisfaction studies suggest that patient-controlled systems are preferred.
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Affiliation(s)
- D Höhener
- Department of Anaesthesiology, Orthopedic University Clinic Balgrist, Forchstrasse 340, 8008 Zurich, Switzerland
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Kopp VJ. Communication with patients before anesthesia and obtention of preanesthetic consent. Curr Opin Anaesthesiol 2007; 15:251-5. [PMID: 17019210 DOI: 10.1097/00001503-200204000-00018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Communication in medicine deserves greater attention than it usually receives. The physician's obligation to obtain informed consent for clinical care and research forces the issue out into the open. Recognition that communication can have legal and economic impacts suggests communication skills should be cultivated as a medical art. This review places communication issues in anesthesia practice, especially those related to informed consent, in an historical, and when possible, scientific context.
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Affiliation(s)
- Vincent J Kopp
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, USA.
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17
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Chirveches-Pérez E, Arnau-Bartés A, Soley-Bach M, Rosell-Cinca F, Clotet-Argemi G, Roura-Poch P, Oriol-Ruscalleda M, Isern-Farrés O, Faro-Blasco M. Efecto de una visita prequirúrgica de enfermería perioperatoria sobre la ansiedad y el dolor. ENFERMERIA CLINICA 2006. [DOI: 10.1016/s1130-8621(06)71171-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
The purpose of this study was to develop and test a standard method of collecting saliva from postoperative patients. Saliva was collected from patients following major abdominal surgery from both parotid glands in intraoral cups and measured in milliliters. Trained research nurses stimulated saliva production with lemon juice and collected saliva at 4 time points on postoperative day 2. Collection time was measured with a stopwatch, and flow rate was calculated by dividing the amount in milliliters by collection time in minutes. Attrition was 9% due to ineligibility after enrollment and 1 withdrawal. In participating patients (n = 68), there were 272 tests planned and 28% were missing. The reasons were postoperative health problems, hospital discharge, and not wanting to be bothered. When saliva collection attempts were made, three-fourths were successful, but the remainder resulted in "dry mouth." Milliliters, minutes, and flow rate were calculated with and without those with dry mouth. Mean flow rates were 0.23 to 0.33 ml/min excluding those with dry mouth and 0.17 to 0.24 ml/min including those with dry mouth. Saliva variables were correlated with antihypertension medications, opioids, opioid side effects, and length of surgery, but statistically significant correlations were not found consistently at all 4 time points. The findings suggest that nurse-researchers studying biological markers can successfully collect saliva from postoperative patients if they recognize the difficulties and make efforts to minimize and control for them.
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Affiliation(s)
| | - Stephen Wotman
- School of Dentistry, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, Ohio, 44106-4904, (ph): 216-368-6840; (fax): 216-368-3024,
| | - Gene Cranston Anderson
- Edward J. and Louise Mellen Professor of Nursing, Frances Payne Bolton School of Nursing, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, Ohio, 44106-4904, (ph): 216-368-3343; (fax): 216-368-3542,
| | - Sukhee Ahn
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Current Address: Assistant Professor School of Nursing, Pusan National University Seo-gu Ami-dong 1-ga, Pusan, 602-739, South Korea, (ph): 82-51-240-7755; (fax): 82-51-248-2669,
| | - Xiaomei Cong
- Frances Payne Bolton School of Nursing, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, Ohio, 44106-4904, (ph): 216-368-3125; (fax): 216-368-3542,
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Kiyohara LY, Kayano LK, Oliveira LM, Yamamoto MU, Inagaki MM, Ogawa NY, Gonzales PESM, Mandelbaum R, Okubo ST, Watanuki T, Vieira JE. Surgery information reduces anxiety in the pre-operative period. ACTA ACUST UNITED AC 2004; 59:51-6. [PMID: 15122417 DOI: 10.1590/s0041-87812004000200001] [Citation(s) in RCA: 75] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
PURPOSE: Patients preparing to undergo surgery should not suffer needless anxiety. This study aimed to evaluate anxiety levels on the day before surgery as related to the information known by the patient regarding the diagnosis, surgical procedure, or anesthesia. METHOD: Patients reported their knowledge of diagnosis, surgery, and anesthesia. The Spielberger State-Trait Anxiety Inventory (STAI) was used to measure patient anxiety levels. RESULTS: One hundred and forty-nine patients were selected, and 82 females and 38 males were interviewed. Twenty-nine patients were excluded due to illiteracy. The state-anxiety levels were alike for males and females (36.10 ± 11.94 vs. 37.61 ± 8.76) (mean ± SD). Trait-anxiety levels were higher for women (42.55 ± 10.39 vs. 38.08 ± 12.25, P = 0.041). Patient education level did not influence the state-anxiety level but was inversely related to the trait-anxiety level. Knowledge of the diagnosis was clear for 91.7% of patients, of the surgery for 75.0%, and of anesthesia for 37.5%. Unfamiliarity with the surgical procedure raised state-anxiety levels (P = 0.021). A lower state-anxiety level was found among patients who did not know the diagnosis but knew about the surgery (P = 0.038). CONCLUSIONS: Increased knowledge of patients regarding the surgery they are about to undergo may reduce their state-anxiety levels.
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Affiliation(s)
- Leandro Yoshinobu Kiyohara
- Anesthesiology Department, Hospital das Clínicas, Faculty of Medicine, University of São Paulo--São Paulo/SP, Brazil
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Lee A, Chui PT, Gin T. Educating patients about anesthesia: a systematic review of randomized controlled trials of media-based interventions. Anesth Analg 2003; 96:1424-1431. [PMID: 12707146 DOI: 10.1213/01.ane.0000055806.93400.93] [Citation(s) in RCA: 87] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
UNLABELLED In this systematic review, we compared the effectiveness of media-based patient education about anesthesia. Fifteen randomized controlled trials (n = 1506) were identified after a systematic search of electronic databases (MEDLINE, EMBASE, CINAHL, PSYCINFO, The Cochrane Controlled Trials Registry), published articles, and contact with authors. Outcomes assessed were anxiety, knowledge, and patient satisfaction. Anxiety levels before anesthesia were less intense in subjects receiving the video and printed information compared with those receiving no intervention (weighted mean difference of 3; 95% confidence interval [95%CI], 1-5 Spielberger's State and Trait Anxiety Inventory). Patients in the video group were more likely to answer all knowledge questions correctly compared with patients with no intervention (relative risk of 6.64; 95%CI, 2.05-21.52). The level of knowledge about pain management was higher in the video group compared with patients with no intervention (weighted mean difference of 17%; 95%CI, 9-25). However, the level of patient satisfaction with the intervention (expectation versus actual anesthetic experience) was similar between the groups (relative risk of 1.06; 95%CI, 0.93-1.22). This systematic review supports the use of video and printed information about general process and risks of anesthesia for patient education before surgery. IMPLICATIONS The effectiveness of media-based interventions for educating patients about general process and risks of anesthesia were compared in this systematic review. The use of video and/or printed information can decrease patient anxiety and increase patient knowledge. However, patient satisfaction was similar between media-based intervention and nonintervention groups.
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Affiliation(s)
- Anna Lee
- Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
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