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Shin JW, Park Y, Park SH, Ha JW, Jung WS, Kim HS, Suk KS, Park SY, Moon SH, Lee BH, Kwon JW, Ahn J. Association of Untreated Pre-surgical Depression With Pain and Outcomes After Spinal Surgery. Global Spine J 2024:21925682241260642. [PMID: 38861501 DOI: 10.1177/21925682241260642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/13/2024] Open
Abstract
STUDY DESIGN Prospective Cohort Study. OBJECTIVE Untreated pre-surgical depression may prolong post-surgical pain and hinder recovery. However, research on the impact of untreated pre-surgical depression on post-spinal surgery pain is lacking. Therefore, this study aimed to assess pre-surgical depression in patients and analyze its relationship with post-surgical pain and overall post-surgical outcomes. METHODS We recruited 100 patients scheduled for lumbar spine surgery due to spondylolisthesis, degenerative lumbar disc diseases, and herniated lumbar disc diseases. Psychiatrists evaluated them for the final selection. We assessed the Beck Depression Inventory (BDI), Japanese Orthopaedic Association (JOA), Oswestry Disability Index (ODI), and EuroQoL 5 Dimensions (EQ-5D) scores, numerical back and leg pain scales, and medication dosage data collected before and at 6 weeks, 3 months, and 6 months after surgery. RESULTS Ninety-one patients were included in this study; 40 and 51 were allocated to the control and depression groups, respectively. The pre- and post-surgical leg pain, back pain, and functional scores were not different. However, the depression group showed higher ODI and EQ-5D and lower JOA scores than the control group 3 months post-surgery. Partial correlation analysis revealed an inverse correlation between the JOA and BDI scores and a positive correlation between the EQ-5D and BDI scores at 3 months postoperatively. CONCLUSION Untreated depression can prolong postoperative pain and hinder recovery. Detecting and treating depression in patients before spine surgery may improve their overall quality of life and functional recovery.
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Affiliation(s)
- Jae-Won Shin
- Department of Orthopedic Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yung Park
- Department of Orthopedic Surgery, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea
| | - Sung-Hoon Park
- Department of Orthopedic Surgery, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea
| | - Joong Won Ha
- Department of Orthopedic Surgery, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea
| | - Woo-Seok Jung
- Department of Orthopedic Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
- Department of Orthopedic Surgery, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea
| | - Hak-Sun Kim
- Department of Orthopedic Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kyung-Soo Suk
- Department of Orthopedic Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Si-Young Park
- Department of Orthopedic Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seong-Hwan Moon
- Department of Orthopedic Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Byung Ho Lee
- Department of Orthopedic Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Ji-Won Kwon
- Department of Orthopedic Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jaeun Ahn
- Department of Psychiatry, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea
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Fiorindi C, Giudici F, Testa GD, Foti L, Romanazzo S, Tognozzi C, Mansueto G, Scaringi S, Cuffaro F, Nannoni A, Soop M, Baldini G. Multimodal Prehabilitation for Patients with Crohn's Disease Scheduled for Major Surgery: A Narrative Review. Nutrients 2024; 16:1783. [PMID: 38892714 PMCID: PMC11174506 DOI: 10.3390/nu16111783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Revised: 05/25/2024] [Accepted: 06/05/2024] [Indexed: 06/21/2024] Open
Abstract
Approximately 15-50% of patients with Crohn's disease (CD) will require surgery within ten years following the diagnosis. The management of modifiable risk factors before surgery is essential to reduce postoperative complications and to promote a better postoperative recovery. Preoperative malnutrition reduced functional capacity, sarcopenia, immunosuppressive medications, anemia, and psychological distress are frequently present in CD patients. Multimodal prehabilitation consists of nutritional, functional, medical, and psychological interventions implemented before surgery, aiming at optimizing preoperative status and improve postoperative recovery. Currently, studies evaluating the effect of multimodal prehabilitation on postoperative outcomes specifically in CD are lacking. Some studies have investigated the effect of a single prehabilitation intervention, of which nutritional optimization is the most investigated. The aim of this narrative review is to present the physiologic rationale supporting multimodal surgical prehabilitation in CD patients waiting for surgery, and to describe its main components to facilitate their adoption in the preoperative standard of care.
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Affiliation(s)
- Camilla Fiorindi
- Department of Health Science, University of Firenze, Azienda Ospedaliero Universitaria Careggi, Largo Brambilla 3, 50139 Florence, Italy; (S.R.); (C.T.); (G.M.); (F.C.); (A.N.); (G.B.)
- Multimodal Prehabilitation Center, Azienda Ospedaliera Universitaria Careggi, Largo Brambilla 6, 50135 Florence, Italy; (G.D.T.); (L.F.)
| | - Francesco Giudici
- Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla 6, 50135 Florence, Italy; (F.G.); (S.S.)
| | - Giuseppe Dario Testa
- Multimodal Prehabilitation Center, Azienda Ospedaliera Universitaria Careggi, Largo Brambilla 6, 50135 Florence, Italy; (G.D.T.); (L.F.)
- Division of Geriatric and Intensive Care Medicine, University of Florence, Azienda Ospedaliero Universitaria Careggi, Largo Brambilla 3, 50139 Florence, Italy
| | - Lorenzo Foti
- Multimodal Prehabilitation Center, Azienda Ospedaliera Universitaria Careggi, Largo Brambilla 6, 50135 Florence, Italy; (G.D.T.); (L.F.)
- Section of Anesthesiology and Intensive Care, University of Florence, Largo Brambilla 3, 50139 Florence, Italy
| | - Sara Romanazzo
- Department of Health Science, University of Firenze, Azienda Ospedaliero Universitaria Careggi, Largo Brambilla 3, 50139 Florence, Italy; (S.R.); (C.T.); (G.M.); (F.C.); (A.N.); (G.B.)
- Multimodal Prehabilitation Center, Azienda Ospedaliera Universitaria Careggi, Largo Brambilla 6, 50135 Florence, Italy; (G.D.T.); (L.F.)
| | - Cristina Tognozzi
- Department of Health Science, University of Firenze, Azienda Ospedaliero Universitaria Careggi, Largo Brambilla 3, 50139 Florence, Italy; (S.R.); (C.T.); (G.M.); (F.C.); (A.N.); (G.B.)
- Multimodal Prehabilitation Center, Azienda Ospedaliera Universitaria Careggi, Largo Brambilla 6, 50135 Florence, Italy; (G.D.T.); (L.F.)
| | - Giovanni Mansueto
- Department of Health Science, University of Firenze, Azienda Ospedaliero Universitaria Careggi, Largo Brambilla 3, 50139 Florence, Italy; (S.R.); (C.T.); (G.M.); (F.C.); (A.N.); (G.B.)
- Multimodal Prehabilitation Center, Azienda Ospedaliera Universitaria Careggi, Largo Brambilla 6, 50135 Florence, Italy; (G.D.T.); (L.F.)
| | - Stefano Scaringi
- Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla 6, 50135 Florence, Italy; (F.G.); (S.S.)
| | - Francesca Cuffaro
- Department of Health Science, University of Firenze, Azienda Ospedaliero Universitaria Careggi, Largo Brambilla 3, 50139 Florence, Italy; (S.R.); (C.T.); (G.M.); (F.C.); (A.N.); (G.B.)
| | - Anita Nannoni
- Department of Health Science, University of Firenze, Azienda Ospedaliero Universitaria Careggi, Largo Brambilla 3, 50139 Florence, Italy; (S.R.); (C.T.); (G.M.); (F.C.); (A.N.); (G.B.)
| | - Mattias Soop
- Department for IBD and Intestinal Failure Surgery, Karolinska University Hospital, SE 177 76 Stockholm, Sweden;
| | - Gabriele Baldini
- Department of Health Science, University of Firenze, Azienda Ospedaliero Universitaria Careggi, Largo Brambilla 3, 50139 Florence, Italy; (S.R.); (C.T.); (G.M.); (F.C.); (A.N.); (G.B.)
- Multimodal Prehabilitation Center, Azienda Ospedaliera Universitaria Careggi, Largo Brambilla 6, 50135 Florence, Italy; (G.D.T.); (L.F.)
- Section of Anesthesiology and Intensive Care, University of Florence, Largo Brambilla 3, 50139 Florence, Italy
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3
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Palmer Kelly E, McGee J, Klatt M, Beckers G, Pawlik TM. The Use of Brief Mindfulness Interventions in the Context of Perioperative Care. Am Surg 2024; 90:1657-1665. [PMID: 38282339 DOI: 10.1177/00031348241230092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2024]
Abstract
The purpose of this review was to synthesize and categorize the literature on the use of brief mindfulness interventions for both patients and physicians across the spectrum of perioperative care. Web-based discovery services and discipline-specific databases were queried. Brief mindfulness interventions were defined as sessions lasting 30 min or less on any single occasion, with a total practice accumulation not exceeding 100 min per week, and a duration of up to 4 weeks. Study screening and data extraction were facilitated through the Covidence software platform. After screening 1047 potential studies, 201 articles were identified based on initial abstract and title screening; 10 studies ultimately met inclusion criteria. All ten studies were published between 2019 and 2023; most (n = 9) reports focused on patients (total joint arthroplasty, n = 3; stereotactic breast biopsy, n = 2; minimally invasive foregut surgery, n = 1; septorhinoplasty, n = 1; cardiac surgery, n = 1; and other/multiple procedures, n = 1); one studied investigated mindfulness interventions among surgeons. The duration of the interventions varied (3 min to 29 min). The most common issue that the mindfulness intervention aimed to address was pain (n = 6), followed by narcotic use (n = 3), anxiety (n = 2), delirium (n = 1), or patient satisfaction (n = 1). While most studies included a small sample size and had inconclusive results, brief mindfulness interventions were noted to impact various health-related outcomes, including mental health outcomes, anxiety, and pain perception. Mindfulness interventions may be a scalable, low-cost, time-limited intervention that has the potential to optimize well-being and surgical outcomes broadly construed.
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Affiliation(s)
- Elizabeth Palmer Kelly
- The Ohio State University Wexner Medical Center, The James Comprehensive Cancer Center, Department of Surgery, Columbus, OH, USA
| | - Julia McGee
- Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - Maryanna Klatt
- Center for Integrative Health, Department of Family and Community Medicine, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Grateful Beckers
- The Ohio State University Wexner Medical Center, The James Comprehensive Cancer Center, Department of Surgery, Columbus, OH, USA
| | - Timothy M Pawlik
- The Ohio State University Wexner Medical Center, The James Comprehensive Cancer Center, Department of Surgery, Columbus, OH, USA
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4
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Ester Molina Beltran E, Neuzillet C, Chorin F. La préhabilitation, un nouveau parcours préopératoire pour améliorer la condition des patients. SOINS; LA REVUE DE REFERENCE INFIRMIERE 2024; 69:18-21. [PMID: 38614513 DOI: 10.1016/j.soin.2024.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/15/2024]
Abstract
The maintenance and optimization of functional capacities before, during, and after treatment are major challenges for frailty persons as cancer's patients. It is now known that physical activity in prehabilitation plays a crucial role in limiting, among other things, post-operative complications. The benefits have already been demonstrated in various studies, including a decrease in hospitalization duration, an increase in cardiorespiratory endurance, improvement in quality of life, and better fatigue management. It is observed that patients who undergo prehabilitation are those who recover their preoperative capacities the fastest. However, it is estimated that only one-third of patients with access to prehabilitation improve their physical capacities.
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Affiliation(s)
| | - Cindy Neuzillet
- Institut Curie, 35 avenue Dailly, 92210 Saint-Cloud, France; Université Versailles Saint-Quentin-en-Yvelines, 47 boulevard Vauban, 78047 Guyancourt, France
| | - Frédéric Chorin
- France Université Côte d'Azur, Laboratoire motricité humaine expertise sport santé (Lamhess), Campus STAPS-Sciences du Sport, 261 boulevard du Mercantour BP3259, 06205 Nice cedex 03, France
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5
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Hanalis-Miller T, Ricon-Becker I, Sakis N, Trachtenberg E, Ohayon F, Wadhawker S, Birnboim Y, Magen A, Sharon E, Tarrasch R, Goldzweig G, Cole SW, Jacoby R, Ben-Eliyahu S. Peri-operative individually tailored psychological intervention in breast cancer patients improves psychological indices and molecular biomarkers of metastasis in excised tumors. Brain Behav Immun 2024; 117:529-540. [PMID: 38346596 DOI: 10.1016/j.bbi.2024.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 01/31/2024] [Accepted: 02/04/2024] [Indexed: 02/24/2024] Open
Abstract
Perioperative stress and inflammatory signaling can invigorate pro-metastatic molecular processes in patients' tumors, potentially worsening long-term survival. Yet, it is unknown whether pre-operative psychotherapeutic interventions can attenuate such effects. Herein, three weeks before surgery, forty women diagnosed with stage I-III invasive ductal/lobular breast carcinoma were randomized to a 6-week one-on-one psychological intervention (6 meetings with a medical psychologist and bi-weekly phone calls) versus standard nursing-staff-attention. The intervention protocol was individually tailored based on evaluation of patients' emotional, cognitive, physiological, and behavioral stress response-patterns, and also included psychoeducation regarding medical treatments and recruitment of social support. Resected primary tumors were subjected to whole-genome RNA sequencing and bioinformatic analyses, assessing a priori hypothesized cancer-relevant molecular signatures. Self-report questionnaires (BSI-18, Hope-18, MSPSS, and a stress-scale) were collected three (T1) and one (T2) week before surgery, a day before (T3) and after (T4) surgery, and three weeks (T5) and 3-months (T6) following surgery. The intervention reduced distress (GSI), depression, and somatization scores (BSI-18: p < 0.01, p < 0.05, p < 0.05; T5 vs. T1). Additionally, tumors from treated patients (vs. controls) showed: (i) decreased activity of transcription control pathways involved in adrenergic and glucocorticoid signaling (CREB, GR) (p < 0.001), pro-inflammatory signaling (NFkB) (p < 0.01), and pro-malignant signaling (ETS1, STAT and GATA families) (p < 0.001, p < 0.01, p < 0.005); (ii) increased M1 macrophage polarization (p < 0.05), and CD4+ T cell activity (p < 0.01); and an unexpected increase in epithelial-to-mesenchymal-transition (EMT) signature (p < 0.005). This is the first randomized controlled trial to show beneficial effects of a psychological perioperative intervention on tumor pro-metastatic molecular biomarkers.
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Affiliation(s)
- Tsipi Hanalis-Miller
- Psychoneuroimmunology Laboratory, School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel; Stress, Hope and Cope Laboratory, School of Behavioral Sciences, The Academic College of Tel Aviv-Yafo, Tel Aviv, Israel
| | - Itay Ricon-Becker
- Cousins Center for Psychoneuroimmunology, Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles (UCLA), Los Angeles, CA, USA
| | - Nahida Sakis
- Psychoneuroimmunology Laboratory, School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel
| | | | - Frida Ohayon
- Department of Surgery, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | - Sonya Wadhawker
- Department of Surgery, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | - Yehudit Birnboim
- Department of Surgery, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | - Ada Magen
- Department of Surgery, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | - Eran Sharon
- Department of Surgery, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | | | - Gil Goldzweig
- Stress, Hope and Cope Laboratory, School of Behavioral Sciences, The Academic College of Tel Aviv-Yafo, Tel Aviv, Israel
| | - Steve W Cole
- Cousins Center for Psychoneuroimmunology, Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles (UCLA), Los Angeles, CA, USA
| | - Rebecca Jacoby
- Stress, Hope and Cope Laboratory, School of Behavioral Sciences, The Academic College of Tel Aviv-Yafo, Tel Aviv, Israel
| | - Shamgar Ben-Eliyahu
- Psychoneuroimmunology Laboratory, School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel; Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel.
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Ekomwereren O, Shehryar A, Abdullah Yahya N, Rehman A, Affaf M, Chilla SP, Kumar U, Faran N, I K H Almadhoun MK, Quinn M, Ekhator C. Mastering the Art of Dermatosurgery: Aesthetic Alchemy in Medical Excellence. Cureus 2023; 15:e49659. [PMID: 38161926 PMCID: PMC10756331 DOI: 10.7759/cureus.49659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/29/2023] [Indexed: 01/03/2024] Open
Abstract
Dermatosurgery, a specialized branch within dermatology, has traversed an extraordinary journey through time, shaped by ancient practices, technological leaps, and shifting societal perceptions. This review explores the evolution of dermatosurgery, highlighting its profound transformation from addressing solely medical concerns to seamlessly integrating aesthetics. From its roots in ancient civilizations, where cultural traditions laid the foundation for modern techniques, to the twentieth-century technological renaissance, marked by innovative tools and enhanced understanding of skin anatomy, dermatosurgery has emerged as a dynamic field. Societal notions of beauty and health have significantly influenced dermatosurgery, blurring the lines between medical necessity and elective aesthetic procedures. The delicate balance between satisfying aesthetic desires and upholding medical ethics is a central challenge that dermatosurgeons face today. Open dialogue between practitioners and patients as well as psychological support plays a pivotal role in navigating this terrain. The training and ethics associated with dermatosurgery have evolved to meet the increasing demand for specialized procedures. Maintaining a focus on patient safety and satisfaction remains paramount as commercial pressures and disparities in access to care loom. Upholding best practices and standards in the field is essential for ensuring consistent, high-quality care for all patients. Looking ahead, dermatosurgery stands on the brink of a transformative era, marked by non-invasive techniques, artificial intelligence (AI) integration, and personalized medicine. The field's ability to harmonize medical science with aesthetic artistry is evident in various case studies, showcasing the intricate balance dermatosurgeons strike between addressing medical concerns and fulfilling aesthetic desires. As dermatosurgery continues to evolve, it promises to provide patients with even more precise, tailored treatments that enhance both their physical well-being and aesthetic satisfaction.
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Affiliation(s)
- Osatohanmwen Ekomwereren
- Trauma and Orthopaedics, Royal Shrewsbury Hospital, Shrewsbury and Telford Hospital NHS Trust, Shrewsbury, GBR
| | | | | | | | - Maryam Affaf
- Internal Medicine, Women's Medical and Dental College, Abbotabad, PAK
| | - Srikar P Chilla
- Medicine, CARE Hospitals, Hyderabad, IND
- School of Health Sciences, University of East London, London, GBR
| | - Uday Kumar
- Medicine, Shaheed Mohtarma Benazir Bhutto Medical College Lyari, Karachi, PAK
| | - Nuzhat Faran
- Internal Medicine, Fatima Memorial Hospital, Lahore, PAK
| | | | - Maria Quinn
- Internal Medicine, Jinnah Hospital, Lahore, PAK
| | - Chukwuyem Ekhator
- Neuro-oncology, New York Institute of Technology, College of Osteopathic Medicine, Old Westbury, USA
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7
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Adamakidou T, Menti K, Charalambous A, Tsiou C, Vlachou E, Govina O. Changes in unmet care needs, social support and distress from initial diagnosis to post-surgery in patients with gynecological cancer: A longitudinal study. Eur J Oncol Nurs 2023; 66:102358. [PMID: 37572628 DOI: 10.1016/j.ejon.2023.102358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 05/28/2023] [Accepted: 06/05/2023] [Indexed: 08/14/2023]
Abstract
PURPOSE This study aimed to explore the changes in unmet care needs, perceived social support, and levels of distress experienced by newly diagnosed Greek patients with gynecological cancer during the phase after diagnosis and before surgical treatment (T0), and 4 months after surgical treatment at the first postoperative follow-up visit (T1). METHODS This was a prospective, longitudinal, descriptive study based on the framework of stress and coping theory. The Needs Evaluation Questionnaire, Depression, Anxiety and Stress Scale (DASS-21), Multidimensional Scale of Perceived Social Support (MSPSS), and a demographic and clinical data questionnaire were distributed to a convenience sample of 86 patients. RESULTS A convenience sample of 86 patients newly diagnoised with gynecological cancer participated in the study. The mean age of the participants was 60.7 years (SD = 10.9 years) while 57.6% of them were married. Overall, patients' needs and social support had significantly decreased at T1 compared to T0 (p = 0.005 and p = 0.029, respectively). DASS-21 subscale scores did not change significantly at T1, whereas anxiety levels were significantly lower at follow-up (p = 0.048). Changes in anxiety levels were associated with changes in needs related to family (p < 0.001), need for assistance/care (p = 0.013) and support (p = 0.004), and total needs (p = 0.004). CONCLUSION The phase following cancer diagnosis and awaiting surgery is a high-risk period for the mental health of women with gynecological cancer, and one that requires special attention from healthcare professionals. By identifying unmet needs, addressing anxiety and providing appropriate social support, healthcare professional can contribute significantly to improving patients' quality of life throughout their cancer journey.
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Affiliation(s)
- Theodoula Adamakidou
- Nursing Department, Postgraduate Program of Μanagement of Chronic Diseases, University of West Attica, Athens, Greece.
| | - Konstantina Menti
- Nursing Department, Postgraduate Program of Μanagement of Chronic Diseases, University of West Attica, Athens, Greece; Agios Savvas Anticancer Hospital, Athens, Greece.
| | | | - Chrysoula Tsiou
- Nursing Department, Postgraduate Program of Μanagement of Chronic Diseases, University of West Attica, Athens, Greece.
| | - Eugenia Vlachou
- Nursing Department, Postgraduate Program of Μanagement of Chronic Diseases, University of West Attica, Athens, Greece.
| | - Ourania Govina
- Nursing Department, Postgraduate Program of Μanagement of Chronic Diseases, University of West Attica, Athens, Greece.
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8
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Mandelblatt JS, Small BJ, Zhou X, Nakamura ZM, Cohen HJ, Ahles TA, Ahn J, Bethea TN, Extermann M, Graham D, Isaacs C, Jacobsen PB, Jim HSL, McDonald BC, Patel SK, Rentscher KE, Root JC, Saykin AJ, Tometich DB, Van Dyk K, Zhai W, Breen EC, Carroll JE. Plasma levels of interleukin-6 mediate neurocognitive performance in older breast cancer survivors: The Thinking and Living With Cancer study. Cancer 2023; 129:2409-2421. [PMID: 37096888 PMCID: PMC10750797 DOI: 10.1002/cncr.34784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 02/08/2023] [Accepted: 03/03/2023] [Indexed: 04/26/2023]
Abstract
BACKGROUND Immune activation/inflammation markers (immune markers) were tested to explain differences in neurocognition among older breast cancer survivors versus noncancer controls. METHODS Women >60 years old with primary breast cancer (stages 0-III) (n = 400) were assessed before systemic therapy with frequency-matched controls (n = 329) and followed annually to 60 months; blood was collected during annual assessments from 2016 to 2020. Neurocognition was measured by tests of attention, processing speed, and executive function (APE). Plasma levels of interleukin-6 (IL-6), IL-8, IL-10, tumor necrosis factor α (TNF-α), and interferon γ were determined using multiplex testing. Mixed linear models were used to compare results of immune marker levels by survivor/control group by time and by controlling for age, racial/ethnic group, cognitive reserve, and study site. Covariate-adjusted multilevel mediation analyses tested whether survivor/control group effects on cognition were explained by immune markers; secondary analyses examined the impact of additional covariates (e.g., comorbidity and obesity) on mediation effects. RESULTS Participants were aged 60-90 years (mean, 67.7 years). Most survivors had stage I (60.9%) estrogen receptor-positive tumors (87.6%). Survivors had significantly higher IL-6 levels than controls before systemic therapy and at 12, 24, and 60 months (p ≤ .001-.014) but there were no differences for other markers. Survivors had lower adjusted APE scores than controls (p < .05). Levels of IL-6, IL-10, and TNF-α were related to APE, with IL-6 explaining part of the relationship between survivor/control group and APE (p = .01). The magnitude of this mediation effect decreased but remained significant (p = .047) after the consideration of additional covariates. CONCLUSIONS Older breast cancer survivors had worse long-term neurocognitive performance than controls, and this relationship was explained in part by elevated IL-6.
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Affiliation(s)
- Jeanne S Mandelblatt
- Department of Oncology, Georgetown University Medical Center, Georgetown University, Washington, DC, USA
- Georgetown Lombardi Institute for Cancer and Aging Research, Georgetown University's Lombardi Comprehensive Cancer Center, Washington, DC, USA
- Cancer Prevention and Control Program, Georgetown University's Lombardi Comprehensive Cancer Center, Washington, DC, USA
| | - Brent J Small
- School of Aging Studies, University of South Florida, Tampa, Florida, USA
| | - Xingtao Zhou
- Department of Biostatistics, Bioinformatics, and Biomathematics, Department of Oncology and Georgetown Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | - Zev M Nakamura
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Harvey J Cohen
- Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
- Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, North Carolina, USA
| | - Tim A Ahles
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Jaeil Ahn
- Department of Biostatistics, Bioinformatics, and Biomathematics, Department of Oncology and Georgetown Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | - Traci N Bethea
- Department of Oncology, Georgetown University Medical Center, Georgetown University, Washington, DC, USA
- Georgetown Lombardi Institute for Cancer and Aging Research, Georgetown University's Lombardi Comprehensive Cancer Center, Washington, DC, USA
- Cancer Prevention and Control Program, Georgetown University's Lombardi Comprehensive Cancer Center, Washington, DC, USA
| | - Martine Extermann
- Department of Oncology, H. Lee Moffitt Cancer Center and Research Institute, University of South Florida, Tampa, Florida, USA
| | - Deena Graham
- John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, New Jersey, USA
| | - Claudine Isaacs
- Georgetown Lombardi Comprehensive Cancer Center, Department of Oncology, Department of Medicine, Georgetown University, Washington, DC, USA
| | - Paul B Jacobsen
- Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Heather S L Jim
- Cancer Prevention and Control Program, H. Lee Moffitt Comprehensive Cancer Center, Tampa, Florida, USA
| | - Brenna C McDonald
- Department of Radiology and Imaging Sciences, Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, Indiana, USA
- Indiana Alzheimer's Disease Research Center, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Sunita K Patel
- City of Hope National Medical Center, Los Angeles, California, USA
| | - Kelly E Rentscher
- Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA
- Cousins Center for Psychoneuroimmunology, University of California, Los Angeles, Los Angeles, California, USA
| | - James C Root
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Andrew J Saykin
- Department of Radiology and Imaging Sciences, Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, Indiana, USA
- Indiana Alzheimer's Disease Research Center, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Danielle B Tometich
- Cancer Prevention and Control Program, H. Lee Moffitt Comprehensive Cancer Center, Tampa, Florida, USA
| | - Kathleen Van Dyk
- Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA
- Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles, California, USA
| | - Wanting Zhai
- Department of Biostatistics, Bioinformatics, and Biomathematics, Department of Oncology and Georgetown Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | - Elizabeth C Breen
- Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA
- Cousins Center for Psychoneuroimmunology, University of California, Los Angeles, Los Angeles, California, USA
| | - Judith E Carroll
- Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA
- Cousins Center for Psychoneuroimmunology, University of California, Los Angeles, Los Angeles, California, USA
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9
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Dhaketa M, Acharya S, Taksande AB, Prasad R, Munjewar PK, Wanjari MB. Hymenoplasty in India: A Comprehensive Review of Contemporary Trends and Impact on Young Adults. Cureus 2023; 15:e41852. [PMID: 37581160 PMCID: PMC10423100 DOI: 10.7759/cureus.41852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 07/13/2023] [Indexed: 08/16/2023] Open
Abstract
Hymenoplasty is a reconstructive surgical procedure aimed at repairing the hymen, and it has gained significant attention in the Indian context due to cultural and societal factors associated with virginity. This review article aims to investigate contemporary patterns of hymenoplasty in India and assess their influence on young adults. The review employed a systematic approach to gather and analyze relevant literature from various academic databases. Selection criteria were established to ensure the inclusion of high-quality studies focusing on hymenoplasty in India. The review provides an overview of the historical context of hymenoplasty, highlighting cultural and societal factors that influence the practice. It also examines the evolution of attitudes and perceptions regarding virginity and the hymen in India. Contemporary trends in hymenoplasty are analyzed, including the prevalence and frequency of procedures, demographic factors, patient profiles, popular motivations, and variations in surgical techniques. The socio-cultural impact on young adults is explored, emphasizing the psychological and emotional implications, the influence of societal norms and family expectations, gender dynamics, and the stigma and societal judgment that individuals face. The article concludes with recommendations for future research, including evaluating long-term outcomes and psychological well-being, exploring cultural and regional variations, assessing counseling services, and further examining ethical considerations and professional guidelines. Furthermore, the importance of comprehensive sex education, open dialogue, and discussions regarding virginity and sexual health are highlighted as crucial steps toward creating a more informed and empathetic society.
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Affiliation(s)
- Mitanshu Dhaketa
- Preventive Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Sourya Acharya
- Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Avinash B Taksande
- Physiology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Roshan Prasad
- Internal Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Pratiksha K Munjewar
- Medical Surgical Nursing, Smt. Radhikabai Meghe Memorial College of Nursing, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Mayur B Wanjari
- Research and Development, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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10
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Liu Y, Wang R, Zhang Y, Feng L, Huang W. Virtual reality psychological intervention helps reduce preoperative anxiety in patients undergoing carotid artery stenting: a single-blind randomized controlled trial. Front Psychol 2023; 14:1193608. [PMID: 37457093 PMCID: PMC10342209 DOI: 10.3389/fpsyg.2023.1193608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 06/14/2023] [Indexed: 07/18/2023] Open
Abstract
Objective This study aimed to explore the effectiveness and applicability of a psychological intervention using virtual reality (VR) to reduce preoperative anxiety in patients undergoing carotid artery stenting (CAS). Methods A total of 114 patients aged 18-86 years who were scheduled to undergo CAS were randomized to the VR and control groups. Patients in the VR group used a VR headset to view a 16-min psychological intervention video, while those in the control group used a tablet for viewing. The primary assessment instrument was the State Anxiety Inventory (S-AI), which was given 20 min before and after the intervention and 24 h after surgery. Secondary assessment tools were the Self-efficacy for Managing Chronic Disease (SEMCD-6) scale, which was completed before the intervention and 24 h after the operation, a smart bracelet to assess sleep quality, monitored in the evening before the operation, and the VR Suitability and Satisfaction Questionnaire, completed 24 h after the operation. Results The two groups were similar in terms of demographic information, preintervention STAI scores and preintervention SEMCD-6 scores (p > 0.05). S-AI scores were lower in both groups after the intervention and surgery, and the scores of the VR group were lower than those of the control group (p = 0.036, p = 0.014). SEMCD-6 scores post-surgery had improved in both groups, but the VR group had significantly higher scores than the control group (p = 0.005). Smart bracelet measurements showed no significant differences in postintervention sleep quality between the two groups (p = 0.540). For satisfaction, the VR group scored higher in all aspects except scheduling. A total of 47 (85.45%) patients reported having a comfortable experience, and only 5 (9.09%) experienced mild adverse effects. Conclusion The use of a virtual reality psychological intervention was beneficial to reduce the anxiety of patients before CAS and improved their self-efficacy. As virtual reality devices evolve and demonstrate better comfort and safety, more comprehensive and in-depth research of the use of VR to reduce patient anxiety should be performed in the future.Clinical trial registration:https://www.chictr.org.cn/showproj.aspx?proj=186412, identifier ChiCTR2200066219.
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Affiliation(s)
- Yanhua Liu
- Department of Neurology, West China Hospital, West China School of Nursing, Sichuan University, Chengdu, China
| | - Rui Wang
- Department of Neurology, West China Hospital, West China School of Nursing, Sichuan University, Chengdu, China
| | - Yang Zhang
- Department of Neurology, West China Hospital, West China School of Nursing, Sichuan University, Chengdu, China
| | - Ling Feng
- Department of Neurology, West China Hospital, West China School of Nursing, Sichuan University, Chengdu, China
| | - Wenxia Huang
- General Practice Medical Center, West China Hospital, West China School of Nursing, Sichuan University, Chengdu, China
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11
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Mareschal J, Hemmer A, Douissard J, Dupertuis YM, Collet TH, Koessler T, Toso C, Ris F, Genton L. Surgical Prehabilitation in Patients with Gastrointestinal Cancers: Impact of Unimodal and Multimodal Programs on Postoperative Outcomes and Prospects for New Therapeutic Strategies-A Systematic Review. Cancers (Basel) 2023; 15:cancers15061881. [PMID: 36980767 PMCID: PMC10047365 DOI: 10.3390/cancers15061881] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 03/02/2023] [Accepted: 03/19/2023] [Indexed: 03/30/2023] Open
Abstract
The advantages of prehabilitation in surgical oncology are unclear. This systematic review aims to (1) evaluate the latest evidence of preoperative prehabilitation interventions on postoperative outcomes after gastrointestinal (GI) cancer surgery and (2) discuss new potential therapeutic targets as part of prehabilitation. Randomized controlled trials published between January 2017 and August 2022 were identified through Medline. The population of interest was oncological patients undergoing GI surgery. Trials were considered if they evaluated prehabilitation interventions (nutrition, physical activity, probiotics and symbiotics, fecal microbiota transplantation, and ghrelin receptor agonists), alone or combined, on postoperative outcomes. Out of 1180 records initially identified, 15 studies were retained. Evidence for the benefits of unimodal interventions was limited. Preoperative multimodal programs, including nutrition and physical activity with or without psychological support, showed improvement in postoperative physical performance, muscle strength, and quality of life in patients with esophagogastric and colorectal cancers. However, there was no benefit for postoperative complications, hospital length of stay, hospital readmissions, and mortality. No trial evaluated the impact of fecal microbiota transplantation or oral ghrelin receptor agonists. Further studies are needed to confirm our findings, identify patients who are more likely to benefit from surgical prehabilitation, and harmonize interventions.
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Affiliation(s)
- Julie Mareschal
- Clinical Nutrition, Service of Endocrinology, Diabetology, Nutrition and Therapeutic Education, Department of Medicine, Geneva University Hospitals, 1205 Geneva, Switzerland
- Division of Abdominal Surgery, Department of Surgery, Geneva University Hospitals, 1205 Geneva, Switzerland
| | - Alexandra Hemmer
- Clinical Nutrition, Service of Endocrinology, Diabetology, Nutrition and Therapeutic Education, Department of Medicine, Geneva University Hospitals, 1205 Geneva, Switzerland
| | - Jonathan Douissard
- Division of Abdominal Surgery, Department of Surgery, Geneva University Hospitals, 1205 Geneva, Switzerland
- Department of Colorectal Surgery, Freeman Hospital-Newcastle upon Tyne Hospitals NHS Trust, Newcastle upon Tyne NE7 7DN, UK
| | - Yves Marc Dupertuis
- Clinical Nutrition, Service of Endocrinology, Diabetology, Nutrition and Therapeutic Education, Department of Medicine, Geneva University Hospitals, 1205 Geneva, Switzerland
| | - Tinh-Hai Collet
- Clinical Nutrition, Service of Endocrinology, Diabetology, Nutrition and Therapeutic Education, Department of Medicine, Geneva University Hospitals, 1205 Geneva, Switzerland
- Diabetes Centre, Faculty of Medicine, University of Geneva, 1205 Geneva, Switzerland
| | - Thibaud Koessler
- Department of Oncology, Geneva University Hospitals, 1205 Geneva, Switzerland
| | - Christian Toso
- Division of Abdominal Surgery, Department of Surgery, Geneva University Hospitals, 1205 Geneva, Switzerland
| | - Frédéric Ris
- Division of Abdominal Surgery, Department of Surgery, Geneva University Hospitals, 1205 Geneva, Switzerland
| | - Laurence Genton
- Clinical Nutrition, Service of Endocrinology, Diabetology, Nutrition and Therapeutic Education, Department of Medicine, Geneva University Hospitals, 1205 Geneva, Switzerland
- Diabetes Centre, Faculty of Medicine, University of Geneva, 1205 Geneva, Switzerland
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12
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Symptom Experiences before Medical Help-Seeking and Psychosocial Responses of Patients with Esophageal Cancer: A Qualitative Study. Eur J Cancer Care (Engl) 2023. [DOI: 10.1155/2023/6506917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
Objective. The purpose of this study was to investigate patients with esophageal cancer symptom experiences before seeking medical help and psychosocial responses. Methods. Within one month of diagnosis, semistructured interviews were held with 14 adult patients with esophageal cancer. To fully comprehend the symptom experiences that patients with esophageal cancer had prior to seeking medical help and the psychosocial responses they had to these experiences, thematic analysis and interpretative phenomenological analysis were used. Results. Patients with esophageal cancer recounted their symptom experiences, and psychosocial responses were categorized into three main themes: physical, psychological, and social. Three subthemes were included in the physiological aspect: early symptoms (warning signs), specific symptoms (the catalyst for seeking medical help), and concurrent symptoms (masked side effects). Four subthemes were associated with psychological aspects: unfairness, regret, worry, and acceptance. Two subthemes were related to the social element, namely, dragging down one’s family and societal self-isolation. Conclusion. Due to the self-remitting nature of early symptoms, the normalization of their interpretation, and concealment by other illnesses, patients with esophageal cancer may delay medical help-seeking. The findings could serve as a reference for healthcare professionals to implement tailored psychosocial interventions and help patients identify symptoms early in order to seek medical help.
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13
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Perioperative escape from dormancy of spontaneous micro-metastases: A role for malignant secretion of IL-6, IL-8, and VEGF, through adrenergic and prostaglandin signaling. Brain Behav Immun 2023; 109:175-187. [PMID: 36646396 DOI: 10.1016/j.bbi.2023.01.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 12/08/2022] [Accepted: 01/12/2023] [Indexed: 01/15/2023] Open
Abstract
We recently showed that a minimally-invasive removal of MDA-MB-231HM primary tumors (PTs) and elimination of their secreted factors (including IL-6, IL-8, VEGF, EGF, PDGF-aa, MIF, SerpinE1, and M-CSF), caused regression of spontaneous micro-metastases into a non-growing dormant state. To explore the underlying mechanisms and potential clinical ramifications of this phenomenon, we herein used the MDA-MB-231HM human breast cancer cell-line, in-vitro, and in vivo following orthotopic implantation in immune-deficient BALB/C nu/nu mice. Employing bioluminescence imaging, we found that adding laparotomy to minimally-invasive removal of the PT caused an outbreak of micro-metastases. However, perioperative β-adrenergic and COX-2 inhibition, using propranolol + etodolac, maintained metastatic dormancy following laparotomy. In-vitro, β-adrenergic agonists (epinephrine or metaproterenol) and prostaglandin-E2 markedly increased MDA-MB-231HM secretion of the pro-metastatic factors IL-6, IL-8, and VEGF, whereas cortisol reduced their secretion, effects that were maintained even 12 h after the washout of these agonists. In-vivo, laparotomy elevated IL-6 and IL-8 levels in both plasma and ex-vivo PT spontaneous secretion, whereas perioperative propranolol + etodolac administration blocked these effects. Similar trends were evident for EGF and MIF. Promoter-based bioinformatics analyses of excised PT transcriptomes implicated elevated NF-kB activity and reduced IRF1 activity in the gene regulatory effects of laparotomy, and these effects were inhibited by pre-surgical propranolol + etodolac. Taken together, our findings suggest a novel mechanism of post-operative metastatic outbreak, where surgery-induced adrenergic and prostanoid signaling increase the secretion of pro-metastatic factors, including IL-6, IL-8, and VEGF, from PT and possibly residual malignant tissue, and thereby prevent residual disease from entering dormancy.
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14
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Young P. Psychological factors and surgical outcomes. Br J Hosp Med (Lond) 2023; 84:1-2. [PMID: 36848166 DOI: 10.12968/hmed.2022.0522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
Several psychological factors, including anxiety and depression, are associated with poor surgical outcomes, likely as a result of chronic dysfunction of the hypothalamic-pituitary-adrenal axis. However, despite some encouraging results, a lack of high-quality studies means that there is limited evidence to support the use of psychological interventions to improve surgical outcomes.
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Affiliation(s)
- Paul Young
- North West School of Anaesthesia, Manchester, UK
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15
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Shakya P, Poudel S. Prehabilitation in Patients before Major Surgery: A Review Article. JNMA J Nepal Med Assoc 2022; 60:909-915. [PMID: 36705159 PMCID: PMC9924929 DOI: 10.31729/jnma.7545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Accepted: 09/03/2022] [Indexed: 01/28/2023] Open
Abstract
The overall outcome of the patient after any surgery is determined not only by the fineness of the surgical procedure but also by preoperative conditioning and postoperative care. Prehabilitation decreases the surgical stress response and increases the preparedness of the patient to undergo planned surgical insult. Preoperatively structured inspiratory muscle exercises, cardiopulmonary fitness program, and planned exercise program for muscles of limbs, back, abdomen, head, and neck allow an overall upliftment of the physiological capacity of the patient to better cope with the surgical stress. Optimization of dietary status by macronutrients, micronutrients, and the nutrients has an impact on augmenting postoperative recovery and shortening the overall hospital stay. Preparing patients for the scheduled surgery and initiating alcohol and smoking cessation programs overhaul the patient's mental health and boost the healing process. This concept of prehabilitation a few weeks before surgery is equally beneficial compared to enhancing operative procedures and postsurgical care. Keywords length of stay; mental health; nutrients; preoperative exercise; smoking cessation.
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Affiliation(s)
- Pawan Shakya
- Department of Surgery, Ramechhap District Hospital, Ramechhap Bazaar, Ramechhap, Nepal,Correspondence: Dr Pawan Shakya, Department of Surgery, Ramechhap District Hospital, Ramechhap Bazaar, Ramechhap, Nepal. , Phone: +977-9860224103
| | - Sagar Poudel
- Department of Surgery, Ramechhap District Hospital, Ramechhap Bazaar, Ramechhap, Nepal
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