The relationship between uncertainty and acute procedure anxiety among surgical patients in Chinese mainland: the mediating role of resilience

BACKGROUND

Surgery, as one of the main diagnostic and treatment methods, is a routine work in medical settings. Patients undergoing surgery often experience acute procedure anxiety due to uncertainty. There is ample evidence showing that uncertainty is a risk factor for the acute procedure anxiety in surgical patients. However, little is known about the psychological processes mediating this relationship. Therefore, this study aims to evaluate resilience as a mediator of the association between uncertainty and anxiety.

METHODS

A population-based cross-sectional survey with a convenience sampling method was conducted, involving 243 surgical patients in Jiaxing, Zhejiang province of China was carried out. Relevant data were collected by self-reporting questionnaires, including demographic characteristics questionnaire, Amsterdam Preoperative Anxiety and Information Scale (APAIS-C), Mishel's Illness Uncertainty Scale (MUIS), Connor-Davidson Resilience Scale (CD-RISC). Pearson correlation analysis was employed to examine correlations between various variables. A path model was used to assess the mediation effect of resilience with respect to uncertainty and acute procedure anxiety.

RESULTS

In the path model, uncertainty have an indirect effect on acute procedure anxiety through resilience. The results suggest that resilience has a mediating role in uncertainty and acute procedure anxiety among surgical patients.

CONCLUSIONS

These findings call for the development of interventions targeting the role of resilience in effectively predicting and preventing acute procedure anxiety and uncertainty among surgical patients.

Functional and Cognitive Decline Among Older Adults After High-risk Surgery

OBJECTIVE

The aim of this study was to determine whether older adults are at higher risk of lasting functional and cognitive decline after surgery, and the impact of decline on survival and healthcare use.

SUMMARY BACKGROUND DATA

Patient-centered outcomes after surgery are poorly characterized.

METHODS

Using data from the Health and Retirement Study linked with Medicare, we matched older adults (≥65 years) who underwent one of 163 high-risk elective operations (ie, inpatient mortality of ≥1%) with nonsurgical controls between 1992 and 2012. Functional decline was defined as an increase in the number of activities of daily living (ADLs) and/or instrumental activities of daily living (IADLs) requiring assistance from baseline. Cognitive decline was defined by worse response to a test of memory and mental processing from baseline. Using logistic regression, we examined whether surgery was associated with functional and cognitive decline, and whether declines were associated with poorer survival and increased healthcare use.

RESULTS

The matched cohort of patients who did not undergo surgery consisted of 3591 (75%) participants compared to 1197 (25%) who underwent surgery. Patients who underwent surgery were at higher risk of functional and cognitive declines [adjusted odds ratio (aOR) 1.52, 95% confidence interval (CI): 1.23-1.87 and aOR 1.32, 95% CI: 1.03-1.71]. Declines were associated with poorer long-term survival [hazard ratio (HR) 1.67, 95% CI: 1.43-1.94 and HR 1.35, 95% CI: 1.15-1.58], and were significantly associated with nearly all measures of increased healthcare utilization (P < 0.001).

CONCLUSION

Older adults undergoing high-risk surgery are at increased risk of developing lasting functional and cognitive declines.

Depression After Open Heart Surgery: Influences of Optimism, Sex, and Event-Related Medical Factors

ABSTRACT

Postoperative depression is a multifaceted condition that can limit quality of life and potentially decrease the survival benefits of open heart surgery (OHS). We postulated that sex, pre-event character strengths, medical, and certain surgery indicators would predict post-event/myocardial infarction depression. To identify predictors, we collected three-wave survey data from 481 OHS patients at a large academic referral institution (age, 62+; female, 42%) and included key medical and surgical information. The final model (F[7, N = 293] = 28.15, p < 0.001, R2 = 0.408) accounted for over two fifths of the variance in post-OHS depression. Pre-event/OHS optimism mitigated post-OHS depression. Being female, older, living alone, longer surgical perfusion time, absence of left main disease greater than 50%, and pre-OHS depression were associated with the increased likelihood of post-OHS depression. Our findings suggest that teaching optimism to OHS patients might be beneficial in reducing the risk of postoperative depression and that female patients should be monitored more closely for the development of depression through an interdisciplinary approach.

Melatonin for preoperative and postoperative anxiety in adults

BACKGROUND

Anxiety in relation to surgery is a well-known problem. Melatonin offers an alternative treatment to benzodiazepines for ameliorating this condition in the preoperative and postoperative periods.

OBJECTIVES

To assess the effects of melatonin on preoperative and postoperative anxiety compared to placebo or benzodiazepines.

SEARCH METHODS

We searched the following databases on 10 July 2020: CENTRAL, MEDLINE, Embase, CINAHL, and Web of Science. For ongoing trials and protocols, we searched clinicaltrials.gov and the World Health Organization (WHO) International Clinical Trials Registry Platform.

SELECTION CRITERIA

We included randomized, placebo-controlled or standard treatment-controlled (or both) studies that evaluated the effects of preoperatively administered melatonin on preoperative or postoperative anxiety. We included adult patients of both sexes (15 to 90 years of age) undergoing any kind of surgical procedure for which it was necessary to use general, regional, or topical anaesthesia.

DATA COLLECTION AND ANALYSIS

One review author conducted data extraction in duplicate. Data extracted included information about study design, country of origin, number of participants and demographic details, type of surgery, type of anaesthesia, intervention and dosing regimens, preoperative anxiety outcome measures, and postoperative anxiety outcome measures.

MAIN RESULTS

We included 27 randomized controlled trials (RCTs), involving 2319 participants, that assessed melatonin for treating preoperative anxiety, postoperative anxiety, or both. Twenty-four studies compared melatonin with placebo. Eleven studies compared melatonin to a benzodiazepine (seven studies with midazolam, three studies with alprazolam, and one study with oxazepam). Other comparators in a small number of studies were gabapentin, clonidine, and pregabalin. No studies were judged to be at low risk of bias for all domains. Most studies were judged to be at unclear risk of bias overall. Eight studies were judged to be at high risk of bias in one or more domain, and thus, to be at high risk of bias overall. Melatonin versus placebo Melatonin probably results in a reduction in preoperative anxiety measured by a visual analogue scale (VAS, 0 to 100 mm) compared to placebo (mean difference (MD) -11.69, 95% confidence interval (CI) -13.80 to -9.59; 18 studies, 1264 participants; moderate-certainty evidence), based on a meta-analysis of 18 studies. Melatonin may reduce immediate postoperative anxiety measured on a 0 to 100 mm VAS compared to placebo (MD -5.04, 95% CI -9.52 to -0.55; 7 studies, 524 participants; low-certainty evidence), and may reduce delayed postoperative anxiety measured six hours after surgery using the State-Trait Anxiety Inventory (STAI) (MD -5.31, 95% CI -8.78 to -1.84; 2 studies; 73 participants; low-certainty evidence). Melatonin versus benzodiazepines (midazolam and alprazolam) Melatonin probably results in little or no difference in preoperative anxiety measured on a 0 to 100 mm VAS (MD 0.78, 95% CI -2.02 to 3.58; 7 studies, 409 participants; moderate-certainty evidence) and there may be little or no difference in immediate postoperative anxiety (MD -2.12, 95% CI -4.61 to 0.36; 3 studies, 176 participants; low-certainty evidence). Adverse events Fourteen studies did not report on adverse events. Six studies specifically reported that no side effects were observed, and the remaining seven studies reported cases of nausea, sleepiness, dizziness, and headache; however, no serious adverse events were reported. Eleven studies measured psychomotor and cognitive function, or both, and in general, these studies found that benzodiazepines impaired psychomotor and cognitive function more than placebo and melatonin. Fourteen studies evaluated sedation and generally found that benzodiazepine caused the highest degree of sedation, but melatonin also showed sedative properties compared to placebo. Several studies did not report on adverse events; therefore, it is not possible to conclude with certainty, from the data on adverse effects collected in this review, that melatonin is better tolerated than benzodiazepines.

AUTHORS' CONCLUSIONS

When compared with placebo, melatonin given as premedication (as tablets or sublingually) probably reduces preoperative anxiety in adults (measured 50 to 120 minutes after administration), which is potentially clinically relevant. The effect of melatonin on postoperative anxiety compared to placebo (measured in the recovery room and six hours after surgery) was also evident but was much smaller, and the clinical relevance of this finding is uncertain. There was little or no difference in anxiety when melatonin was compared with benzodiazepines. Thus, melatonin may have a similar effect to benzodiazepines in reducing preoperative and postoperative anxiety in adults.

Health Literacy in Surgery

Background:

Low health literacy is associated with poor health outcomes in many chronic diseases and may have an important role in determining surgical outcomes. This study aims to comprehensively review the current state of science on adult health literacy in surgery and to identify knowledge gaps for future research.

Methods:

Using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, a systematic search was conducted to identify all studies from January 2002 through May 2018 that used validated instruments to assess health literacy among adult patients undergoing surgery. Studies were assessed for quality using the Newcastle-Ottawa scale and evaluated on findings by their focus on identifying health literacy levels, understanding associations with surgical outcomes, and/or developing interventions to address low health literacy.

Key Results:

There were 51 studies on health literacy with data from 22,139 patients included in this review. Low health literacy was present in more than one-third of surgical patients (34%, interquartile range 16%–50%). The most commonly used validated instrument for assessment of health literacy in the surgical population was the Newest Vital Sign. Most studies were focused on identifying the prevalence of low health literacy within a surgery population (84%, n = 43). Few studies focused on understanding the association of health literacy to surgical outcomes (12%, n = 6) and even fewer studies developed interventions to address health literacy (4%, n = 2).

Discussion:

Low health literacy is common among surgical patients. Important opportunities exist to better understand the role of health literacy in determining surgical outcomes and to develop more health literacy-sensitive models of surgical care. [HLRP: Health Literacy Research and Practice. 2020;4(1):e45–e65.]

Plain Language Summary:

Health literacy has not been well-studied in surgery but likely plays an important role. In this article, we reviewed all current research on health literacy in surgery to help us understand where we are at and where we need to go. We found that low health literacy is common and we need more ways to address it in surgery.

Long-Term Effect of Multiple Operations on Psychosocial Function in Teenage Cleft Lip and Palate Patients

BACKGROUND

Cleft lip and palate patients undergo a significant number of interventions during their childhood and adolescence. Although the intention of such interventions is to improve psychosocial functioning, there exists a paucity of data on the psychosocial outcomes of the burden of care on cleft children. In this work, the long-term effects of quantity and timing of childhood operations on teenagers with cleft lip and palate were evaluated.

METHODS

Cleft lip and palate patients (aged 14 to 17 years; n = 55) and an age-matched unaffected cohort (n = 14) prospectively enrolled from two institutions were administered the anger, anxiety, and depressive symptoms instruments from the Pediatric Patient-Reported Outcomes Measurement Information System. Total number of operations and operations stratified by age groups (0 to 7, 8 to 10, 11 to 13, and 14 to 17 years) were evaluated in relationship to instrument scores. Descriptive statistics, independent t tests, Pearson correlations, and multiple linear regression analyses were conducted.

RESULTS

No differences in overall psychosocial functioning were found between the cleft lip and palate and comparison groups. Total quantity of childhood operations did not correlate to psychosocial functioning of cleft lip and palate teenagers. However, multiple linear regression analyses demonstrated that increased number of operations in the 8- to 10-year-old age range predicted increased anxiety and depressive symptoms in teenagers (β = 0.38, p = 0.009; and β = 0.29, p = 0.03, respectively).

CONCLUSIONS

It was previously reported by the authors' group that the 8- to 10-year-old age range is an at-risk period for psychosocial distress in children with craniofacial anomalies. Their current work demonstrates that increased number of operations during this time frame may result in long-term consequences in anxiety and depression in cleft lip and palate patients.

CLINICAL QUESTION/LEVEL OF EVIDENCE

Risk, II.

Parental anxiety in pediatric surgery consultations: the role of health literacy and need for information

INTRODUCTION

Although important, parental anxiety, health literacy and need-for-information in pediatric surgery outpatient clinics have not been extensively studied. Lower educational attainments, minorities and lower socioeconomic status have been associated with limited health literacy. Parental anxiety has been related to health literacy, sex, education and information needs. The aim of this study is to investigate health literacy and need-for-information and their association to parental anxiety in consultations of pediatric surgery.

MATERIALS & METHODS

We conducted an observational, cross-sectional study in the outpatient pediatric surgery clinic from December 2016 to October 2017. Health literacy, anxiety and need-for-information of parents/guardians of children waiting for pediatric surgical consultation were evaluated. Multivariate regression analysis was used to examine the impact of health literacy and need-for-information on parental/guardian anxiety considering sociodemographic and clinical characteristics of the participants.

RESULTS

Almost half (46.1%) of the 664 parents/guardians recruited had limited or problematic health literacy and 79.8% of the sample was classified as being anxious. Parental/guardian anxiety was associated at the multiple regression analysis with parental health literacy level (β = -0.282, p < 0.001), need-for-information preoperatively (β = 0.907, p < 0.001), educational level (β = -0.716, p = 0.001), sex (β = 1.563, p < 0.001), and severity of the condition of the child (β = 0.379, p < 0.001).

CONCLUSION

Parents/guardians experience high levels of anxiety, which is associated to health literacy and need-for-information. These factors should be considered in pediatric surgical consultations, aiming to reduce parental anxiety.

TYPE OF STUDY

Retrospective Study.

LEVEL OF EVIDENCE

Level II.

Feeling Old, Body and Soul: The Effect of Aging Body Reminders on Age Identity

OBJECTIVES

Although changes in body functioning and appearance signal the aging process to ourselves and others, studies give limited attention to the effect of bodily experiences of aging on age identity. Our study examines the effect on age identity of 3 categories of aging body reminders: everyday body problems, body repairs, and body aids.

METHODS

Hierarchical linear models are run using 5 waves of the National Health and Aging Trends Study (2011-2015). Models predict the effect on age identity of change in the count of everyday body problems (e.g., pain), body repairs (i.e., surgeries and medications), and body aids (e.g., hearing aids).

RESULTS

Increases in everyday body problems and body repairs (in particular, medications) predict older identities, with the strongest average effect found for everyday body problems. These results are observed in models controlling on health, suggesting that body reminders exert independent effects.

DISCUSSION

Our study reveals a realm of aging experiences-bodily experiences-that influence age identity. Avenues for further research include examinations of other aging body reminders, as well as variation across individuals.

An investigation of the effect of patient-controlled analgesia on long-term quality of life after major surgery: A prospective cohort study

BACKGROUND

Chronic pain is a common postoperative complication in patients undergoing major surgery and may significantly affect their quality of life (QOL). Whether patient-controlled analgesia (PCA) can reduce the risk of chronic postsurgical pain and promote long-term QOL is still unclear.

METHODS

In this prospective cohort study, we followed up patients undergoing major surgery, recorded changes in their postoperative QOL over time using the World Health Organization Quality of Life-BREF (WHOQOL-BREF) questionnaire and chronic pain events, evaluated the long-term effects of distinct PCA techniques (intravenous, epidural, or none) on their QOL and risk of chronic pain, and explored relevant predictors. The patients' QOL and chronic pain events were collected preoperatively, 3, 6, and 12 months after surgery. Generalized linear mixed models were used to control for individual heterogeneity and adjust for potential confounding factors.

RESULTS

We included 328 patients undergoing major surgery from September 22, 2015, to December 31, 2016, in this study. Multivariate regression models showed that patients using intravenous PCA had a better QOL in physical health (adjusted coefficient 3.7, 95% CI, 0.5-8.0) compared with those receiving non-PCA treatments. Distinct PCA techniques did not significantly affect QOL in psychological, social relationship, or environmental domains of the WHOQOL-BREF scale or the risk of chronic postsurgical pain.

CONCLUSION

Patients using intravenous PCA had a better QOL in physical health over time after major surgery, which may have been due to factors other than pain-relieving effects.

Safety and efficacy of perioperative benzodiazepine administration: study protocol for a systematic review and meta-analysis

INTRODUCTION

Perioperative benzodiazepines are used because of their anxiolytic, sedative and amnestic effects. Evidence has demonstrated an association of benzodiazepines with adverse neuropsychiatric effects. Nonetheless, because of their potential benefits, perioperative benzodiazepines continue to be used routinely. We seek to evaluate the body of evidence of the risks and benefits of benzodiazepine use during the perioperative period.

METHODS AND ANALYSIS

We will search Cochrane CENTRAL, MEDLINE, EMBASE, PsychINFO, CINAHL and Web of Science from inception to March 2019 for randomised controlled trials (RCTs) and observational studies evaluating the administration of benzodiazepine medications as compared with all other medications (or nothing) in patients undergoing cardiac and non-cardiac surgery. We will exclude studies assessing the use of benzodiazepines for procedural sedation or day surgery. We will examine the impact of giving these medications before, during and after surgery. Outcomes of interest include the incidence of delirium, duration of delirium, postprocedure cognitive change, the incidence of intraoperative awareness, patient satisfaction/quality of life/quality of recovery, length-of-stay (LOS) in the intensive care unit (ICU), hospital LOS and in-hospital mortality.Reviewers will screen references and assess eligibility using predefined criteria independently and in duplicate. Two reviewers will independently collect data using prepiloted forms. We will present results separately for RCTs and observational studies. We will pool data using a random effect model and present results as relative risk with 95% CIs for dichotomous outcomes and mean difference with 95% CI for continuous outcomes. We will pool adjusted ORs for observational studies. We will assess risk of bias for individual studies using the Cochrane Collaboration tool for RCTs. For observational studies, we will use tools designed by the Clinical Advances through Research and Information Translation group. Quality of evidence for each outcome will be assessed using the Grading of Recommendations Assessment, Development and Evaluation approach.

ETHICS AND DISSEMINATION

This systematic review involves no patient contact and no interaction with healthcare providers or systems. As such, we did not seek ethics board approval. We will disseminate the findings of our systematic review through the presentation at peer-reviewed conferences and by seeking publication in a peer-reviewed journal.

PROSPERO REGISTRATION NUMBER

CRD42019128144.

Lifetime surgical exposure, episodic memory, and forniceal microstructure in older adults

Introduction: Aging is associated with heterogeneous cognitive trajectories. There is considerable interest in identifying risk factors for pathological aging, with recent studies demonstrating a link between surgical procedures and proximal cognitive decline; however, the role of lifetime exposure to surgical procedures and cognitive function has been relatively unexplored. This pilot study aimed to evaluate the association between total lifetime surgical procedures and memory function in older adults. Methods: A cohort of 62 older adults underwent a neuropsychological evaluation and health history assessment. Self-reported lifetime surgical history was categorized as "cardiac" or "non-cardiac." General linear models were fit with demographics as nuisance covariates, and the total number of non-cardiac surgeries as our predictor of interest. Total scores on measures of episodic memory, language, working memory, fluency, and visuospatial function were separate outcome variables. In a secondary analysis, vascular risk factors were included as covariates. Diffusion tensor imaging was obtained for exploratory analyses of selected regions of interest. Results: The mean age of participants was 70, and 0-13 lifetime non-cardiac surgical procedures were reported. Higher numbers of lifetime non-cardiac surgical procedures were associated with worse verbal learning and memory (p = .04). The negative association between lifetime non-cardiac procedures and cognition was specific to memory. Exploratory analyses showed that higher number of lifetime non-cardiac procedures was related to lower FA in the fornix body (p = .02). Conclusions: These results of this pilot study suggest that greater lifetime exposure to surgery may be associated with worse verbal learning and memory in healthy older adults. These findings add to a growing body of literature suggesting that cumulative medical events may be risk factors for negative cognitive outcomes.

Factors Influencing Seeking and Reaching Care in Patients With Peritonitis in Rwanda

BACKGROUND

Peritonitis is an emergency which frequently requires surgical intervention. The aim of this study was to describe factors influencing seeking and reaching care for patients with peritonitis presenting to a tertiary referral hospital in Rwanda.

METHODS

This was a cross-sectional study of patients with peritonitis admitted to University Teaching Hospital of Kigali. Data were collected on demographics, prehospital course, and in-hospital management. Delays were classified according to the Three Delays Model as delays in seeking or reaching care. Chi square test and logistic regression were used to determine associations between delayed presentation and various factors.

RESULTS

Over a 9-month period, 54 patients with peritonitis were admitted. Twenty (37%) patients attended only primary school and 15 (28%) never went to school. A large number (n = 26, 48%) of patients were unemployed and most (n = 45, 83%) used a community-based health insurance. For most patients (n = 44, 81%), the monthly income was less than 10,000 Rwandan francs (RWF) (11.90 U.S. Dollars [USD]). Most (n = 51, 94%) patients presented to the referral hospital with more than 24 h of symptoms. More than half (n = 31, 60%) of patients had more than 4 d of symptoms on presentation. Most (n = 37, 69%) patients consulted a traditional healer before presentation at the health care system. Consultation with a traditional healer was associated with delayed presentation at the referral hospital (P < 0.001). Most (n = 29, 53%) patients traveled more than 2 h to reach a health facility and this was associated with delayed presentation (P = 0.019). The cost of transportation ranged between 5000 and 1000 RWF (5.95-11.90 USD) for most patients and was not associated with delayed presentation (P = 0.449).

CONCLUSIONS

In this study, most patients with peritonitis present in a delayed fashion to the referral hospital. Factors associated with seeking and reaching care included sociodemographic characteristics, health-seeking behaviors, cost of care, and travel time. These findings highlight factors associated with delays in seeking and reaching care for patients with peritonitis.

Association of Temperament With Preoperative Anxiety in Pediatric Patients Undergoing Surgery: A Systematic Review and Meta-analysis

IMPORTANCE

Preoperative anxiety is associated with poor behavioral adherence during anesthetic induction and adverse postoperative outcomes. Research suggests that temperament can affect preoperative anxiety and influence its short- and long-term effects, but these associations have not been systematically examined.

OBJECTIVE

To examine the associations of temperament with preoperative anxiety in young patients undergoing surgery.

DATA SOURCES

Studies from MEDLINE, Embase, CINAHL, PsycINFO, Web of Science, and the Cochrane Central Register of Controlled Trials databases were searched from database inception to June 2018.

STUDY SELECTION

All prospective studies reporting associations of temperament with preoperative anxiety were included. Overall, 43 of 5451 identified studies met selection criteria.

DATA EXTRACTION AND SYNTHESIS

Using the PRISMA guidelines, reviewers independently read 43 full-text articles, extracted data on eligible studies, and assessed the quality of each study. Data were pooled using the Lipsey and Wilson random-effects model.

MAIN OUTCOMES AND MEASURES

Primary outcome was the association of temperament with preoperative anxiety in patients undergoing surgery.

RESULTS

A total of 23 studies, with 4527 participants aged 1 to 18 years, were included in this review. Meta-analysis of 12 studies including 1064 participants revealed that emotionality (r = 0.11; 95% CI, 0.04 to 0.19), intensity of reaction (r = 0.29; 95% CI, 0.11 to 0.46), and withdrawal (r = 0.40; 95% CI, 0.23 to 0.55) were positively associated with preoperative anxiety, whereas activity level (r = -0.23; 95% CI, -0.31 to -0.16) was negatively correlated with preoperative anxiety. Impulsivity was not significantly associated with preoperative anxiety.

CONCLUSIONS AND RELEVANCE

This systematic review and meta-analysis provided evidence suggesting that temperament may help identify pediatric patients at risk of preoperative anxiety and guide the design of prevention and intervention strategies. Future studies should continue to explore temperament and other factors influencing preoperative anxiety and their transactional effects to guide the development of precision treatment approaches and to optimize perioperative care.

Development and Validation of the MiPrep Survey: An Instrument Assessing Patients' Perceived Preparation for Medical Interventions Including Medical Imaging, Radiotherapy, and Surgery

BACKGROUND

Adequately preparing patients for medical interventions is an important component of quality healthcare. Nevertheless, few instruments for assessing patients' preparation exist.

OBJECTIVES

To develop a psychometrically rigorous instrument to assess patients' perceptions of the quality of preparation.

METHODS

An instrument to measure patients' preparation for medical interventions (MiPrep) was developed and tested with patients undergoing medical imaging, radiotherapy, or surgery. Patients were recruited and asked to complete 2 surveys. Survey A assessed patient and intervention characteristics. Survey B (postintervention) contained MiPrep to assess validity (face, content, and construct) and reliability (internal consistency and test-retest).

RESULTS

A total of 869 (85%) patients consented to participate and 551 (63%) returned the postintervention survey. Face and content validity were demonstrated. Exploratory factor analysis identified 2 survey modules: receipt and adequacy of information (2 domains) and overall appraisal of patient-centered care (1 domain). Reliability was evidenced by adequate internal consistency (Cronbach α 0.81-0.89) and item-total correlations higher than 0.20. Nevertheless, individual item test-retest reliability requires further confirmation. The final instrument contained 27 items.

CONCLUSIONS

The MiPrep instrument has evidence of being a valid and reliable instrument of preparation for medical interventions. Healthcare providers can use the instrument as a quality assurance tool to identify areas for improvement and areas of excellence in patients' preparation. Future studies should verify these findings in other populations and examine the divergent and predictive validity of the instrument.

General attitudes toward research: a pilot survey of HIV-positive surgical patients

BACKGROUND

The general attitude of HIV-positive surgical patients toward research has not been described, and it is uncertain whether interventions aimed at improving general attitudes toward research are required in this group. The aim of this pilot survey was to address the aforementioned paucity in the literature.

METHOD

This was a prospective survey of 39 HIV-positive surgical patients. The 7-item Research Attitudes Questionnaire (RAQ) and a demographic characteristics questionnaire were administered to each study participant. Likert responses for the RAQ were converted into numeric values, and cumulative research attitude scores were computed for each study participant. A descriptive analysis of study participant responses to the RAQ was performed. Statistical associations between demographic characteristics and cumulative research attitude scores were also assessed.

RESULTS

Depending on the RAQ item, between 74.3% and 95.9% of study participants responded positively toward research. Negative responses ranged between 0.0% and 10.3%, while neutral responses to RAQ items ranged between 2.6% and 23.1%. Female study participants had lower median research attitudes scores when compared with their male counterparts (p = 0.014).

CONCLUSION

In general, study participants expressed a positive attitude toward research. The proportion of neutral responses for some RAQ items suggests there are certain aspects of research which require clarification to prospective research participants. Efforts should be made to improve female HIV-positive surgical patients' overall attitude toward research.

Validity and reliability study of the Turkish version of the Postoperative Recovery Index of patients undergoing surgical intervention

Background/aim

For the purpose of providing the optimal postoperative care for patients and assisting them in terms of recovery, their health conditions and particular symptoms should be evaluated systematically with an appropriate measurement tool. This research was designed with the purpose of conducting the validity and reliability study of the Postoperative Recovery Index-Turkish Version (PoRI-TR) and determining the postoperative recovery conditions.

Materials and methods

The sample of this study, which was planned methodologically and analytically, consisted of 382 patients who had a surgical intervention in a university hospital between September 2016 and June 2017. Analyses concerning the Turkish validity and reliability of the PoRI-TR were conducted. In the evaluation, a patient information form, the PoRI-TR, and the Quality of Recovery-40 Questionnaire (QoR-40) were used.

Results

The PoRI-TR point average was calculated as 3.39 ± 0.916 and the Cronbach alpha reliability coefficient was calculated as α = 0.967. It was determined that the five-factor structure of the PoRI-TR, which was reduced from 37 items to 25, was adapted well.

Conclusion

It was seen that the PoRI-TR is a valid and reliable measurement tool for Turkish patients.

A Review of Decision Aids for Patients Considering More Than One Type of Invasive Treatment

With continuous advances in medicine, patients are faced with several medical or surgical treatment options for their health conditions. Decision aids may be useful in helping patients navigate these options and choose based on their goals and values. We reviewed the literature to identify decision aids and better understand the effect on patient decision-making. We identified 107 decision aids designed to help patients make decisions between medical treatment or screening options; 39 decision aids were used to help patients choose between a medical and surgical treatment, and five were identified that aided patients in deciding between a major open surgical procedure and a less invasive option. Many of the decision aids were used to help patients decide between prostate, colorectal, and breast cancer screening or treatment options. Although most decision aids were not associated with a significant effect on the actual decision made, they were largely associated with increased patient knowledge, decreased decisional conflict, more accurate perception of risks, increased satisfaction with their decision, and no increase in anxiety surrounding their decision. These data identify a gap in use of decision aids in surgical decision-making and highlight the potential to help surgical patients make value-based, knowledgeable decisions regarding their treatment.

Validity and reliability of the Amsterdam Preoperative Anxiety and Information Scale in the Turkish population

Background/aim

This study aimed to adapt the Amsterdam Preoperative Anxiety and Information Scale (APAIS) to measure the preoperative anxiety of adult Turkish patients undergoing surgery.

Materials and methods

The sample of this methodological study included 210 patients. Data were collected by using personal information forms, the APAIS, and the State Anxiety Scale (STAI). Cronbach’s α-coefficient was calculated, and test–retest reliability was tested.

Results

Cronbach’s α-coefficients of the APAIS anxiety and information requirement subscales were 0.897 and 0.786, respectively. The mean test and retest scores of the APAIS were not different. The test and retest scores of the patients were significantly, positively, and strongly related. The APAIS and STAI-I were correlated. Factorial analysis revealed that two factors accounted for 81.435% of the total variance with an eigenvalue of >1. These results showed that the Turkish version of the APAIS is a valid and reliable scale.

Conclusion

The Turkish translation of the APAIS is valid and can be reliably used to determine the preoperative anxiety experienced by patients who are undergoing elective surgery.

[Concerns about child´s surgery. Are there differences if you belong to health sector?]

INTRODUCTION

A surgical intervention is a stress situation for every human being. Parents of children who undergo scheduled surgeries have some degree of anxiety about them.

OBJECTIVE

To identify the main paternal concerns regarding surgery. Assess the influence of working in health (nurses, auxiliary staff and doctors) to underestimate, magnify or mislead the real concerns.

MATERIAL AND METHOD

A comparative cross-sectional study was conducted between two populations divided by their relationship with the hospital setting that completed a questionnaire with 35 items. 138 questionnaires were collected and analyzed.

RESULTS

Differences are observed regarding the perception we have, as hospital staff, of the levels, relationships and types of concerns that we believe parents present before their child's surgery regarding the true perceptions that these parents present.

CONCLUSION

The present study shows that, although the hospital staff has experience in the management of pediatric patients and their family environment, the habituation to the hospital environment can generate small distortions in terms of the levels and groupings of the different concerns present before the hospital surgery of a child, having to take it into account to offer the best care work.

The Effect of Mirroring Display of Virtual Reality Tour of the Operating Theatre on Preoperative Anxiety: A Randomized Controlled Trial

A virtual reality (VR) tour of the operating theatre could reduce preoperative anxiety by providing a realistic experience for children. This randomized clinical trial was designed to determine whether parental co-experience of preoperative VR tour through a mirroring display could further reduce preoperative anxiety. Eighty children scheduled for elective surgery under general anesthesia were randomly allocated into either the control or mirroring group. Children in the control group watched a 4-min immersive VR video showing the operating theatre and explaining the preoperative process, via a head mounted display. In the mirroring group, parents of children watched the same video through mirroring display concurrently while their child experienced the immersive VR tour. Preoperative anxiety and satisfaction score were measured. Eighty children completed the final analysis (control group = 40 and mirroring group = 40). Preoperative anxiety of children (p = 0.025) and parents (p = 0.009) were lower in the mirroring group compared with the control group. Parents' satisfaction in the mirroring group was significantly higher than those in the control group (p = 0.008). Parental co-experience of the VR tour with children through mirroring the display was effective in reducing preoperative anxiety in both children and parents.

Sitagliptin for prevention of stress hyperglycemia in patients without diabetes undergoing general surgery: A pilot randomized study

AIM

We investigated if a dipeptidyl peptidase-4 inhibitor, sitagliptin, can prevent perioperative stress hyperglycemia in patients without prior history of diabetes mellitus undergoing general surgery.

METHODS

This double-blind pilot trial randomized general surgery patients to receive sitagliptin (n = 44) or placebo (n = 36) once daily, starting one day prior to surgery and continued during the hospital stay. The primary outcome was occurrence of stress hyperglycemia, defined by blood glucose (BG) >140 mg/dL and >180 mg/dL after surgery. Secondary outcomes included: length-of-stay, ICU transfers, hypoglycemia, and hospital complications.

RESULTS

BG >140 mg/dL was present in 44 (55%) of subjects following surgery. There were no differences in hyperglycemia between placebo and sitagliptin (56% vs. 55%, p = 0.93). BG >180 mg/dL was observed in 19% and 11% of patients treated with placebo and sitagliptin, respectively, p = 0.36. Both treatment groups had resulted in similar postoperative BG (148.9 ± 29.4 mg/dL vs. 146.9 ± 35.2 mg/dL, p = 0.73). There were no differences in length-of-stay (4 vs. 3 days, p = 0.84), ICU transfer (3% vs. 5%, p = 1.00), hypoglycemia <70 mg/dL (6% vs. 11%, p = 0.45), and complications (14% vs. 18%, p = 0.76).

CONCLUSION

Preoperative treatment with sitagliptin did not prevent stress hyperglycemia or complications in individuals without diabetes undergoing surgery.

Third-Year Medical Students' Reactions to Surgical Patients in Pain: Doubt, Distress, and Depersonalization

CONTEXT

Medical students have limited instruction about how to manage the interpersonal relationships required to care for patients in pain.

OBJECTIVES

The objective of this study was to characterize the experiences of medical students as they encounter pain, suffering, and the emotional experiences of doctoring.

METHODS

We used qualitative analysis to explore the content of 341 essays written by third-year medical students who described their experiences with surgical patients in pain. We used an inductive process to develop a coding taxonomy and then characterized the content of these essays related to empathy, patient-clinician interaction, and descriptions of clinical norms.

RESULTS

Students found it difficult to reconcile patient suffering with the therapeutic objective of treatment. They feared an empathic response to pain might compromise the fortitude and efficiency required to be a doctor and they pursued strategies to distance themselves from these feelings. Students described tension around prescription of pain medications and worried about the side effects of medications used to treat pain. Students felt disillusioned when operations caused suffering without therapeutic benefit or were associated with unexpected complications. Although patients had expressed a desire for intervention, students worried that the burdens of treatment and long-term consequences were beyond patient imagination.

CONCLUSION

These observations about patient-doctor relationships suggest that there is a larger problem among clinicians relating to patient distress and personal processing of the emotional nature of patient care. Efforts to address this problem will require explicit instruction in skills to develop a personal strategy for managing the emotionally challenging aspects of clinical work.

Can pain catastrophizing be changed in surgical patients? A scoping review

Background

Catastrophizing, a coping style characterized by an exaggerated negative affect when experiencing or anticipating pain, is an important factor that adversely affects surgical outcomes. Various interventions have been attempted with the goal of reducing catastrophizing and, by extension, improving treatment outcomes. We performed a systematic review to determine whether catastrophizing can be altered in surgical patients and to present evidence for interventions aimed at reducing catastrophizing in this population.

Methods

Using a scoping design, we performed a systematic search of MEDLINE and Embase. Studies reporting original research measuring catastrophizing, before and after an intervention, on the Pain Catastrophizing Scale (PCS) or Coping Strategies Questionnaire (CSQ) were selected. Studies were assessed for quality, the nature of the intervention and the magnitude of the effect observed.

Results

We identified 47 studies that measured the change in catastrophizing score following a broad range of interventions in surgical patients, including surgery, patient education, physiotherapy, cognitive behavioural therapy, psychologist-directed therapy, nursing-directed therapy and pharmacological treatments. The mean change in catastrophizing score as assessed with the PCS ranged from 0 to –19, and that with the CSQ, from +0.07 to –13. Clinically important changes in catastrophizing were observed in 7 studies (15%).

Conclusion

Catastrophizing was observed to be modifiable with an intervention in a variety of surgical patient populations. Some interventions produced greater reductions than others, which will help direct future research in the improvement of surgical outcomes.

Is surgery a risk factor for separation anxiety in children?

OBJECTIVE

Postoperative anxiety symptoms are distressing for both family and child. The aim of this study was to examine the prevalence of postoperative anxiety symptoms in children.

METHODS

60 children aged 6-12 undergoing surgery were included in the study group. The study group was assessed three times in terms of separation anxiety disorder (SAD), at the time of presentation, 1 and 3 months postoperatively. A personal information form and the SAD section of the K-SADS-PL on the basis of DSM-IV diagnostic criteria for screening SAD symptoms were used.

RESULTS

Study group consisted of 19 girls (31.7%) and 41 boys (68.3%) (mean age 8.9 ± 2.3). Four (6.6%) of the cases at the time of presentation and 13 (21.6%) in the study group met SAD diagnostic criteria in 1 month and 21 (35.0%) in 3 months. Anxiety disorder symptoms were significantly higher in the study group at 3 months postoperatively (p < 0.05). There is significant correlation between both SAD symptoms and duration of hospitalization. There was also a positive correlation between duration of hospitalization and parental education and SAD symptoms.

CONCLUSION

Greater SAD was observed in children undergoing surgical procedures. It will be useful to physicians to consider SAD after surgery in pediatric patients especially when the level of parental education and duration of hospitalization increase. Since SAD may persist long after surgery, it may cause constant fear in personality disorders and lead to psychological problems by significantly lowering quality of life.

Impact on the brain of the inflammatory response to surgery

The brain is both the orchestrator as well as the target of the innate immune system's response to the aseptic trauma of surgery. When trauma-induced inflammation is not appropriately regulated persistent neuro-inflammation interferes with the synaptic plasticity that underlies the learning and memory aspects of cognition. The complications that ensue, include postoperative delirium (POD) and postoperative cognitive dysfunction (POCD) at two poles of a constellation that is now termed perioperative neurocognitive disorders. While the relationship of acute POD to the more indolent POCD is not completely understood both can be further complicated by earlier-onset of dementia and higher mortality. How and why these disorders occur is the focus of this report. The innate immune system response to peripheral trauma signals to the brain through a regulated cascade of cellular and molecular actors producing a teleological defense mechanism, "sickness behavior," to curtail further injury and initiate repair. Sickness behavior, including disordered cognition, is terminated by neural and humoral pathways that restore homeostasis and launch the organism on a path to good health. With so many "moving parts" the innate immune system is vulnerable in clinical settings that include advanced age and lifestyle-induced diseases such as "unhealthy" obesity and the inevitable insulin resistance. Under these conditions, inflammation may become exaggerated and long-lived. Consideration is provided how to identify the high-risk surgical patient and both pharmacological (including biological compounds) and non-pharmacological strategies to customize care.

Study on physiological and psychological comprehensive nursing of elderly tumor patients after surgery

The aim of this study is to formulate nursing schemes for elderly tumor patients after surgery according to their clinical characteristics, and give effective guidance for alleviating the patients’ psychological anxiety. One hundred elderly tumor patients admitted to the oncology department of the Affiliated Cancer Hospital of Harbin Medical University were included and divided into an intervention group (50) and a control group (50). Nursing intervention was performed on the intervention group, and routine nursing was performed in the control group. One day before surgery, all the patients were asked to fill in a self-rating anxiety scale (SAS) and a self-rating depression scale (SDS), and their blood pressure and heart rate data were measured. After surgery, the patients were asked to fill in a form which investigated their pain degree, recovery situation and satisfaction degree. The heart rate and blood pressure of the patients in the intervention group recovered faster than those of the control group, with lower SAS and SDS scores and shorter recovery time. In conclusion, effective nursing intervention played a crucial role in the postoperative recovery of elderly tumor patients by reducing pain and anxiety degrees, which improved the patients’ satisfaction with the nursing.

The Psychosocial Experiences and Needs of Children Undergoing Surgery and Their Parents: A Systematic Review

INTRODUCTION

Surgery in children can be difficult for patients and parents. We aimed to summarize pediatric patients' and parents' psychosocial experiences and needs in surgery.

METHOD

We used the Ovid search engine and screened 877 abstracts across three databases to extract data on pediatric patients' and parents' surgical experiences.

RESULTS

Our search yielded 11 eligible studies representing 1,307 children undergoing surgery and their parents. Children's adverse experiences included psychological and behavioral changes before, during, and after surgery (e.g., anxiety, eating disturbances). Parents commonly experienced psychological distress. Children's needs related to medical and health care services, whereas parents had high information needs.

DISCUSSION

Children's adverse experiences can negatively affect medical outcomes. Children's experiences are inextricably linked to their parents' and can become negatively affected by their parents' adverse experiences. Patients and parents with previous hospitalizations and surgeries had worse surgical experiences, highlighting further research in the context of chronic illness.

The Measurement of Preoperative Anxiety

Preoperative anxiety was assessed using the hospital anxiety and depression (HAD) scale, multiple affect adjective check list (MAACL) and linear analogue anxiety scale (LAAS) in 100 consecutive day case patients undergoing termination of pregnancy. The HAD scale, a recently introduced self assessment scale comprising 7 multiple choice questions, was readily accepted and easily understood by patients. There was a high degree of correlation between the HAD scale and both the MAACL (correlation coefficient 0.74) and the LAAS (correlation coefficient 0.67). There was only a moderate degree of correlation between the HAD scale and the anaesthetist's assessment of anxiety (correlation coefficient 0.46). The HAD scale is a useful method of subjective measurement of preoperative anxiety.

The influence of stress responses on surgical performance and outcomes: Literature review and the development of the surgical stress effects (SSE) framework

BACKGROUND

Surgical adverse events persist despite several decades of system-based quality improvement efforts, suggesting the need for alternative strategies. Qualitative studies suggest stress-induced negative intraoperative interpersonal dynamics might contribute to performance errors and undesirable patient outcomes. Understanding the impact of intraoperative stressors may be critical to reducing adverse events and improving outcomes.

DATA SOURCES

We searched MEDLINE, psycINFO, EMBASE, Business Source Premier, and CINAHL databases (1996-2016) to assess the relationship between negative (emotional and behavioral) responses to acute intraoperative stressors and provider performance or patient surgical outcomes.

RESULTS/CONCLUSIONS

Drawing on theory and evidence from reviewed studies, we present the Surgical Stress Effects (SSE) framework. This illustrates how emotional and behavioral responses to stressors can influence individual surgical provider (e.g. surgeon, nurse) performance, team performance, and patient outcomes. It also demonstrates how uncompensated intraoperative threats and errors can lead to adverse events, highlighting evidence gaps for future research efforts.

Investigating the Relationship Between Religiosity and Psychological Distress Among Surgical Inpatients: A Pilot Study

Psychological distress may hinder recovery following surgery. Studies examining the relationship between psychological distress and religiosity in the acute post-operative setting are lacking. The present study investigated this relationship, evaluated protocol design, and explored coping mechanisms. Psychological distress of surgical inpatients was assessed using the Hospital Anxiety and Depression Scale (HADS) and Rotterdam Symptom Checklist (RSCL). Religiosity was assessed using the Santa Clara Strength of Religious Faith Questionnaire. Correlations were obtained using Minitab software. Qualitative analysis identified coping mechanisms. Of eligible inpatients, 13/54 were recruited. No significant correlation was found between religiosity and psychological distress. The RSCL had a strong correlation with HADS (R = 0.82, p = 0.001). Assessment of distress was >2 min faster using RSCL compared to HADS. Relationships with pets, friends or family, and God emerged as the most common coping mechanism. Given study limitations, no conclusion was drawn regarding the relationship between religiosity and psychological distress. Weaknesses in study protocol were identified, and recommendations were outlined to facilitate the definitive study. This includes use of RSCL instead of HADS. Further study is warranted to explore how to strengthen relationships for inpatients.

Effects of Educational Intervention on State Anxiety and Pain in People Undergoing Spinal Surgery: A Randomized Controlled Trial

Preoperative educational intervention for anxiety and pain affects patients undergoing spinal surgery. The effects, however, have never been examined using randomized controlled designs. To investigate the effects of education on anxiety and pain for patients undergoing spinal surgery, a randomized trial with block design was used. Patients were recruited from a medical center in central Taiwan. We invited 90 patients to participate in this study. Inclusion criteria were (a) age ≥20 years, (b) voluntary participation, (c) able to understand Taiwanese Mandarin Chinese or Taiwanese, and (4) no hearing or vision impairments after using aids. Patients (n = 86) undergoing lumbar spinal surgery were randomized into either an Intervention group (using educational intervention; n = 43) or a Control group (n = 43); four patients voluntarily dropped out after surgery (one in Intervention group; three in Control group). Patients had their anxiety (using the State-Trait Anxiety Inventory; STAI) and pain (using a visual analog scale) measured the day before surgery, 30 minutes before surgery, and the day after surgery. After controlling for demographics, the adjusted anxiety and pain levels were significantly lower for the Intervention group: mean STAI scores were 52.67 at baseline and 47.54 at 30 minutes before surgery (p < .001); mean pain scores were 6.07 at baseline and 5.28 on day after surgery (p < .001). Preoperative educational intervention is effective in informing patients undergoing spinal surgery that can lead to a reduction in pain, anxiety, and fear postoperatively.

Patient Perspectives on Transitions of Surgical Care: Examining the Complexities and Interdependencies of Care

This study examined a thematic network aimed at identifying experiences that influence patients' outcomes (e.g., patients' satisfaction, anxiety, and discharge readiness) in an effort to improve care transitions and reduce patient burden. We drew upon the Sociology and Complexity Science Toolkit to analyze themes derived from 61 semistructured, longitudinal interviews with 20 patients undergoing either a benign or malignant colorectal resection (three interviews per patient over a 30-day after hospital discharge). Thematic interdependencies illustrate how most outcomes of care are significantly influenced by two cascades identified as patients' medical histories and home circumstances. Patients who reported previous medical or surgical histories also experienced less distress during the discharge process, whereas patients with no prior experiences reported more concerns and greater anxiety. Patient dissatisfactions and challenges were due in large part to the contrasts between hospital and home experiences. Our hybrid approach may inform patient-centered guidelines aimed at improving transitions of care among patients undergoing major surgery.

Psychometric Assessment of the Child Surgery Worries Questionnaire Among Portuguese Children

Worries are common in surgical patients, especially in children. The present study analyzed the factor structure and the psychometric properties of a Portuguese version of the Child Surgery Worries Questionnaire (CSWQ-P) in a Portuguese sample of 490 children. Exploratory factor analysis, conducted via principal axis factoring with oblimin rotation, provided evidence for a four-factor structure of the 21 item questionnaire. A confirmatory factor analysis was also conducted, showing the good fit of this solution. The CSWQ-P proved to have one more subscale than the original Spanish version CSWQ. Correlations with the children's trait anxiety provided evidence of convergent validity for the CSWQ-P. Females also scored higher on worries than males on all subscales. Psychometric properties of this revised version of the CSWQ provided support for use with young children, and indicate the CSWQ-P has value for use in healthcare practice and in clinical research.

Surgeons' and surgical trainees' acute stress in real operations or simulation: A systematic review

BACKGROUND AND PURPOSE

Acute stress in surgery is ubiquitous and has an immediate impact on surgical performance and patient safety. Surgeons react with several coping strategies; however, they recognise the necessity of formal stress management training. Thus, stress assessment is a direct need. Surgical simulation is a validated standardised training milieu designed to replicate real-life situations. It replicates stress, prevents biases, and provides objective metrics. The complexity of stress mechanisms makes stress measurement difficult to quantify and interpret. This systematic review aims to identify studies that have used acute stress estimation measurements in surgeons or surgical trainees during real operations or surgical simulation, and to collectively present the rationale of these tools, with special emphasis in salivary markers.

METHODS

A search strategy was implemented to retrieve relevant articles from MEDLINE and SCOPUS databases. The 738 articles retrieved were reviewed for further evaluation according to the predetermined inclusion/exclusion criteria.

RESULTS

Thirty-three studies were included in this systematic review. The methods for acute stress assessment varied greatly among studies with the non-invasive techniques being the most commonly used. Subjective and objective tests for surgeons' acute stress assessment are being presented.

CONCLUSION

There is a broad spectrum of acute mental stress assessment tools in the surgical field and simulation and salivary biomarkers have recently gained popularity. There is a need to maintain a consistent methodology in future research, towards a deeper understanding of acute stress in the surgical field.

Depression and anxiety in patients undergoing elective and emergency surgery: Cross-sectional study from Allama Iqbal Memorial Teaching Hospital, Sialkot

OBJECTIVE

To determine the frequency of depression and anxiety in post-operative patients undergoing elective and emergency surgery.

METHODS

The cross-sectional analytical study was conducted at the Department of Surgery and Department of Psychiatry of the Allama Iqbal Memorial Teaching Hospital, Sialkot, Pakistan, from September 2013 to April 2016, and comprised patients due for elective or emergency surgery. Patients admitted to the surgical wards, including general surgical, neurosurgical, urological and orthopaedic wards, undergoing major surgical procedures were enrolled. The patients were divided into elective surgery group 1 and emergency surgery group 2. The hospital anxiety and depression scale was used to screen for symptoms of anxiety and depression. SPSS 22 was used for data analysis.

RESULTS

Of the 6,624 patients, 4,635(69.97%) were in group 1 and 1,989(30.03%) in group 2.The mean age of patients was 36.75±10.3years in group 1 and 39.11±11.4 years in group 2. There were 1,715(37%) males and 2,920(63%) females in group 1, while 518(26%) males and 1,471(74%) females were in group 2. Anxiety was present in 914(45.95%) and 656(32%) patients at 0 and 3 weeks in patients undergoing emergency surgery, while in elective surgery patients it was noted in 509(10.93%) and 1,390(29.87%) subjects, respectively. Depression was present in 218(10.96%) and 616(30.97%) patients at 0 and 3 weeks in patients undergoing emergency surgery, while in elective surgery it was noted in 463(9.98%) and 1,488(32.1%) respectively.

CONCLUSIONS

Depression and anxiety were quite frequent in patients undergoing major surgeries. Anxiety was more common in patients who underwent emergency surgeries.

Marital Satisfaction of the Post-Rehabilitation Burn Patient

The self-reported marital satisfaction of post-rehabilitation burn-injured persons was examined in this study. Using the Locke-Wallace Marital Adjustment Scale 50 burn-injured persons and 52 general surgery patients were compared on two sets of scores of marital satisfaction. Analysis of the data revealed no significant differences in marital satisfaction scores except in the area of sex relations. The burn-injured group has statistically significantly more conflict in this area than did the general surgery group.

Attitudes of Parents and Health Care Workers to Major Surgery for High-Risk Preterm Infants

OBJECTIVES

To assess preferences of health care workers (HCWs) and parents of term and preterm infants to adverse health outcomes, and how perceived surgical mortality influences decision-making.

STUDY DESIGN

A total of 536 participants (157 HCWs, 201 parents of term infants, and 178 parents of preterm infants) were recruited to take part in a structured interview. Preferences related to treatment of a critically ill preterm infant with necrotizing enterocolitis were measured by health state rank permutation analysis and pivotal risk analysis. Between-group and subgroup comparisons were performed.

RESULTS

HCWs rank adverse health states less favorably than parents of preterm infants, consistently ranking 2 of the most adverse health states worse than death. Pivotal risk values of HCWs for all health states were consistently the lowest of the 3 groups. High operative mortality was associated uniformly with reduction in pivotal risks for all groups both in favorable and adverse health states. Subgroup analyses revealed significant discrepancies in preferences between fathers and mothers as well as doctors and nurses. Regular religious practice was significantly associated with increased pivotal risks in parental subgroups.

CONCLUSIONS

As discrepancies in health state preferences existed between subgroups (ie, doctors vs nurses, mothers vs fathers) and perceived operative mortality consistently biased parental and HCW health state preferences, we recommend that HCWs should first identify differences regarding patient management before interviewing the parents together. HCWs should be aware of inadvertently biasing parents when discussing the risks and outcomes of surgery in conjunction with the overall long-term prognosis of the underlying condition.

Prevention and Intervention Strategies to Alleviate Preoperative Anxiety in Children

Preoperative anxiety (anxiety regarding impending surgical experience) in children is a common phenomenon that has been associated with a number of negative behaviors during the surgery experience (e.g., agitation, crying, spontaneous urination, and the need for physical restraint during anesthetic induction). Preoperative anxiety has also been associated with the display of a number of maladaptive behaviors postsurgery, including postoperative pain, sleeping disturbances, parent-child conflict, and separation anxiety. For these reasons, researchers have sought out interventions to treat or prevent childhood preoperative anxiety and possibly decrease the development of negative behaviors postsurgery. Such interventions include sedative premedication, parental presence during anesthetic induction, behavioral preparation programs, music therapy, and acupuncture. The present article reviews the existing research on the various modes of intervention for preoperative anxiety in children. Clinical implications and future directions are discussed.

Hypnosis for Acute Procedural Pain: A Critical Review

Clinical evidence for the effectiveness of hypnosis in the treatment of acute procedural pain was critically evaluated based on reports from randomized controlled clinical trials (RCTs). Results from the 29 RCTs meeting inclusion criteria suggest that hypnosis decreases pain compared to standard care and attention control groups and that it is at least as effective as comparable adjunct psychological or behavioral therapies. In addition, applying hypnosis in multiple sessions prior to the day of the procedure produced the highest percentage of significant results. Hypnosis was most effective in minor surgical procedures. However, interpretations are limited by considerable risk of bias. Further studies using minimally effective control conditions and systematic control of intervention dose and timing are required to strengthen conclusions.

Patient satisfaction questionnaires in surgery: inpatients' perceptions and experiences of surgical wards in general surgery

The NHS continually promotes patient-centred care. One way of assessing this is by looking at inpatient satisfaction rates as this is a central aspect of patient care. A patient's experience during their surgical admission can impact their perception of the care they receive, their treatment, recovery and follow-up. Currently NHS questionnaires are often posted out following patient discharge to assess patient satisfaction rates. However, it is important to assess inpatient satisfaction as this can change following discharge. Our survey highlighted areas for improvement when delivering care.

Caring for the surgically anxious patient: a review of the interventions and a guide to optimizing surgical outcomes

BACKGROUND

Preoperative surgical anxiety is an unpleasant and common reaction exhibited by patients who are scheduled for surgical procedures. Beyond emotional effects on the patient, it can also have negative repercussions on the surgery including longer hospital stays and poorer outcomes. Given the widespread impacts of preoperative anxiety, it is critical for surgeons to gain a better understanding of how to identify and reduce surgical anxiety in their patients.

DATA SOURCES

This study used the PubMed database to review the current literature to evaluate screening tools and interventions for surgically anxious patients.

CONCLUSIONS

Psychiatric anxiety surveys are currently the most appropriate form of assessment for surgical anxiety. Patient education is important for preventing and reducing anxiety levels in patients. Both nonpharmacological and pharmacological interventions have been shown to be effective in reducing patient anxiety and treatment should be based on patient preference, resources available, and the surgeon's experience.