A qualitative study on the perioperative experiences and demands of haemophilic arthropathy patients undergoing total joint replacement.

INTRODUCTION: Total joint replacement is the optimal treatment option for patients with severe haemophilic arthritis. Current research emphasizes patient-reported outcomes as a vital measure for evaluating surgical outcomes and patient satisfaction. Nevertheless, very limited information about the subjective experience of perioperative haemophiliacs in the literature, highlighting the need for exploration in this area. AIM: To investigate the psychological experiences and health demands of haemophilic arthropathy patients during the perioperative period of total joint replacement. DESIGN: Qualitative descriptive research with semistructured individual interviews. METHODS: From June to September 2023, nine patients with severe haemophilic arthropathy who underwent total joint replacement at a Haemophilia Diagnosis and Treatment Centre in China were interviewed for average 37 min per person. Data were analysed using the traditional content analysis method and reported following the consolidated criteria for reporting qualitative research. The study is reported according to the COREQ checklist. RESULTS: Interviews described two main themes: (1) emotional decline which involves preoperative overoptimism, early postoperative anxiety and disease uncertainty during the early independent rehabilitation. (2) wellness aspiration which includes rehabilitation support and spiritual healing. CONCLUSION: This study reveals the patients' significant psychological changes and their well-being aspiration, particularly out-of-hospital rehabilitation needs. Strengthening communication between multidisciplinary teams and patients, enhancing the involvement of nurses, broadening the scope of functions at primary Haemophilia Treatment Centres, and developing telerehabilitation, these concerted efforts may improve the overall treatment experience for patients.

Perioperative psychological distress in patients with intracranial tumors; a single center study.

PURPOSE: Distress Thermometer (DT) was adopted to evaluate distress in neuro-oncology on a scale from 1 to 10. DT values above 4 indicate major distress and should initiate psycho(onco)logical co-therapy. However, data about peri-operative distress is scarce. Hence, we evaluated peri-operative distress levels in a neurosurgical patient cohort with various intracranial tumors using the DT. METHODS: We conducted a retrospective study including inpatients with brain tumors who underwent surgery in our department between October 2015 and December 2019. Patients were routinely assessed for distress using the DT before or after initial surgery. A comparative analysis was performed via Wilcoxon rank-sum test. RESULTS: 254 patients were eligible. Mean DT value of the entire cohort was 5.4 ± 2.4. 44.5% (n = 114) of all patients exceeded DT values of ≥ 6. In our cohort, poor post-operative neurological performance and occurrence of motor deficits were significantly associated with major distress. When analysed for peri-operative changes, DT values significantly declined within the male sub-cohort (6.0 to 4.6, p = 0.0033) after surgery but remained high for the entire cohort (5.7 and 5.3, p = 0.1407). Sub-cohort analysis for other clinical factors revealed no further significant changes in peri-operative distress. CONCLUSION: Distress levels were high across the entire cohort which indicated a high need for psychological support. Motor deficits and poor post-operative neurological performance were significantly associated with DT values above 6. Distress levels showed little peri-operative variation.

Patient-Centeredness in the Perioperative Period-A Rapid Review of Current Research.

PURPOSE: The indication of surgery is a critical moment in a person's life implying different needs, feelings, or fears. The aim of the current literature review was to elucidate the prevailing utilization of the concepts 'patient-centeredness' and 'person-centeredness' within the perioperative period. DESIGN: A rapid review design. METHODS: Literature searches were conducted in the databases PubMed, Scopus (Elsevier), American Psychological Association PsychInfo (Ovid), Embase (Ovid), CINAHL (Ovid), and Cochrane Library in December 2022. Rayyan software was used to assess the articles. Joanna Briggs Institute critical appraisal tools were used to evaluate the quality of the included articles. Thematic analysis was used to identify themes across the articles. FINDINGS: The electronic database searches identified 1,967 articles. A total of 12 articles were assessed in full text against the inclusion and exclusion criteria, and finally, a total of seven articles were included. The articles originated from six countries, employed disparate methodological approaches, and featured a heterogeneous array of participants representing various health care settings. Patient-centeredness held the mantle as the most prominently used concept across the seven articles, whereas person-centeredness emerged as the least frequently explored concept. One theme was identified across the articles; Preparedness. This was related to shared decision-making and information pre, peri- and postoperative. CONCLUSIONS: This rapid review suggests that patient preparedness, particularly through shared decision-making and providing information, is a recurring theme in the limited studies on patient- or centeredness in the perioperative context. The fact that only one single study focuses on person-centered care underscores the pressing need for a comprehensive re-evaluation of modern perioperative care.

Effectiveness of Peer-Based and Conventional Video Education in Reducing Perioperative Depression and Anxiety Among Coronary Artery Bypass Grafting Patients: A Randomized Controlled Trial.

PURPOSE: Depression and anxiety are common comorbidities in patients undergoing coronary artery bypass grafting (CABG), with potential adverse effects on surgical outcomes. Effective interventions to reduce depression and anxiety in these patients are therefore warranted. This study investigated the effectiveness of peer-based video education compared to conventional video education in reducing perioperative depression and anxiety in CABG patients. DESIGN: A three-arm, parallel, randomized, controlled trial design was employed. METHODS: A total of 114 participants were randomly assigned to 1 of 3 groups (n = 38 per group): standard education (control), conventional video education, and peer-based video education. State anxiety levels were measured using the Spielberger State Anxiety Questionnaire at 1 day before surgery (baseline), 1 hour before surgery, and 4 weeks after surgery. Depression levels were measured using the Beck Depression Inventory Short-Form at baseline and 4 weeks after surgery. Statistical analyses, including χ2, Fisher's exact test, one-way analysis of variance, and repeated-measures analysis of variance, were applied to analyze the collected data. FINDINGS: Both peer-based and conventional video education groups demonstrated lower preoperative anxiety levels compared to the control group. However, only the peer-based video education group exhibited a statistically significant difference (P < .05). Four weeks after surgery, anxiety and depression levels decreased in all participants compared to baseline, with no statistically significant differences among the three groups. CONCLUSIONS: Our findings suggest that peer-based video education is more effective in controlling preoperative anxiety in patients undergoing CABG than conventional video education and standard education. Moreover, video-based education, whether conventional or peer-based, appears to be as effective as standard education in reducing anxiety and depression 4 weeks after CABG surgery. Further research is warranted to investigate the influence of content and presentation methods on patient outcomes and explore the potential long-term benefits of video-based education in promoting patient care.

Renal recipients' knowledge and self-efficacy during first year after implementing an evidence based educational intervention as routine care at the transplantation clinic.

BACKGROUND: Following an implementation plan based on dynamic dialogue between researchers and clinicians, this study implemented an evidence-based patient education program (tested in an RCT) into routine care at a clinical transplant center. The aim of this study was to investigate renal recipients' knowledge and self-efficacy during first year the after the intervention was provided in an everyday life setting. METHODS: The study has a longitudinal design. The sample consisted of 196 renal recipients. Measurement points were 5 days (baseline), 2 months (T1), 6 months (T2), and one-year post transplantation (T3). Outcome measures were post-transplant knowledge, self-efficacy, and self-perceived general health. RESULTS: No statistically significant changes were found from baseline to T1, T2, and T3. Participants' levels of knowledge and self-efficacy were high prior to the education program and did not change throughout the first year post transplantation. CONCLUSION: Renal recipients self-efficacy and insight in post-transplant aspects seem to be more robust when admitted to the hospital for transplantation compared to baseline observations in the RCT study. This may explain why the implemented educational intervention did not lead to the same positive increase in outcome measures as in the RCT. This study supports that replicating clinical interventions in real-life settings may provide different results compared to results from RCT's. In order to gain a complete picture of the impacts of an implemented intervention, it is vital also to evaluate results after implementing findings from RCT-studies into everyday practice.

Perioperative neurocognitive functions in patients with neuroepithelial intracranial tumors.

PURPOSE: This study aimed to assess perioperative neurocognitive functions in patients with surgery for intracranial neuroepithelial tumors. METHODS: Seventy-one patients [38 male, 33 female, mean age 47.2 years (range 18 to 81)] with surgery for an intracranial neuroepithelial tumor were included in this prospective single-center study. Mini-mental status examination (MMSE) and extensive neurocognitive testing (divided into the categories attention, memory, and executive functions and adjusted for age, sex, and education) were performed pre-(t0) and early postoperatively (t1). Part of the patient cohort (n = 32) also underwent neurocognitive testing during follow-up (t2). The Karnofsky Performance Status Scale (KPS) was used to assess patients' functional independence. Patients' quality of life was recorded by the Short Form 36 (SF 36) pre- and postoperatively in a part of the patient cohort. Pre- and postoperative comparisons were performed using the Wilcoxon-test for paired samples. Post hoc Bonferroni correction was performed to adjust for multiple testing. To assess the influence of risk factors on neurocognitive functions, Spearman correlations and the chi-squared test were performed. Subgroup analyses for patients with low-grade and high-grade tumors were performed. RESULTS: Postoperative deterioration was observed in 5 of 39 subtests of extensive neurocognitive testing in all 3 categories, whereas no improvement was shown. Patients with WHO Grade I tumors showed no deterioration of cognitive functions. Patients with WHO Grade II and III tumors showed significantly worse results in the executive functions category patients with WHO Grade IV tumors showed deterioration in the attention category. Significantly worse functional independence was recorded postoperatively and during follow-up (P < 0.001). Patients reported poorer physical health (SF 36, P = 0.001) at t1, whereas mental health did not differ significantly (P = 0.480). Risk factors for postoperative deterioration of cognition are low KPS scores, postoperative radiotherapy and tumor location in the temporal lobe. CONCLUSIONS: After surgery on an intracranial neuroepithelial tumor, early postoperative deterioration of neurocognitive functions, functional independence and physical health occur. Similar results were also shown during follow-up suggesting that these effects are not only due to postoperative systemic factors or fatigue. This knowledge might improve perioperative surveillance of neurocognitive functions.

A Qualitative Study of Perioperative Depression and Anxiety in Older Adults.

OBJECTIVE: We had three aims 1) understand barriers to perioperative management of anxiety and depression in older surgical patients; 2) identify preferences and requirements for interventions to manage their anxiety and depression; and 3) explore the feasibility of implementing such interventions in perioperative care. DESIGN: A qualitative study using semistructured interviews was conducted. SETTING: Participants were recruited at a large academic medical center. PARTICIPANTS: We interviewed older surgical patients and clinicians to characterize their perspectives on management of anxiety and depression symptoms, with emphasis on patient needs, barriers, and potential interventions to address these needs. MEASUREMENTS: We used the Consolidated Framework for Intervention Research to guide the development of interview questions related to intervention implementation feasibility. Thematic analysis was used to analyze interview responses. RESULTS: Forty semistructured interviews were conducted. Key barriers for perioperative management of depression and anxiety included fear of surgery, acute pain, postoperative neurocognitive disorders, limited understanding of what to expect regarding surgery and recovery, and overwhelmingly complex medication management. Patients and clinicians suggested that a bundled mental health management intervention targeted for older surgical patient population comprised of behavioral and pharmacologic strategies can help mitigate anxiety and depression symptoms during the perioperative period. Clinicians emphasized the need for a collaborative engagement strategy that includes multiple stakeholders in the design, planning, and implementation of such an intevention. CONCLUSION: New care models need to be developed to integrate mental health care into the current perioperative care practice.

Prediction of Pain and Opioid Utilization in the Perioperative Period in Patients Undergoing Primary Knee Arthroplasty: Psychophysical and Psychosocial Factors.

Objective: To identify factors associated with pain severity and opioid consumption in the early perioperative period. Design: Prospective observational cohort study. Setting: Tertiary academic medical center. Subjects: Patients with osteoarthritis older than age 45 years undergoing primary total knee replacement at Brigham and Women's Hospital. A total of 126 patients enrolled. Methods: Preoperatively, pain questionnaires and quantitative sensory testing were performed on patients to develop a psychosocial and psychophysical profile. Postoperatively, pain scores and opioid consumption were measured as primary end points. Univariate and multiple linear regression analyses were performed to determine the predictive value of these characteristics on perioperative pain scores and opioid consumption. Results: Regression analysis revealed several predictors of acute postoperative pain scores including temporal summation of pain (TSP; P = 0.001), body mass index (BMI; P = 0.044), number of previous knee surgeries (P = 0.006), and female gender (P = 0.023). Similarly, predictors of opioid utilization included TSP (P = 0.011), BMI (P = 0.02), age (P = <0.001), and tourniquet time (P = 0.003). Conclusions: The only significant, unique predictors of both pain and opioid consumption were TSP, an index of central pain facilitatory processes, and BMI. Interestingly, psychosocial factors, such as catastrophizing and somatization, although correlated with postoperative pain scores and opioid consumption, generally did not independently explain substantial variance in these measures. This study suggests that BMI and quantitative sensory testing, specifically the temporal summation of pain, may provide value in the preoperative assessment of patients undergoing total knee arthroplasty and other surgeries via predicting their level of risk for adverse pain outcomes.

Postoperative behavioral changes in Chinese children undergoing hypospadias repair surgery: A prospective cohort study.

BACKGROUND: The perioperative period can be psychologically challenging, and children may exhibit behavioral changes following surgical anesthesia. It is unknown whether children in China have additional risk factors associated with negative behavioral changes. OBJECTIVES: The aim of this study was to investigate the incidence of behavioral changes in children after hypospadias repair surgery and to identify potential risk factors associated with negative behavioral changes. METHODS: A prospective cohort of 177 children aged 2-12 years scheduled for hypospadias repair surgery from 2016 to 2017 was studied. The primary outcome was the incidence of behavioral changes on postoperative days 14 and 30 evaluated with the Post-Hospitalization Behavioral Questionnaire. Data collected included demographic data, anesthesia details, procedure details, admission details, child anxiety, child temperament, pain, and emergence delirium. Multivariable logistic regression was used to identify risk factors associated with postoperative negative behavioral changes. RESULTS: A total of 60.5% (107/177) of children exhibited negative postoperative behavioral changes on day 14 and 46.5% (79/170) exhibited changes on day 30 after the surgery. Approximately 2.3% (4/177) and 2.4% (4/170) of children showed improved behavior on postoperative days 14 and 30, respectively. The frequency of temper tantrums changed the most. The logistic regression results suggested that a younger age (odds ratio: 0.86; 95% confidence interval 0.76-0.96), emotional temperament (odds ratio: 1.1; 95% confidence interval 1.0-1.2) and maternal education (odds ratio: 2.2; 95% confidence interval 1.1-4.5) were associated with negative postoperative behavioral changes on day 14. On day 30, a younger age (odds ratio: 0.87; 95% confidence interval 0.77 to 0.98) was the only factor associated with negative postoperative behavioral changes. CONCLUSION: For children undergoing hypospadias repair surgery in our institution, approximately three in five showed postoperative behavioral changes. In addition to a younger age and a higher maternal education, an emotional temperament is associated with a high incidence of negative postoperative behavioral changes.

Psychosocial behaviour reactions, psychosocial needs, anxiety and depression among patients with rectal cancer before and after colostomy surgery: A longitudinal study.

AIMS AND OBJECTIVES: To compare the differences in psychosocial behaviour reactions, psychosocial needs, anxiety and depression before and after colostomy surgery and to explore the predictors of psychosocial behaviour reactions. BACKGROUND: Colorectal cancer is increasing worldwide. Abdominoperineal resection accompanied by permanent colostomy can cause complicated psychosocial reactions and needs. However, colostomy patients' trajectories of psychosocial adjustment at different time points must be discussed. DESIGN: A longitudinal study. METHODS: Using a convenience sampling method, 67 patients planning to undergo colostomy surgery were recruited from a tertiary cancer centre in southern China from January 2013-January 2014. Data collection consisted of two phases, conducted 1-2 days before surgery and 1-2 days prior to discharge. The Ostomy Psychosocial Behaviour Reaction Questionnaire, the Ostomy Psychosocial Needs Questionnaire, the Hospital Anxiety and Depression Scale and a self-designed demographic questionnaire were used to collect data. STROBE guidelines were followed. RESULTS: The participants had a moderate level of psychosocial behaviour reactions, a deep and wide range of psychosocial needs and a high incidence of anxiety and depression before and after surgery. Anxiety before surgery was significantly higher than that after surgery. Psychosocial needs and anxiety were significant predictors of psychosocial behaviour reactions. CONCLUSIONS: Patients' anxiety was alleviated after surgery. The combination of ascertaining and meeting various psychosocial needs and managing negative emotions was helpful in alleviating patients' stress responses before and after surgery. RELEVANCE TO CLINICAL PRACTICE: An increased focus on the relationships among psychosocial behaviour reactions, psychosocial needs, anxiety and depression at different time points in colostomy patients is necessary for future research and practice.

Effect of multimedia-based nursing visit on perioperative anxiety in esophageal squamous cell carcinoma patients undergoing video-assisted thoracoscopic surgery.

Little is known about the multimedia-based preoperative nursing visit for squamous cell carcinoma (ESCC) patients undergoing video-assisted thoracoscopic surgery (VAST). The aim of this study was to evaluate the effects of preoperative multimedia-based nursing visit on perioperative anxiety in ESCC patients undergoing VAST. A total of 128 ESCC patients undergoing VAST were randomly divided into intervention group (n = 63) or control group (n = 65). The anxiety level was measured by state-trait anxiety inventory (STAI) and visual analog scale (VAS). The vital signs were also recorded. The data were collected at three different time points: before the intervention, 1 h before surgery and 24 h after surgery. There was no statistically significant difference in baseline STAI score, VAS scores and vital signs (P > 0.05). The intervention group reported significantly lower anxiety and improved vital signs in terms of systolic blood pressure, diastolic blood pressure and heart rate at 1 h before surgery and 24 h after surgery (P < 0.05). However, no significant difference in respiratory rate was observed between two groups at 1 h before surgery and 24 h after surgery (P > 0.05). Preoperative nursing visit with multimedia could reduce perioperative anxiety levels as well as help to stabilize vital sign for ESCC patients undergoing VAST.

Sources of distress among patients undergoing surgery for colorectal cancer: a qualitative study.

BACKGROUND: Distress is common among cancer and surgical patients and can lead to worse outcomes if untreated. The objective of this study was to explore sources of distress among colorectal cancer patients undergoing surgery. MATERIALS AND METHODS: This was a qualitative study using in-depth, semistructured, one-on-one interviews in an academic setting. Patients were recruited if they had a pathologically confirmed diagnosis of colon or rectal cancer. Purposive sampling was used to recruit patients who were about to undergo (preoperative), or had recently undergone (postoperative), curative resection for colorectal cancer. RESULTS: All participants (n = 24) reported experiencing distress during treatment. Participants identified sources of distress preoperatively (negative emotional reaction to diagnosis, distress from preconception of cancer diagnosis, and distress interacting with healthcare system). Sources of distress during in-hospital recovery included negative emotional reaction to having a surgery and negative emotions experienced in the hospital. Postoperative sources of distress included mismatch of expectations and experience of recovery, dealing with distressing physical symptoms and complications after surgery, and distress worrying about recurrence. Participants identified other sources of distress that were not time-specific (distress related to social support network, from disruption of life, and worrying about death). CONCLUSIONS: Our results highlight a potential role for a comprehensive screening program to identify which patients require assistance with addressing sources of distress during the surgical experience. Understanding how sources of distress may vary by time will help us tailor interventions at different time points of the surgical experience.

The Psychosocial Effects of Perioperative Complications After Bariatric Surgery.

BACKGROUND: Bariatric surgery is an effective weight loss tool that results in sustained weight loss, improvement in obesity-related comorbidities, and positive psychosocial outcomes. However, bariatric procedures also present with risks, as surgical complications are not uncommon. OBJECTIVE: This study aims to better understand the effect of postoperative complications from bariatric surgeries on patients' psychosocial well-being. MATERIALS AND METHODS: Surgical data on postoperative complications were matched with results from self-administered psychosocial questionnaires. Depression, anxiety, and quality of life (QOL) were assessed preoperatively, and at 1-year postoperatively. RESULTS: A total of 365 patients were included. Overall, the complication rate was 15.3% (n = 56), with 31 (8.5%) patients experiencing complications within 30 days of surgery, and 25 (6.8%) experiencing late complications. All patients achieved significant weight loss at 1-year postoperatively. Patients with uncomplicated recoveries showed significant improvement in depression (P < 0.001), anxiety (P < 0.001), mental QOL (P < 0.001), and physical QOL (P < 0.001) at 1-year postsurgery. Patients who experienced postoperative complications showed significant improvement in depression (P < 0.001), anxiety (P = 0.04) and physical QOL (P < 0.001), but not in mental QOL (P = 0.210). Despite improved psychosocial outcomes from baseline, patients experiencing complications showed higher postoperative depression scores (P < 0.01) and lower physical QOL (P < 0.01) than patients without complication. Comparison between those with early and late complications did not show significant difference in outcomes. CONCLUSIONS: Complications following bariatric surgery can hinder improvements in patient's psychological well-being and QOL. Bariatric centers should provide more support for patients who have experienced complications.

A prospective study comparing perioperative anxiety and posthospital behavior in children with autism spectrum disorder vs typically developing children undergoing outpatient surgery.

BACKGROUND: Research describing the experience of youth with autism spectrum disorders in the perioperative setting is limited. This study compared youth with autism spectrum disorder to typically developing children in the perioperative setting and examined group differences in: child anxiety, parent anxiety, premedication patterns, induction compliance, and changes in behavior postprocedure. METHODS: Participants were 60 youth (32 with autism spectrum disorder, 28 typically developing) of ages 2-19 years undergoing outpatient surgery and their parents. Parents and research assistants rated children's anxiety at 3 time points (waiting room, preoperative holding, separation), and parents rated their own anxiety in the waiting room and at separation. The anesthesiologist rated induction compliance. Postprocedure behavior change was assessed via phone survey 1 and 7 days postprocedure. Analyses examined group differences in anxiety, medication patterns, and behavior. RESULTS: Children with autism spectrum disorder had higher research assistant reported anxiety than typically developing youth in the holding room only. There were no group differences in parent report of their own anxiety or their child's anxiety across time points. Compared to typically developing youth, children with autism spectrum disorder were more likely to receive a premedication (including nonstandard premedication), and had poorer induction compliance. Groups did not differ on posthospital behavior change 1 or 7 days postsurgery. CONCLUSION: Findings revealed ratings of anxiety in youth with and without autism spectrum disorder facing surgery varied by reporter and setting, highlighting the importance of using multiple reporters in research of youth with autism spectrum disorder in the perioperative period. Furthermore, while results showed group differences in premedication patterns and induction compliance, groups did not differ in level of negative behavior change after surgery. Future research can examine how individual differences in youth with autism impact anxiety in the perioperative setting and degree of behavior change postprocedure.

Perioperative Interdisciplinary Intervention Contributes to Improved Outcomes of Adolescents Treated With Hip Preservation Surgery.

BACKGROUND: Adolescent hip preservation surgery (HPS) candidates typically present with chronic pain, which can negatively affect psychological function and surgical outcomes. A previous study demonstrated high rates of psychological symptoms and maladaptive behaviors in this population. This study quantified psychological and functional improvements in these patients from preoperative presentation to postoperative follow-up. An integrated interdisciplinary approach is also described. METHODS: A total of 67 patients undergoing HPS were evaluated preoperatively and postoperatively at 1 year by staff psychologists. Perioperative psychological intervention consisted of education, counseling, and administration of self-report measures. Self-report measure scores were compared preoperatively and postoperatively, grouped by orthopaedic diagnoses. Frequency analysis, correlational analysis, and analysis of variance were conducted. RESULTS: Psychological function improved significantly at follow-up: decreased emotional symptomatology (46.1 to 43.6, P=0.013), anxiety (49.6 to 45.8, P<0.001), school problems (46.6 to 44.7, P=0.035), internalizing problems (46.3 to 44.1, P=0.015), social stress (44.5 to 42.3, P=0.024), sense of inadequacy (49.0 to 46.0, P=0.004), and increased self-concept (51.1 to 54.1, P=0.003). Resiliency factors also significantly improved: increased mastery (50.3 to 52.9, P=0.001) and resourcefulness (49.7 to 52.0, P=0.046), decreased emotional reactivity (46.3 to 42.9, P=0.001), and vulnerability (47.7 to 44.7, P=0.011). Physical function and return to activity also significantly improved (University of California-Los Angeles: 7.1 to 8.7, P=0.017; modified Harris Hip Score: 67.3 to 83.8, P<0.001). Return to activity positively correlated with optimism and self-efficacy (P=0.041). Femoroacetabular impingement and hip dysplasia patients consistently reported feeling less depressed (P=0.036), having fewer somatic complaints (P=0.023), fewer internalized problems (P=0.037), and exhibiting fewer atypical behaviors (P=0.036) at follow-up. Slipped capital femoral epiphysis patients did not demonstrate improvements in psychological functioning postoperatively. CONCLUSIONS: Perioperative psychological education and counseling, in combination with HPS, improved postoperative psychological and physical function. Patients reported reduced anxiety, school problems, and social stress, with marked increase in resilience. Increased mobility and return to activity significantly correlated with improved optimism and self-efficacy. LEVEL OF EVIDENCE: Level II-therapeutic studies-investigating the results of treatment.

Levels of anxiety in parents in the 24 hr before and after their child's surgery: A descriptive study.

AIMS AND OBJECTIVES: To (i) investigate pre- and postoperative anxiety levels in parents of surgical patients; (ii) identify factors that affect parental anxiety; and (iii) analyse assistance provided and overall parental satisfaction to assess whether and how this aspect can impact their anxiety level. BACKGROUND: Surgery as an event generates anxiety in children and their parents. Children who are anxious before surgery are likely to develop more postoperative psychological and physiological complications than those who are not. The role parents play in influencing emotional states of their children has been well demonstrated. However, specific national programmes aimed at helping parents develop new models for coping are relatively inexistent in Italy. STUDY DESIGN: Longitudinal study. METHODS: One hundred and one parents of children undergoing surgery at a healthcare facility in Padua, Italy, completed the Italian version of the State-Trait Anxiety Inventory Form Y questionnaire. They also answered questions about their parents' socio-demographic situation, the amount and quality of preoperative information received, assistance provided and their overall satisfaction with this information. RESULTS: The preoperative level of anxiety in parents who were interviewed was higher than Italian normative data, especially in Pediatric Cardiac Surgery and Pediatric Urology departments. Mothers had a significantly higher level of anxiety than fathers. Communicating possible complications of surgical procedures increased anxiety, while providing information about pre- and postsurgery nutrition and pain management and providing local anaesthetic on children decreased parental anxiety. Parents expressed a sufficiently high level of satisfaction although they defined the hospital environment as uncomfortable. CONCLUSIONS: Aspects of care that can make hospitalisation less traumatic for parents are as follows: greater support, involving them in the treatment process, improving hospital department admission procedures and providing thorough preoperative information. RELEVANCE TO CLINICAL PRACTICE: Healthcare professionals are encouraged to pay attention to communication modalities providing detailed information to parents.

[Effects of therapeutic suggestions on the recovery of patients undergoing major orthopaedic surgery]. / Az ortopédiai nagymutétek során alkalmazott terápiás szuggesztiók hatása a beteg gyógyulására.

INTRODUCTION AND AIM: Hip and knee replacement surgery is very demanding for patients. Medication consumption is further increased by perioperative anxiety. Besides pain killer and anxiolytic medications, patients' recovery can be enhanced by applying therapeutic suggestions, which are easily applicable during the patient-physician communication. METHOD: In our prospective, randomized, controlled study we examined the effects of positive suggestions on patients undergoing hip or knee arthroplasty in spinal anaesthesia. Members of the suggestion group received the therapeutic suggestions during a pre-surgery physician visit, and by listening to an audio recording during surgery. RESULTS: Compared to the control group (n = 50), in the suggestion group (n = 45) the need of medication (pain killer and adjuvant pain medication) during the surgery was lower (p = 0.037), the mean change from baseline in the well-being of the patients was better on the 2nd [1.31 (0.57; 2.04); p<0.001] and 4th [0.97 (0.23; 1.7); p = 0.011] postoperative day and less transfusion had to be administered (OR: 2.37; p = 0.004). However, there was no difference between the two groups in the postoperative need of medications, in the length of hospitalisation and in the frequency of complications. Conslusion: Our results indicate that the administration of therapeutic suggestions in the perioperative period may be beneficial for orthopaedic surgery patients. Orv Hetil. 2018; 159(48): 2011-2020.

Perioperative sexual interest in women with suspected gynecologic malignancies.

OBJECTIVES: For women with gynecologic cancer, the impact of surgery on sexual interest and desire in the immediate and later postoperative period is not well characterized. The objective of this study was to report the perioperative trends of changing sexual interest and desire in a cohort of women undergoing surgery for suspected gynecologic malignancies. METHODS: This is an ancillary analysis of a cohort study analyzing health-related outcomes in women who underwent primary surgical management of a suspected gynecologic malignancy between 10/2013 and 10/2014. Subjects completed the Patient-Reported Outcomes Measurement Information System Sexual Function and Satisfaction Questionnaire (PROMIS-SFQ) preoperatively and questions on sexual interest and desire at one, three, and six months postoperatively. Bivariate tests and multiple linear regression were used to analyze data. RESULTS: Of 231 women who completed a baseline PROMIS-SFQ, 187 (81%) completed one-month, 170 (74%) three-month, and 174 (75%) six-month follow-up interviews. Following surgery, 71% of enrolled subjects were diagnosed with a malignancy. Women age <55 had a greater decrease in sexual interest from baseline to one month than women age >55 (-5.5±1.0 vs -2.3±0.9, p=0.02). In a multivariable analysis, age <55 remained associated with a larger decrease in sexual interest at one month postoperatively (-4.6, 95% CI: -1.8, -7.4), as did having cancer vs benign disease for women of all ages (-5.6, 95% CI: -9.6, -1.5). CONCLUSIONS: This study provides new data regarding the timing and magnitude of changes in sexual interest following gynecologic oncology procedures.

The Effect of Surgical Stress on Postoperative Tαß and Tγδ Cell Distribution.

BACKGROUND: It was previously shown that appropriate distribution of immune cells between different tissues and organs of the body is required for proper function of the immune system. Our previous experiments demonstrated that surgical trauma in mice induces Tγδ lymphocyte migration from peripheral blood to peritoneal lymphoid organs. Tγδ cells have regulatory activity as they suppress the cell-mediated immune response in vitro via TGF-ß. In the current study, we aim to evaluate the influence of surgery on both Taß and Tγδ lymphocyte distribution in patients that underwent operation. MATERIALS AND METHODS: We investigated the percentage of Tαß and Tγδ cells in peripheral blood of patients undergoing standard surgical procedures (gastric resection, colorectal resection, cholecystectomy, and strumectomy) before and 3 days after operation. The percentage of Tαß and Tγδ cells was evaluated by FACS Canto II cytofluorimeter. RESULTS: We showed that only major surgery located in the peritoneal cavity (gastric and colorectal surgery) decreases the percentage of Tγδ cells in peripheral blood as opposed to less traumatic surgery (strumectomy and cholecystectomy) which does not have such effect. However, significant reduction of Tγδ cells after operation was only observed in a group of patients that underwent gastrectomy. Additionally, we found that gastrectomy results in significant reduction of cumulative Tγδ CD4 and Tγδ CD25 lymphocyte counts. CONCLUSION: Surgery results in decreased percentage of Tγδ lymphocytes in peripheral human blood, and this correlates with the severity and location of the surgical trauma. This observation may help to predict postoperative recovery after gastroabdominal surgery.

Perioperative Quality of Life in Cushing's Disease.

BACKGROUND: Our study evaluated the perioperative quality of life (QoL) in Cushing's disease (CD) patients, along with correlations between patient variables and cure rate. METHODS: The 36-item Short-Form Health Survey (SF)-36 questionnaire was used to assess perioperative QoL. Patients completed one survey preoperatively and two surveys postoperatively. Retrospective chart review was conducted to collect SF-36 data as well as examine variables including: age, hospital stay, size of tumour, pathological diagnosis, timing of cure, and complication rates. Statistical analysis was conducted on the scores reported by the SF-36, and were compared with the normal Canadian population values, and to a sample of QoL from nonfunctioning pituitary tumour patients. This project was approved by University of British Columbia Research Ethics Board #H15-01572. RESULTS: In general, CD patients have relatively poor QoL that does improve as expected when cured, but not quite to normal levels. Factors associated with cure included presence of macroadenoma, confirmatory pathology, and patient age. Postoperative timing of cure appears to affect the durability of cure, with an immediate cure having a higher durability rate than delayed cure. Most recurrences occurred within 10 months postoperatively. CONCLUSIONS: This review of the perioperative QoL in CD helps to illustrate how QoL changes throughout the treatment process, how QoL compares to normal Canadian population levels, and how QoL compares to patients with nonfunctioning pituitary adenomas. As treatment outcome has such a high impact on QoL, the variables identified in this study will help to better inform patients about the treatment course.