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.
Anxiety , Resilience, Psychological , Surgical Procedures, Operative , Humans , Anxiety/psychology , Cross-Sectional Studies , East Asian People , Surveys and Questionnaires , Uncertainty , Surgical Procedures, Operative/psychology
Anxiety , Complementary Therapies , Integrative Medicine , Pain, Postoperative , Surgical Procedures, Operative , Humans , Anxiety/prevention & control , Anxiety/therapy , Anxiety Disorders/etiology , Anxiety Disorders/prevention & control , Anxiety Disorders/therapy , Pain, Postoperative/etiology , Pain, Postoperative/prevention & control , Pain, Postoperative/therapy , Surgical Procedures, Operative/adverse effects , Surgical Procedures, Operative/psychology , Integrative Medicine/methods , Complementary Therapies/methods
RESUMEN Antecedentes: en la Argentina, la especialidad Cirugía General se encuentra en crisis y esta situación alarmante se halla vinculada a las malas condiciones laborales del cirujano general. Objetivo: describir la percepción que el cirujano joven tiene al terminar su programa de formación, en relación con su perspectiva laboral, actividad quirúrgica y académica. Material y métodos: estudio transversal basado en una encuesta dirigida a cirujanos jóvenes en Córdoba, Argentina. Resultados: participaron 53 encuestados. El 58% eran hombres y la mediana de edad fue 32 años. El 72% ejercía Cirugía General y el 55% trabajaba en el sector privado. El 34% pertenecía a la Asociación de Cirugía de Córdoba y el 23% a la Asociación Argentina de Cirugía. En cuanto a la experiencia profesional, el 53,1% eran cirujanos junior y el 64% eran competentes para realizar procedimientos de baja o mediana complejidad. En relación con la perspectiva laboral, el 89% consideró que el cirujano joven no consigue salida laboral rápida y el 96,2% refirió que sus prácticas no eran bien remuneradas. Respecto de la calidad de vida personal y laboral, el 57% manifestó frustración e incertidumbre económica. En cuanto a las cirujanas, la tasa de inequidades de género y hostigamiento sexual en el ámbito laboral fue del 73% y 50%, respectivamente. Conclusión: encontramos la percepción de un bajo nivel de competencia para las cirugías de mayor complejidad y una baja tasa de adherencia a sociedades quirúrgicas. Debido a la escasa oferta laboral existe gran frustración e incertidumbre económica. Actualmente, predomina y persiste el maltrato y hostigamiento hacia las cirujanas.
ABSTRACT Background: In Argentina, the specialty of general surgery is in crisis, and this alarming situation is associated with the poor working conditions of general surgeons. Objective: The aim of this study is to describe the perception of young surgeons at the end of their training program, in relation to their job prospects, surgical and academic activity. Material and methods: We conducted a cross-sectional study based on a survey responded by young surgeons in Cordoba, Argentina. Results: The survey was responded by 53 young surgeons; 58% were men and median age was 32 years. Seventy-two percent practiced general surgery and 55% worked in the private setting. Thirtyfour percent were members of Asociación de Cirugía de Córdoba and 23% belonged to Asociación Argentina de Cirugía. As for professional experience, 53.1% were junior surgeons and 64% were capable of performing low or medium complexity procedures. Eighty-nine percent considered that young surgeons do not get a job quickly and 96.2% reported that they were not well paid for their practice. When asked about their personal and professional quality of life, 57% expressed frustration and economic uncertainty. Among women surgeons, 73% reported gender inequities and 50% reported sexual harassment in the workplace. Conclusion: Young surgeons perceived they had low level of competencies for high complexity surgical procedures and reported low rate of membership in surgical societies. Most of them feel frustrated due to scarce job opportunities and expressed economic uncertainty. Nowadays, abuse and harassment of women surgeons still prevails and persists.
Humans , Male , Female , Adult , Middle Aged , Perception , Surgeons/psychology , Motivation , Quality of Life/psychology , General Surgery , Surgical Procedures, Operative/psychology , Women, Working/psychology , Cross-Sectional Studies , Data Interpretation, Statistical , Sexual Harassment/psychology , Working Conditions/psychology , Medicine , Occupational Groups/psychology
Introducción: La psicoprofilaxis quirúrgica permite poner en funcionamiento mecanismos defensivos capaces de amortiguar el impacto psicoafectivo y emocional que, potencialmente, implica la cirugía. Objetivo: Constatar la efectividad de un programa de psicoprofilaxis quirúrgica basada en la magia en la mejora de diversos indicadores de confort pre y postquirúrgicos. Método: Tras la realización de soporte psicoprofiláctico con un programa de pocos minutos basado en la magia, con grupo control equivalente, se han examinado diferentes aspectos relacionados con el dolor el estrés y la ansiedad pre y postquirúrgica en la infancia durante el ingreso e intervención quirúrgica en una muestra de 52 niños y sus correspondientes padres. Resultados y conclusión: Se han hallado evidencias de una menor presencia de estrés y ansiedad en los niños del grupo experimental frente al grupo control, así como el aumento en la transmisión de emociones positivas con los padres durante su ingreso y transcurso de la cirugía, y una significativa disminución de la ansiedad pre-quirúrgica. Por último, el grupo de psicoporfilaxis basado en la magia presenta, de manera estadísticamente significativa, menos dolor y menos ansiedad postoperatoria que el grupo control. (AU)
Introduction: the surgical psycho-prophylaxis alows us to put into action defensive mechanisms which are able to soften the psychoaffective and emotional impact which, potentially, implies the surgery. Objective: To prove the effectiveness of a surgical prophylactic programme based on the magic and in the improvement of several pre and post surgical comfort indicators. Method: After performing psycho-prophilactic support through a programme of a few minutes based on the magic, with an equivalent control group, we have examined different aspects related to pre and post surgical pain, stress and anxiety in children during their hospitalization and surgical intervention in a sample of 52 children and their parents. Results and conclusion: Evidences of lower levels of stress and anxiety have been observed in the experimental group of children in comparison with those of the control group,together with an improvement in the sharing of positive emotions with their parents during the hospitalization and surgery, and also less pre-surgical anxiety. Finally, the group of children whose prophilaxis is based on the magic shows, in a significant statistical way, less pain and less post-surgical anxiety than the control group. (AU)
Humans , Child, Preschool , Child , Magic , Pediatrics , Surgical Procedures, Operative/nursing , Surgical Procedures, Operative/psychology , Non-Randomized Controlled Trials as Topic , Stress, Psychological , Anxiety
BACKGROUND: Little is known about family members' and patients' expression of negative emotions among high-risk preoperative conversations. OBJECTIVES: This study aimed to identify the occurrence and patterns of the negative emotions of family members and patients in preoperative conversations, to investigate the conversation themes and to explore the correlation between the negative emotions and the conversation themes. METHODS: A retrospective study was conducted using the Chinese version of Verona Coding Definitions of Emotional Sequences (VR-CoDES-C) to code 297 conversations on high-risk procedures. Inductive content analysis was used to analyse the topics in which negative emotions nested. The χ2 Test was used to test the association between the cues and the conversation themes. RESULTS: The occurrence rate of family members' and patients' negative emotions was very high (85.9%), much higher when compared to most conversations under other medical settings. The negative emotions were mainly expressed by cues (96.4%), and cue-b (67.4%) was the most frequent category. Cues and concerns were mostly elicited by family members and patients (71.6%). Negative emotions were observed among seven themes, in which 'Psychological stress relating to illness severity, family's care and financial burden' (30.3%) ranked the top. Cue-b, cue-c and cue-d had a significant correlation (p < .001) with certain themes. CONCLUSIONS: Family members and patients conveyed significantly more negative emotions in the high-risk preoperative conversations than in other medical communications. Certain categories of cues were induced by specific emotional conversation contents. PATIENT CONTRIBUTION: Family members and patients contributed to data.
Clinical Coding , Communication , Family , Patients , Physician-Patient Relations , Surgical Procedures, Operative , China , Emotions , Family/psychology , Humans , Patients/psychology , Referral and Consultation , Retrospective Studies , Risk , Surgical Procedures, Operative/psychology , Surveys and Questionnaires
Introducción: El tratamiento quirúrgico de la extirpación de órganos parece satisfacer una serie depatologías que surgen como necesidades de salud de las poblaciones. En este contexto, se instala elestado de incertidumbre.Objetivo: Investigar la incertidumbre de la extracción de un órgano en pacientes quirúrgicos.Método: Estudio transversal realizado con pacientes hospitalizados en la clínica quirúrgica de unhospital universitario. Variables sociodemográficas y clínicas fueron recogidas, además, se aplicó laescala de incertidumbre en la enfermedad de Mishel.Resultados: El perfil de diagnósticos médicos en los 60 participantes mostró que las enfermedadesmás frecuentes fueron las neoplasias. Con relación a la aplicación de la escala, el 68% de losparticipantes presentaron puntuaciones mayores o iguales a 80 puntos. El valor hallado para el alfa deCronbach fue de 0,842. Los procedimientos quirúrgicos histerectomía abdominal y mastectomía, quefueron los más frecuentes para los participantes, están asociados con áreas de incertidumbre.Conclusiones: Los altos niveles de incertidumbre demostraron la necesidad de la gestión de estacondición. Los aspectos psicosociales de los tratamientos quirúrgicos son desconsiderados a expensasde la restauración clínica, circunstancias en que se descuida el sufrimiento emocional del paciente. Lamejora de la comunicación entre los profesionales de la salud y el paciente puede influir para prevenirla manifestación de la falta de información, una de las formas de la expresión de la incertidumbre.Aspectos como el perfil socioeconómico del paciente, el nivel educativo y los ingresos deben tenerseen cuenta en el tratamiento quirúrgico de la extracción de órganos. La incertidumbre experimentada porestos pacientes debe conocerse mejor y difundirse ampliamente para que estos aspectos se destaquenen el entorno de la atención médica (AU)
Introduction: The surgical treatment of organ removal seems to meet a number of pathologies thatemerge as health needs of populations. In this context, the state of uncertainty is installed.Objective: To investigate the uncertainty in illness in surgical patients of organ removal.Method: Cross-sectional study developed with patients admitted to the surgical outpatient clinic of auniversity hospital. Sociodemographic and clinical variables were collected, in addition to applyingMishel uncertainty in illness scale.Results: The profile of medical diagnoses in the 60 participants showed that the most frequentdiseases were the neoplasms. As for the scale application, 68% of the participants presented scoresgreater than or equal to 80 points. The value found for the Cronbachs Alpha was 0.842. The surgicalprocedures abdominal hysterectomy and mastectomy, which were the most prevalent for theparticipants, are associated with uncertainty domains.Conclusions: High levels of uncertainty demonstrated the need for the management of this condition.The psychosocial aspects of surgical treatments are disregarded at the expense of the clinicalrestoration, circumstances that neglect the patients emotional suffering. The improvement ofcommunication between the health professional and the patient can influence to prevent themanifestation of the lack of information, one of the forms of expressing uncertainty. Aspects such as thepatients socioeconomic profile, educational level and income must be taken into account in the surgicaltreatment of organ removal. The uncertainty experienced by these patients needs to be better knownand widely disseminated to gain prominence in the health care setting (AU)
Humans , Male , Female , Adolescent , Young Adult , Adult , Middle Aged , Aged , Aged, 80 and over , Surgical Procedures, Operative/psychology , Tissue and Organ Harvesting/psychology , Uncertainty , Socioeconomic Factors , Cross-Sectional Studies
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.
Activities of Daily Living , Cognition/physiology , Cognitive Dysfunction/epidemiology , Geriatric Assessment/methods , Postoperative Complications/epidemiology , Surgical Procedures, Operative/psychology , Aged , Cognitive Dysfunction/physiopathology , Cognitive Dysfunction/psychology , Female , Follow-Up Studies , Humans , Incidence , Male , Michigan/epidemiology , Postoperative Complications/physiopathology , Postoperative Complications/psychology , Retrospective Studies , Risk Factors , Survival Rate/trends
Child, Hospitalized , Emotions , Patient Education as Topic , Pediatrics , Preoperative Care/psychology , Surgical Procedures, Operative , Child , Child, Hospitalized/education , Child, Hospitalized/psychology , Female , Humans , Parent-Child Relations , Pediatric Nursing , Surgical Procedures, Operative/education , Surgical Procedures, Operative/psychology
BACKGROUND: Access to elective surgical procedures has been impacted by the COVID-19 pandemic. METHODS: We sought to understand the patient experience by developing and distributing an anonymous online survey to those who underwent non-emergency surgery at a large academic tertiary medical center between March and October 2020. RESULTS: The survey was completed by 184 patients; the majority were white (84%), female (74.6%), and ranged from 18 to 88 years old. Patients were likely unaware of case delay as only 23.6% reported a delay, 82% of which agreed with that decision. Conversely, 44% felt that the delay negatively impacted their quality of life. Overall, 82.7% of patients indicated high satisfaction with their care. African American patients more often indicated a "neutral" vs "satisfactory" hospital experience (P < .05) and considered postponing their surgery (P < .01). Interestingly, younger patients (<60) were more likely than older (≥60) patients to note anxiety associated with having surgery during the pandemic (P < .01), feeling unprepared for discharge (P < .02), not being allowed visitors (P < .02), and learning about the spread of COVID-19 from health care providers (P < .02). DISCUSSION: These results suggest that patients are resilient and accepting of changes to health care delivery during the current pandemic; however, certain patient populations may have higher levels of anxiety which could be addressed by their care provider. These findings can help inform and guide ongoing and future health care delivery adaptations in response to care disruptions.
COVID-19/epidemiology , Pandemics , Surgical Procedures, Operative/psychology , Adult , Black or African American/psychology , Black or African American/statistics & numerical data , Age Factors , Aged , Aged, 80 and over , Anxiety/epidemiology , Elective Surgical Procedures , Female , Humans , Male , Middle Aged , Patient Satisfaction/statistics & numerical data , Perioperative Period , Quality of Life , Surgical Procedures, Operative/statistics & numerical data , Surveys and Questionnaires , Tertiary Care Centers , Time-to-Treatment/statistics & numerical data , White People/psychology , White People/statistics & numerical data , Young Adult , American Indian or Alaska Native/statistics & numerical data
The surgical outcomes of disorders on sex development (DSD) are comparatively well studied in the literature, whereas studies investigating its impacts on mental health are scarce. In this study, we aimed to evaluate psychiatric diagnoses, sex roles, quality of life, and adolescents who were surgically treated because of DSD as well as parental attitudes in their parents. The study group consisted of 19 patients diagnosed with DSD and the control group consisted of 20 age- and gender-matched healthy peers. The Kiddie-Schedule for Affective Disorders and Schizophrenia was performed by a child and adolescent psychiatrist to assess the psychiatric diagnoses. To evaluate quality of life (QoL) and sex roles, The Pediatric Quality of Life Inventory (PedsQL), and the Bem Sex Role Inventory were used, respectively. Mothers completed the PedsQL-Parent Form and the Parental Attitude Research Instrument (PARI). Of 19 children in the patient group, 14 (73.7%) had a past or current history of at least one psychiatric disorder. The most common psychiatric disorder was major depression. There was no significant difference between the two groups in terms of sex roles. A statistically significant difference was found between the study and control groups in four factor scores of the PARI. While there was no significant difference between the groups in terms of the children's QoL scores, parent-proxy reports of psychosocial health scores and total QoL scores of the study group were significantly lower than the controls. This finding shows that parents perceived the QoL of their children with DSD as worse than their healthy peers, probably due to their concerns for the future. In conclusion, it is important to identify and treat the psychiatric disorders concomitant in patients with DSD.
Adolescent Behavior/psychology , Disorders of Sex Development/therapy , Adolescent , Disorders of Sex Development/psychology , Female , Humans , Male , Quality of Life/psychology , Surgical Procedures, Operative/adverse effects , Surgical Procedures, Operative/methods , Surgical Procedures, Operative/psychology
Postoperative Complications , Surgical Procedures, Operative/adverse effects , Clinical Reasoning , Humans , Medical Errors/adverse effects , Medical Errors/prevention & control , Medical Errors/psychology , Patient Harm/adverse effects , Patient Harm/prevention & control , Patient Harm/psychology , Postoperative Complications/prevention & control , Postoperative Complications/psychology , Postoperative Complications/therapy , Surgical Procedures, Operative/psychology
Surgical education requires proficiency with multiple types of learning to create capable surgeons. This article reviews a conceptual framework of learning that starts with the biological basis of learning and how neural networks encode memory. We then focus on how information can be absorbed, organized, and recalled, discussing concepts such as cognitive load, knowledge retrieval, and adult learning. Influences on memory and learning such as stress, sleep, and unconscious bias are explored. This overview of the biological and psychological aspects to learning provides a foundation for the articles to follow.
Education, Medical, Graduate/methods , General Surgery/education , Learning/physiology , Surgical Procedures, Operative/education , Surgical Procedures, Operative/psychology , Teaching/psychology , Brain/anatomy & histology , Brain/physiology , Humans , Prejudice/psychology , Sleep/physiology , Stress, Psychological/physiopathology , Stress, Psychological/psychology , United States
BACKGROUND: It was to examine the influence of preoperative doctor-patient communication (D-PC) on surgery, and to improve the postoperative recovery effect of patients via meta-analysis. METHODS: Meta-analysis was performed to study the influence of preoperative D-PC on surgery and improve the postoperative recovery effect of patients. Boolean logic search method was adopted, and "Preoperative communication", "psychological counseling", "Surgical effect", and "D-PC" were set as search terms. Literature retrieval of PubMed, Medline, and CNKI from the establishment to the present was conducted. Literatures that performed comparative studies and set group without preoperative communication between doctors and patients as a control were screened. Review Manager (RevMan) was adopted to carry out meta-analysis. RESULTS: Fifteen papers were selected in this analysis, most of which were of low-risk bias (medium or high quality). Meta-analysis revealed that there was no statistical heterogeneity in postoperative speech function between control and experimental groups (Chi2 =1.04, I2=0%, P=0.96), and postoperative speech function of experimental group was remarkably better in contrast to control group (Z=4.09, P<0.00001). No statistical heterogeneity was found in the Asiatic aphasia test (AAT) results between two groups (Chi2 =3.77, I2=0%, P=0.44), and there was no considerable difference in AAT test results between groups (Z=1.37, P=0.17). There was statistical heterogeneity in the postoperative quality of life scores between different groups (Chi2 =115.99, I2=97%, P<0.00001), and postoperative quality of life scores of patients in experimental group were greatly superior to the control (Z=1.98, P=0.05). There was statistical heterogeneity in daily communication ability between groups (Chi2 =14.60, I2=73%, P=0.006), and daily communication ability of patients in experimental group was substantially stronger in contrast to the control (Z=7.40, P<0.00001). DISCUSSION: Through meta-analysis methods, it was found that preoperative D-PC can effectively improve the postoperative speech function and daily communication ability recovery of patients, the postoperative quality of life, and the postoperative recovery of patients.
Counseling , Quality of Life , Surgical Procedures, Operative , Humans , Physician-Patient Relations , Surgical Procedures, Operative/psychology
Importance: Postoperative recovery is difficult to define or measure. Research addressing interventions aimed to improve recovery after abdominal surgery often focuses on measures such as duration of hospital stay and complication rates. Although these clinical parameters are relevant, understanding patients' perspectives regarding postoperative recovery is fundamental to guiding patient-centered care. Objective: To elucidate the meaning of recovery from the perspective of patients undergoing abdominal surgery. Design, Setting, and Participants: This international qualitative study involved semistructured interviews with patients recovering from abdominal surgery from October 2016 to November 2018 in tertiary hospitals in 4 countries (Canada, Italy, Brazil, and Japan). A purposive maximal variation sampling method was used to ensure the recruitment of patients with varying demographic, clinical, and surgical characteristics. Data on race were not collected. Each interview lasted between 1 and 2 hours. Interviews were recorded and then transcribed verbatim. Transcripts were then analyzed using an inductive thematic analysis approach. Data analysis was conducted from July 2019 to September 2019. Main Outcomes and Measures: The qualitative analysis revealed themes reflecting the meaning of recovery from the perspective of patients undergoing abdominal surgery. Results: Thirty patients recovering from abdominal surgery were interviewed (15 [50%] female; mean [SD] age, 57 [18] years; 10 [33%] underwent major surgery; 16 [53%] underwent laparoscopic surgery). The interviews revealed that for patients undergoing abdominal surgery, the meaning of recovery embodied 5 overarching themes: (1) returning to habits and routines, (2) resolution of symptoms, (3) overcoming mental strains, (4) regaining independence, and (5) enjoying life. Themes associating the meaning of recovery to traditional parameters, such as earlier hospital discharge or absence of complications, were not identified in the interviews. Conclusions and Relevance: This qualitative study suggests that the meaning of recovery from the perspective of patients undergoing abdominal surgery goes beyond traditional clinical parameters. The elements of recovery identified in this study should be taken into account in patient-surgeon discussions about recovery and when developing patient-centered strategies to improve postoperative outcomes.
Abdomen/surgery , Convalescence/psychology , Surgical Procedures, Operative , Adult , Aged , Female , Functional Status , Humans , Interviews as Topic , Laparoscopy , Leisure Activities , Life Style , Male , Middle Aged , Patient-Centered Care , Pleasure , Postoperative Period , Qualitative Research , Quality of Life , Recovery of Function , Stress, Psychological/etiology , Surgical Procedures, Operative/adverse effects , Surgical Procedures, Operative/psychology
BACKGROUND: Degenerative cervical myelopathy (DCM) can significantly impair a patient's quality of life (QOL). In this study, we aimed to identify predictors associated with QOL improvement after surgery for DCM. METHODS: This study included 148 patients who underwent surgery for DCM. The European QOL-5 Dimension (EQ-5D) score, the Japanese Orthopedic Association for the assessment of cervical myelopathy (C-JOA) score, and the Nurick grade were used as outcome measures. Radiographic examinations were performed at enrollment. The associations of baseline variables with changes in EQ-5D scores from preoperative to 1-year postoperative assessment were investigated using a multivariable linear regression model. RESULTS: The EQ-5D and C-JOA scores and the Nurick grade improved after surgery (P < 0.001, P < 0.001, and P < 0.001, respectively). Univariable analysis revealed that preoperative EQ-5D and C-JOA scores were significantly associated with increased EQ-5D scores from preoperative assessment to 1 year after surgery (P < 0.0001 and P = 0.045). Multivariable regression analysis showed that the independent preoperative predictors of change in QOL were lumbar lordosis (LL), sacral slope (SS), and T1 pelvic angle (TPA). According to the prediction model, the increased EQ-5D score from preoperatively to 1 year after surgery = 0.308 - 0.493 × EQ-5D + 0.006 × LL - 0.008 × SS + 0.004 × TPA. CONCLUSIONS: Preoperative LL, SS, and TPA significantly impacted the QOL of patients who underwent surgery for DCM. Less improvement in QOL after surgery was achieved in patients with smaller LL and TPA and larger SS values. Patients with these risk factors may therefore require additional support to experience adequate improvement in QOL.
Cervical Vertebrae/surgery , Quality of Life/psychology , Spinal Cord Diseases/psychology , Spinal Cord Diseases/surgery , Surgical Procedures, Operative/psychology , Surgical Procedures, Operative/statistics & numerical data , Aged , Female , Forecasting , Humans , Japan , Male , Middle Aged , Outcome Assessment, Health Care , Postoperative Period , Prospective Studies , Treatment Outcome
BACKGROUND: Patient engagement is the establishment of active partnerships between patients, families, and health professionals to improve healthcare delivery. The objective of this project was to conduct a series of patient engagement workshops to identify areas to improve the surgical experience and develop strategies to address areas identified as high priority. METHODS: Faculty surgeons and patients were invited to participate in three in-person meetings. Evaluation included identifying and developing strategies for three priority areas to improve the surgical experience and level of engagement achieved at each meeting. RESULTS: Sixteen faculty surgeons and 32 patients participated. Some 63 themes to improve the surgical experience were identified; the three highest-priority themes were physician communication, discharge process, and expectations at home after discharge. Individual improvement strategies for these three prioritized themes (12, 36 and 6 respectively) were used to develop a formal strategic plan, and included a physician communication survey, discharge process worksheet and video, and guideline regarding what to expect at home after discharge. Overall, the level of engagement achieved was considered high by over 85 per cent of the participants. CONCLUSION: A high level of patient engagement was achieved. Priorities were identified with patients and surgeons to improve surgical experience, and strategies were developed to address these areas.
Patient Participation , Quality Improvement , Surgical Procedures, Operative , Aftercare , Communication , Female , Humans , Male , Patient Discharge , Patient Participation/methods , Physician-Patient Relations , Surgical Procedures, Operative/methods , Surgical Procedures, Operative/psychology , Surgical Procedures, Operative/standards
Background: Consolation behaviors toward the sick are common in humans. Anxiety in the relatives of the sick is also common. Anxiety can cause detrimental effects on multiple systems. However, our understanding on the neural mechanisms of these behaviors is limited because of the lack of small animal models. Methods: Five of 6- to 8-week-old CD-1 male mice were housed in a cage. Among them, 2 mice had right common artery exposure (surgery) and the rest were without surgery. Allo-grooming and performance in light and dark box and elevated plus maze tests of the mice were determined. Results: Mice without surgery had increased allo-grooming toward mice with surgery but decreased allo-grooming toward non-surgery intruders. This increased allo-grooming toward surgery mice was higher in familiar observers of surgery mice than that of mice that were not cage-mates of surgery mice before the surgery. Familiar observers developed anxious behavior after being with surgery mice. Surgery mice with familiar observers had less anxious behavior than surgery mice without interacting with familiar observers. Multiple brain regions including paraventricular thalamic nucleus (PVT) were activated in familiar observers. The activated cells in PVT contained orexin receptors. Injuring the neurons with ibotenic acid, antagonizing orexin signaling with an anti-orexin antibody or inhibiting neurons by chemogenetic approach in PVT abolished the consolation and anxious behaviors of familiar observers. Conclusions: Mice show consolation behavior toward the sick. This behavior attenuates the anxious behavior of surgery mice. The orexin signaling in the PVT neurons play a critical role in the consolation of familiar observers toward surgery mice and their anxious behavior. Considering that about 50 million patients have surgery annually in the United States, our study represents the initial attempt to understand neural mechanisms for consolation and anxiety of a large number of people.
Anxiety/physiopathology , Behavior, Animal/physiology , Empathy/physiology , Midline Thalamic Nuclei/physiology , Animals , Anxiety/prevention & control , Behavior, Animal/drug effects , Empathy/drug effects , Humans , Interleukin-6/metabolism , Male , Mice , Midline Thalamic Nuclei/drug effects , Models, Animal , Models, Neurological , Orexin Receptor Antagonists/administration & dosage , Orexin Receptors/metabolism , Precision Medicine , Surgical Procedures, Operative/adverse effects , Surgical Procedures, Operative/psychology
