Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 3.315
Filtrar
1.
BMJ Case Rep ; 14(1)2021 Jan 11.
Artigo em Inglês | MEDLINE | ID: mdl-33431454

RESUMO

In this paper, we report the psychological and emotional experience of a patient who regained vision after over a decade of vision loss. The negative psychological implications of blindness are well recognised and there is a robust link between visual impairment and low mood and depressive symptoms. Although uncommon, low mood and depressive symptoms have been reported in patients whose sight has been restored, and lack of research gives rise to the possibility their prevalence may be grossly under-recognised in such patient groups. The effects can be so severe that patients may revert to living in darkness in mimicry of their previous lifestyle, effectively obviating the sight-restoring surgery. Healthcare professionals have a responsibility to address this traditionally neglected need by facilitating social, psychological and medical interventions that may ease the return to vision.


Assuntos
Transtornos de Adaptação/etiologia , Cegueira/cirurgia , Transplante de Córnea/psicologia , Depressão/etiologia , Complicações Pós-Operatórias/psicologia , Transtornos de Adaptação/psicologia , Transtornos de Adaptação/reabilitação , Adulto , Cegueira/psicologia , Cegueira/reabilitação , Depressão/diagnóstico , Depressão/psicologia , Depressão/reabilitação , Humanos , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/reabilitação , Fatores de Tempo , Resultado do Tratamento , Visão Ocular
2.
Curr Opin Anaesthesiol ; 34(1): 27-32, 2021 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-33315641

RESUMO

PURPOSE OF REVIEW: Postoperative delirium (POD) is one of the most severe complications after surgery.The consequences are dramatic: longer hospitalization, a doubling of mortality and almost all cases develop permanent, yet subtle, cognitive deficits specific to everyday life. Actually, no global guideline with standardized concepts of management exists. Advances in prevention, diagnosis and treatment can improve recognition and risk stratification of delirium and its consequences. RECENT FINDINGS: Management of POD is a multiprofessional approach and consists of different parts: First, the detection of high-risk patients with a validated tool, preventive nonpharmacological concepts and an intraoperative anesthetic management plan that is individualized to the older patient (e.g. avoiding large swings in blood pressure, vigilance in maintaining normothermia, ensuring adequate analgesia and monitoring of anesthetic depth). In addition to preventive standards, treatment and diagnostic concepts must also be available, both pharmaceutical and nonpharmacological. SUMMARY: Not every POD can be prevented. It is important to detect patients with high risk for POD and have standardized concepts of management. The most important predisposing risk factors are a higher age, preexisting cognitive deficits, multimorbidity and an associated prodelirious polypharmacy. In view of demographic change, the implementation of multidisciplinary approaches to pharmacological and nonpharmacological POD management is highly recommended.


Assuntos
Anestesia/efeitos adversos , Anestésicos/efeitos adversos , Delírio/prevenção & controle , Delírio/terapia , Complicações Pós-Operatórias , Anestésicos/administração & dosagem , Transtornos Cognitivos/prevenção & controle , Transtornos Cognitivos/psicologia , Disfunção Cognitiva/complicações , Delírio/diagnóstico , Delírio/etiologia , Humanos , Hipnóticos e Sedativos/administração & dosagem , Complicações Pós-Operatórias/psicologia , Fatores de Risco
3.
Cochrane Database Syst Rev ; 12: CD009861, 2020 12 08.
Artigo em Inglês | MEDLINE | ID: mdl-33319916

RESUMO

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.


Assuntos
Ansiolíticos/uso terapêutico , Ansiedade/tratamento farmacológico , Melatonina/uso terapêutico , Procedimentos Cirúrgicos Operatórios/psicologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Alprazolam/uso terapêutico , Ansiolíticos/efeitos adversos , Viés , Clonidina/uso terapêutico , Esquema de Medicação , Humanos , Melatonina/efeitos adversos , Midazolam/uso terapêutico , Pessoa de Meia-Idade , Oxazepam/uso terapêutico , Cuidados Pós-Operatórios , Complicações Pós-Operatórias/tratamento farmacológico , Complicações Pós-Operatórias/psicologia , Cuidados Pré-Operatórios , Viés de Publicação , Ensaios Clínicos Controlados Aleatórios como Assunto
4.
JAMA Netw Open ; 3(12): e2028117, 2020 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-33346846

RESUMO

Importance: Bariatric surgical procedures have been associated with increased risk of unhealthy alcohol use, but no previous research has evaluated the long-term alcohol-related risks after laparoscopic sleeve gastrectomy (LSG), currently the most used bariatric procedure. No US-based study has compared long-term alcohol-related outcomes between patients who have undergone Roux-en-Y gastric bypass (RYGB) and those who have not. Objective: To evaluate the changes over time in alcohol use and unhealthy alcohol use from 2 years before to 8 years after a bariatric surgical procedure among individuals with or without preoperative unhealthy alcohol use. Design, Setting, and Participants: This retrospective cohort study analyzed electronic health record (EHR) data on military veterans who underwent a bariatric surgical procedure at any of the bariatric centers in the US Department of Veterans Affairs (VA) health system between October 1, 2008, and September 30, 2016. Surgical patients without unhealthy alcohol use at baseline were matched using sequential stratification to nonsurgical control patients without unhealthy alcohol use at baseline, and surgical patients with unhealthy alcohol use at baseline were matched to nonsurgical patients with unhealthy alcohol use at baseline. Data were analyzed in February 2020. Interventions: LSG (n = 1684) and RYGB (n = 924). Main Outcomes and Measures: Mean alcohol use, unhealthy alcohol use, and no alcohol use were estimated using scores from the validated 3-item Alcohol Use Disorders Identification Test-Consumption (AUDIT-C), which had been documented in the VA EHR. Alcohol outcomes were estimated with mixed-effects models. Results: A total of 2608 surgical patients were included in the final cohort (1964 male [75.3%] and 644 female [24.7%] veterans. Mean (SD) age of surgical patients was 53.0 (9.9) years and 53.6 (9.9) years for the matched nonsurgical patients. Among patients without baseline unhealthy alcohol use, 1539 patients who underwent an LSG were matched to 14 555 nonsurgical control patients and 854 patients who underwent an RYGB were matched to 8038 nonsurgical control patients. In patients without baseline unhealthy alcohol use, the mean AUDIT-C scores and the probability of unhealthy alcohol use both increased significantly 3 to 8 years after an LSG or an RYGB, compared with control patients. Eight years after an LSG, the probability of unhealthy alcohol use was higher in surgical vs control patients (7.9% [95% CI, 6.4-9.5] vs 4.5% [95% CI, 4.1-4.9]; difference, 3.4% [95% CI, 1.8-5.0])). Similarly, 8 years after an RYGB, the probability of unhealthy alcohol use was higher in surgical vs control patients (9.2% [95% CI, 8.0-10.3] vs 4.4% [95% CI, 4.1-4.6]; difference, 4.8% [95% CI, 3.6-5.9]). The probability of no alcohol use also decreased significantly 5 to 8 years after both procedures for surgical vs control patients. Among patients with unhealthy alcohol use at baseline, prevalence of unhealthy alcohol use was higher for patients who underwent an RYGB than matched controls. Conclusions and Relevance: In this multi-site cohort study of predominantly male patients, among those who did not have unhealthy alcohol use in the 2 years before bariatric surgery, the probability of developing unhealthy alcohol use increased significantly 3-8 years after bariatric procedures compared with matched controls during follow-up.


Assuntos
Alcoolismo/etiologia , Cirurgia Bariátrica/psicologia , Obesidade/cirurgia , Complicações Pós-Operatórias/psicologia , Veteranos/psicologia , Alcoolismo/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade/psicologia , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Estados Unidos/epidemiologia , Veteranos/estatística & dados numéricos
5.
Anesth Analg ; 131(5): 1582-1588, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-33079882

RESUMO

BACKGROUND: Frailty is a reduced capacity to recover from a physiologically stressful event. It is well established that preoperative frailty is associated with poor postoperative outcomes, but it is unclear if this includes cognitive decline following anesthesia and surgery. This retrospective observational study was a secondary analysis of data from a previous study (the Anaesthesia, Cognition, Evaluation [ACE] study). We aimed to identify if preoperative frailty or prefrailty is associated with preoperative and postoperative neurocognitive disorders or postoperative cognitive dysfunction. METHODS: The ACE study enrolled 300 participants aged ≥60 scheduled for elective total hip joint replacement and who underwent a full neuropsychological assessment at baseline and 3 and 12 months postoperatively. We applied patient data to 2 frailty models; both were based on an accumulation of deficits score: the reported Edmonton frail scale (REFS) and the comprehensive geriatric assessment-frailty index (CGA-FI) based on the comprehensive geriatric assessment. We calculated these 2 scores using baseline data collected from the medical history, demographic and clinical data as well as self-reported questionnaires. Some items on the REFS (3 of 18 or 17%) and the CGA-FI (37 of 51 or 27%) did not have an equivalent item in the ACE data. RESULTS: The mean age (standard deviation [SD]) was 70.1 years (6.6) with more women (197 [66%]). Using the REFS model, 40 of 300 (13.3%) patients were classified as vulnerable, mild, or moderately frail. Using the CGA-FI model, 69 of 300 (23%) were classified as intermediate or high frailty. The REFS and the CGA-FI were strongly correlated (r = 0.75; P < .01) with 34 of 300 (11%) meeting criteria for frailty by both the REFS and the CGA-FI.Frailty or prefrailty was associated with cognitive decline at 3 and 12 months using the REFS (odds ratio [OR], 1.51, 95% confidence interval [CI], 1.02-2.23 and OR, 2.00, 95% CI, 1.26-3.17, respectively) after adjusting for baseline mini-mental state examination (MMSE), smoking, hypertension, diabetes, history of acute myocardial infarction (AMI), and estimated intelligence quotient (IQ). Age did not modify this association. After adjusting for multiple comparisons, 3-month cognitive decline was no longer significantly associated with baseline frailty. CONCLUSIONS: This retrospective analysis demonstrates an association between baseline frailty and postoperative neurocognitive disorders, particularly using the more extensive REFS scoring method. This supports preoperative screening for frailty to risk-stratify patients, and identify and implement preventive strategies and to improve postoperative outcomes for older individuals.


Assuntos
Artroplastia de Quadril/efeitos adversos , Transtornos Cognitivos/etiologia , Fragilidade , Complicações Pós-Operatórias/psicologia , Idoso , Idoso de 80 Anos ou mais , Artroplastia de Quadril/psicologia , Transtornos Cognitivos/epidemiologia , Feminino , Idoso Fragilizado , Avaliação Geriátrica , Humanos , Masculino , Testes de Estado Mental e Demência , Testes Neuropsicológicos , Complicações Pós-Operatórias/epidemiologia , Valor Preditivo dos Testes , Estudos Retrospectivos , Fatores de Risco , Autorrelato , Fatores Sexuais , Inquéritos e Questionários
6.
Anesth Analg ; 131(4): 1228-1236, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32925344

RESUMO

BACKGROUND: Recent limited evidence suggests that the use of a processed electroencephalographic (EEG) monitor to guide anesthetic management may influence postoperative cognitive outcomes; however, the mechanism is unclear. METHODS: This exploratory, single-center, randomized clinical trial included patients who were ≥65 years of age undergoing elective noncardiac surgery. The study aimed to determine whether monitoring the brain using a processed EEG monitor reduced EEG suppression and subsequent postoperative delirium. The interventional group received processed EEG-guided anesthetic management to keep the Patient State Index (PSI) above 35 computed by the SEDline Brain Function Monitor (Masimo, Inc, Irvine, CA), while the standard care group was also monitored, but the EEG data were blinded from the clinicians. The primary outcome was intraoperative EEG suppression. A secondary outcome was incident postoperative delirium during the first 3 days after surgery. RESULTS: All outcomes were analyzed using the intention-to-treat paradigm. Two hundred and four patients with a mean age of 72 ± 5 years were studied. Minutes of EEG suppression adjusted by the length of surgery was found to be less for the interventional group than the standard care group (median [interquartile range], 1.4% [5.0%] and 2.5% [10.4%]; Hodges-Lehmann estimated median difference [95% confidence interval {CI}] of -0.8% [-2.1 to -0.000009]). The effect of the intervention on EEG suppression differed for those with and without preoperative cognitive impairment (interaction P = .01), with the estimated incidence rate ratio (95% CI) of 0.39 (0.33-0.44) for those with preoperative cognitive impairment and 0.48 (0.44-0.51) for those without preoperative cognitive impairment. The incidence of delirium was not found to be different between the interventional (17%) and the standard care groups (20%), risk ratio = 0.85 (95% CI, 0.47-1.5). CONCLUSIONS: The use of processed EEG to maintain the PSI >35 was associated with less time spent in intraoperative EEG suppression. Preoperative cognitive impairment was associated with a greater percent of surgical time spent in EEG suppression. A larger prospective cohort study to include more cognitively vulnerable patients is necessary to show whether an intervention to reduce EEG suppression is efficacious in reducing postoperative delirium.


Assuntos
Monitores de Consciência , Eletroencefalografia , Monitorização Neurofisiológica Intraoperatória/métodos , Procedimentos Cirúrgicos Operatórios/métodos , Idoso , Idoso de 80 Anos ou mais , Anestesia , Anestésicos/administração & dosagem , Disfunção Cognitiva/epidemiologia , Disfunção Cognitiva/etiologia , Delírio/epidemiologia , Delírio/etiologia , Delírio do Despertar/epidemiologia , Feminino , Humanos , Incidência , Masculino , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/psicologia , Estudos Prospectivos
7.
Am Heart J ; 228: 27-35, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32745733

RESUMO

BACKGROUND: Limited data suggest that transcatheter (TAVR) as compared with surgical aortic valve replacement (SAVR) may be more effective in female than male patients. To date, most evidence is derived from subgroup analyses of large trials, and a dedicated randomized trial evaluating whether there is a difference in outcomes between these interventions in women is warranted. The RHEIA trial will compare the safety and efficacy of TAVR with SAVR in women with severe symptomatic aortic stenosis requiring aortic valve intervention, irrespective of surgical risk. METHODS/DESIGN: The RHEIA trial is a prospective, randomized, controlled study that will enroll up to 440 patients across 35 sites in Europe. Women with severe symptomatic aortic stenosis, with any but prohibitive surgical risk status, will be randomized 1:1 to undergo aortic valve intervention with either transfemoral TAVR with the SAPIEN 3 or SAPIEN 3 Ultra device or SAVR and followed up for 1 year. The objective is to determine whether TAVR is non-inferior to SAVR in this patient population and, if this is fulfilled whether TAVR is actually superior to SAVR. The primary safety/efficacy endpoint is a composite of all-cause mortality, all stroke, and re-hospitalization (for valve or procedure-related symptoms or worsening congestive heart failure) at 1 year post-procedure. Other outcomes (assessed at 30 days and/or 1 year) include all-cause mortality; bleeding, vascular, cardiac, cerebrovascular and renal complications; aortic valve prosthesis and left ventricular function; cognitive function, health status, and quality of life. DISCUSSION: The RHEIA study has been designed to evaluate the safety and efficacy of TAVR compared with SAVR specifically in women with severe symptomatic aortic stenosis, irrespective of the level of surgical risk. The results will be the first to provide specific randomized evidence to guide treatment selection in female patients with severe symptomatic aortic stenosis. TRIAL REGISTRATION: clinicaltrials.gov: NCT04160130.


Assuntos
Estenose da Valva Aórtica , Valva Aórtica , Próteses Valvulares Cardíacas , Complicações Pós-Operatórias , Qualidade de Vida , Risco Ajustado/métodos , Substituição da Valva Aórtica Transcateter , Idoso , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/cirurgia , Estenose da Valva Aórtica/diagnóstico , Estenose da Valva Aórtica/fisiopatologia , Estenose da Valva Aórtica/psicologia , Estenose da Valva Aórtica/cirurgia , Feminino , Nível de Saúde , Próteses Valvulares Cardíacas/efeitos adversos , Próteses Valvulares Cardíacas/classificação , Humanos , Avaliação de Processos e Resultados em Cuidados de Saúde , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/fisiopatologia , Complicações Pós-Operatórias/prevenção & controle , Complicações Pós-Operatórias/psicologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores de Risco , Índice de Gravidade de Doença , Substituição da Valva Aórtica Transcateter/efeitos adversos , Substituição da Valva Aórtica Transcateter/instrumentação , Substituição da Valva Aórtica Transcateter/métodos
8.
Br J Anaesth ; 125(5): 750-761, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32838982

RESUMO

BACKGROUND: Recent studies show activity of ketamine metabolites, such as hydroxynorketamine, in producing rapid relief of depression-related symptoms and analgesia. To improve our understanding of the pharmacokinetics of ketamine and metabolites norketamine, dehydronorketamine, and hydroxynorketamine, we developed a population pharmacokinetic model of ketamine and metabolites after i.v. administration of racemic ketamine and the S-isomer (esketamine). Pharmacokinetic data were derived from an RCT on the efficacy of sodium nitroprusside (SNP) in reducing the psychotomimetic side-effects of ketamine in human volunteers. METHODS: Three increasing i.v. doses of esketamine and racemic ketamine were administered to 20 healthy volunteers, and arterial plasma samples were obtained for measurement of ketamine and metabolites. Subjects were randomised to receive esketamine/SNP, esketamine/placebo, racemic ketamine/SNP, and racemic ketamine/placebo on four separate occasions. The time-plasma concentration data of ketamine and metabolites were analysed using a population compartmental model approach. RESULTS: The pharmacokinetics of ketamine and metabolites were adequately described by a seven-compartment model with two ketamine, norketamine, and hydroxynorketamine compartments and one dehydronorketamine compartment with metabolic compartments in-between ketamine and norketamine, and norketamine and dehydronorketamine main compartments. Significant differences were found between S- and R-ketamine enantiomer pharmacokinetics, with up to 50% lower clearances for the R-enantiomers, irrespective of formulation. Whilst SNP had a significant effect on ketamine clearances, simulations showed only minor effects of SNP on total ketamine pharmacokinetics. CONCLUSIONS: The model is of adequate quality for use in future pharmacokinetic and pharmacodynamic studies into the efficacy and side-effects of ketamine and metabolites. CLINICAL TRIAL REGISTRATION: Dutch Cochrane Center 5359.


Assuntos
Anestésicos Dissociativos/farmacocinética , Ketamina/farmacocinética , Adulto , Anestésicos Dissociativos/administração & dosagem , Biotransformação , Simulação por Computador , Estudos Cross-Over , Método Duplo-Cego , Composição de Medicamentos , Feminino , Humanos , Injeções Intravenosas , Ketamina/administração & dosagem , Ketamina/análogos & derivados , Ketamina/sangue , Ketamina/química , Masculino , Modelos Teóricos , Nitroprussiato/uso terapêutico , Complicações Pós-Operatórias/prevenção & controle , Complicações Pós-Operatórias/psicologia , Estereoisomerismo , Adulto Jovem
10.
J Pediatr Orthop ; 40 Suppl 1: S22-S24, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32502066

RESUMO

INTRODUCTION: Physicians and surgeons in all specialties encounter and manage complications throughout their careers. Little attention has been given to a surgeon's emotional experience and reaction to the stresses of managing complications. METHODS: The author has reviewed relevant literature and added observations from 4 decades of experience with a pediatric orthopedic faculty. The author also reviewed the types of complications and principles of successful management of surgical complications. RESULTS AND DISCUSSION: A small number of published articles dealing with the issues of physician and surgeon responses to stressful occurrences were found. Proper management of complications will markedly reduce the stress upon the surgeon. Analysis of the complications with colleagues is essential to the reduction of feelings of guilt, and are useful in preventing future events. Discussions of the accompanying stress between the surgeon and colleagues, family, and occasionally counselors are helpful in achieving resolution and emotional healing. CONCLUSIONS: Greater attention to emotional stress issues affecting caregivers, and especially surgeons, is needed. This should happen at all levels of education from medical school through postgraduate training, and in the everyday practice of surgery. Research to clarify the effectiveness of various interventions is needed.


Assuntos
Cirurgiões Ortopédicos/psicologia , Complicações Pós-Operatórias/psicologia , Esgotamento Profissional/prevenção & controle , Humanos , Procedimentos Ortopédicos/efeitos adversos , Pediatria
11.
Transplant Proc ; 52(9): 2626-2630, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32553507

RESUMO

BACKGROUND: One of the peculiar aspects of the transplant patient's life is that, in the post-surgery phase, the patient lives in an "isolation" condition, having to pay particular attention to the living environment and preferring a limited social life given that the immunosuppressive treatment entails immunodepression in the patient. With coronavirus disease 2019 (COVID)-19, as in a post-surgery situation, social isolation is being implemented. MATERIALS AND METHODS: The study started on March 17, 2020, and ended on April 24, 2020. Consulting/phone interviews were made. The phone questionnaire, submitted to 71 patients, consisted of a set of 15 questions that investigated structure and psychological resistance. Eight patients have been monitored exclusively for the psychological aspect through a more articulate supporting path. RESULTS: In essence, from the overall analysis of the data derived from the study of the positioning of patients based on the stage of renal function, the bands related to the development of psychopathological aspects, and the use of positive personal resources, it emerges that patients in stage V kidney failure are in the first bracket as regards the development of psychopathological aspects (absence of these experiences) and in the third bracket as regards the good use of positive resources to deal with isolation. Therefore, it can be deduced that, although with data that can be expanded, a serious or medium-serious situation from an organic point of view in this socio-health emergency situation is well addressed by the transplanted patient. CONCLUSION: Transplant patients have faced the measure of social distancing adequately and in adherence to the treatment thanks to the phone assistance of all the medical-surgical and psychological team.


Assuntos
Infecções por Coronavirus/prevenção & controle , Transplante de Órgãos/psicologia , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Complicações Pós-Operatórias/prevenção & controle , Quarentena/psicologia , Isolamento Social/psicologia , Betacoronavirus , Infecções por Coronavirus/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transplante de Órgãos/efeitos adversos , Pneumonia Viral/psicologia , Complicações Pós-Operatórias/psicologia , Complicações Pós-Operatórias/virologia , Período Pós-Operatório , Inquéritos e Questionários
12.
PLoS One ; 15(5): e0233412, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32453759

RESUMO

BACKGROUND: Postoperative depression is one of the most common mental disorders in patients undergoing cancer surgery and it often delays postoperative recovery. We investigated whether dezocine, an analgesic with inhibitory effect on the serotonin and norepinephrine reuptake, could relieve postoperative depressive symptoms in patients undergoing colorectal cancer surgery. METHODS: This randomized, controlled, single-center, double-blind trial was performed in the Second Affiliated Hospital of the Army Medical University. A total of 120 patients were randomly assigned to receive either sufentanil (1.3 µg/kg) with dezocine (1 mg/kg) (dezocine group; n = 60) or only sufentanil (2.3 µg/kg) (control group; n = 60) for patient-controlled intravenous analgesia after colorectal cancer surgery. The primary outcome was the Beck Depression Inventory score at 2 days after surgery. The secondary outcomes included the Beck Anxiety Inventory, sleep quality, and quality of recovery scores. RESULTS: Compared with those in the control group, patients in the dezocine group had lower depression scores (7.3±3.4 vs. 9.9±3.5, mean difference 2.6, 95% CI: 1.4-3.9; P<0.001) at 2 days after surgery and better night sleep quality at the day of surgery (P = 0.010) and at 1 day after the surgery (P<0.001). No significant difference was found in other outcomes between the two groups. CONCLUSIONS: Intravenous analgesia using dezocine can relieve postoperative depression symptoms and improve sleep quality in patients undergoing colorectal cancer surgery.


Assuntos
Analgésicos Opioides/administração & dosagem , Compostos Bicíclicos Heterocíclicos com Pontes/administração & dosagem , Neoplasias Colorretais/cirurgia , Depressão/prevenção & controle , Procedimentos Cirúrgicos do Sistema Digestório/psicologia , Dor Pós-Operatória/tratamento farmacológico , Sufentanil/administração & dosagem , Tetra-Hidronaftalenos/administração & dosagem , Administração Intravenosa , Idoso , Analgesia Controlada pelo Paciente , Analgésicos Opioides/uso terapêutico , Compostos Bicíclicos Heterocíclicos com Pontes/uso terapêutico , China , Depressão/etiologia , Método Duplo-Cego , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Dor Pós-Operatória/psicologia , Complicações Pós-Operatórias/tratamento farmacológico , Complicações Pós-Operatórias/psicologia , Sufentanil/uso terapêutico , Tetra-Hidronaftalenos/uso terapêutico , Resultado do Tratamento
13.
Plast Reconstr Surg ; 145(5): 917e-926e, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32332528

RESUMO

BACKGROUND: Whether to irradiate the tissue expander before implant exchange or to defer irradiation until after exchange in immediate, two-stage expander/implant reconstruction remains uncertain. The authors evaluated the effects of irradiation timing on complication rates and patient-reported outcomes in patients undergoing immediate expander/implant reconstruction. METHODS: Immediate expander/implant reconstruction patients undergoing postmastectomy radiation therapy at 11 Mastectomy Reconstruction Outcomes Consortium sites with demographic, clinical, and complication data were analyzed. Patient-reported outcomes were assessed with BREAST-Q, Patient-Reported Outcomes Measurement Information System, and European Organisation for Research and Treatment of Cancer Breast Cancer-Specific Quality-of-Life Questionnaire surveys preoperatively and 2 years postoperatively. Survey scores and complication rates were analyzed using bivariate comparison and multivariable regressions. RESULTS: Of 317 patients who met inclusion criteria, 237 underwent postmastectomy radiation therapy before expander/implant exchange (before-exchange cohort), and 80 did so after exchange (after-exchange cohort). Timing of radiation had no significant effect on risks of overall complications (OR, 1.25; p = 0.46), major complications (OR, 1.18; p = 0.62), or reconstructive failure (OR, 0.72; p = 0.49). Similarly, radiation timing had no significant effect on 2-year patient-reported outcomes measured by the BREAST-Q or the European Organisation for Research and Treatment of Cancer survey. Outcomes measured by the Patient-Reported Outcomes Measurement Information System showed less anxiety, fatigue, and depression in the after-exchange group. Compared with preoperative assessments, 2-year patient-reported outcomes significantly declined in both cohorts for Satisfaction with Breasts, Physical Well-Being, and Sexual Well-Being, but improved for anxiety and depression. CONCLUSIONS: Radiation timing (before or after exchange) had no significant effect on complication risks or on most patient-reported outcomes in immediate expander/implant reconstruction. Although lower levels of anxiety, depression, and fatigue were observed in the after-exchange group, these differences may not be clinically significant. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.


Assuntos
Implante Mamário/efeitos adversos , Implantes de Mama/efeitos adversos , Neoplasias da Mama/terapia , Complicações Pós-Operatórias/epidemiologia , Dispositivos para Expansão de Tecidos/efeitos adversos , Expansão de Tecido/efeitos adversos , Adulto , Ansiedade/epidemiologia , Ansiedade/etiologia , Ansiedade/psicologia , Implante Mamário/instrumentação , Implante Mamário/métodos , Depressão/epidemiologia , Depressão/etiologia , Depressão/psicologia , Fadiga/epidemiologia , Fadiga/etiologia , Feminino , Humanos , Mastectomia/efeitos adversos , Pessoa de Meia-Idade , Medidas de Resultados Relatados pelo Paciente , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/psicologia , Estudos Prospectivos , Qualidade de Vida , Radioterapia Adjuvante/efeitos adversos , Radioterapia Adjuvante/métodos , Fatores de Tempo , Tempo para o Tratamento , Expansão de Tecido/instrumentação
14.
Zhonghua Wei Chang Wai Ke Za Zhi ; 23(4): 415-420, 2020 Apr 25.
Artigo em Chinês | MEDLINE | ID: mdl-32306613

RESUMO

Sphincteric-saving surgery (SSS) is currently a hot spot in the treatment of mid-low rectal cancer. Although it preserves the anatomical continuity of the colon and anus, the postoperative functional outcomes and quality of life (QOL) remains to be confirmed. Current studies have shown that quality of life worsens at the first month after surgery, improves within 3-6 months, and stabilizes at about 1 year. The QOL was associated with patient-related factors, tumor-related factors, treatment-related factors and postoperative complications. For patient-related factors, younger patients have worse role function and sexual function but better cognitive function and physical function. Male patients deteriorate significantly in sexual and social function. For tumor-related factors, patients with lower rectal cancer have poorer defecation function. Those with advanced rectal cancer are more likely to suffer from side-effects related to chemotherapy. For treatment-related factors, patients undergoing intersphincteric resection have worse role function, body image and sexual interest. Preventive ileostomy results in the deterioration of role function, body image and sexual interest. Chemotherapy causes taste changes and chest pain. For postoperative complication, patients with anastomotic leakage have worse bowel function and psychological state. Patients with major low anterior resection syndrome and genitourinary dysfunction have worse global health score, social function and role function. In conclusion, short-term quality of life after sphincteric-saving surgery is acceptable. To improve QOL, specific intervention and guidance should be given to patients in this stage. Meanwhile, since many factors influence the quality of life simultaneously, researchers are confused about the questionnaire outcomes. Therefore, more specific and comprehensive tools are needed to evaluate QQL after sphincteric-saving surgery.


Assuntos
Canal Anal/cirurgia , Protectomia/efeitos adversos , Qualidade de Vida , Neoplasias Retais/cirurgia , Pesquisa Biomédica/normas , Feminino , Doenças Urogenitais Femininas/etiologia , Doenças Urogenitais Femininas/psicologia , Humanos , Ileostomia/psicologia , Masculino , Doenças Urogenitais Masculinas/etiologia , Doenças Urogenitais Masculinas/psicologia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/psicologia , Protectomia/métodos , Protectomia/psicologia , Inquéritos e Questionários
15.
Transplant Proc ; 52(5): 1388-1393, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32307139

RESUMO

Aiming to investigate the prevalence of chronic pain and its impact on quality of life of lung transplantation (LTx) recipients, we performed a transversal study collecting data using a standard interview model in 2 different periods: first, in 2016 we studied LTx recipients after 3 to 11 months of the transplantation; and second, in 2019, we studied the same patients after 39 to 55 months of transplantation surgery. The chosen questionnaires were the Brief Pain Inventory and Short-Form Health Survey. Chronic pain was identified in 47.2% of the analyzed recipients at the initial interview and in 40.7% at the second evaluation. In both periods, the domain quality of life was the most affected in contrast to functional capacity, which was the least affected. On the first analysis, a moderate negative correlation was found between pain intensity and functional capacity domains (-0,42/P = .010), pain (-0,46/P = .005), and mental health (-047/P = .004); meanwhile, the second survey showed a moderate/high negative correlation for most of the domains, except for the mental health (-0,036/P = .120). We conclude that the prevalence of chronic pain after LTx is high, and the pain intensity had a moderate negative correlation with domains such functional capacity, mental health, and pain at the first analysis in contrast to the moderate/high negative correlation for almost every domain, except mental health, at the second analysis.


Assuntos
Dor Crônica/etiologia , Dor Crônica/psicologia , Transplante de Pulmão/efeitos adversos , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/psicologia , Adulto , Dor Crônica/epidemiologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Prevalência , Qualidade de Vida/psicologia , Inquéritos e Questionários
16.
Facial Plast Surg Aesthet Med ; 22(3): 213-218, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32223570

RESUMO

Background: Understanding the multidimensional postoperative patient experience after rhinoplasty is critical for preoperative counseling and postoperative management. Methods: A prospective clinical study was conducted from June to December 2019 for 60 patients undergoing cosmetic and/or functional rhinoplasty by two facial plastic surgeons. All patients were administered the brief pain inventory, a clinically validated pain instrument, including multiple quality of life (QOL) domains, survey at postoperative days (PODs) 1, 2, 3, and 8. Nasal Obstruction Symptom Evaluation (NOSE) scores were used to predict patients having greatest QOL disturbance. Primary outcomes were postoperative QOL domains, pain scores, and oxycodone usage. Statistical analysis was performed using STATA 14.0 (STATA Corp., College Station, TX). Preoperative NOSE and postoperative Euro Quality of Life 5-Dimension scores were also recorded. Results: Patients showed greatest disruption to QOL in the first 3 PODs and essentially returned to normal levels by POD8, which mirrored trends in pain and opioid usage. All tested QOL domains (general activity, sleep, work, mood, enjoyment, and relationships) were strongly correlated with overall pain. NOSE scores were not significantly associated with pain or QOL impairment. Conclusions: This is the first study to prospectively evaluate the rhinoplasty patient's postoperative experience using a pain instrument, including multiple QOL domains. Utilizing a validated clinical instrument allows for standardized comparison of postrhinoplasty pain and QOL disruption with other surgical procedures and disease processes. These data may help guide preoperative counseling and set accurate patient expectations for the postoperative period.


Assuntos
Satisfação do Paciente , Qualidade de Vida , Rinoplastia/psicologia , Adulto , Feminino , Humanos , Masculino , Obstrução Nasal/psicologia , Medição da Dor , Complicações Pós-Operatórias/psicologia , Período Pós-Operatório , Estudos Prospectivos , Pesquisa Qualitativa , Inquéritos e Questionários , Avaliação de Sintomas
17.
Acta Neurol Scand ; 142(3): 216-220, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32198926

RESUMO

BACKGROUND: During the latest decades, the hypothesis that the subjective experience of free will is determined by preconscious activity in the dominant dorsal medial frontal cortex (dMFC) has repeatedly challenged our commonly held concepts of moral responsibility. AIMS OF THE STUDY: To investigate whether dMFC activity determines the sense of free will and to investigate the effects of resections in this area on quality of life (QoL). METHODS: A cohort of nine patients affected by transient declines in speech and movement skills after surgery involving the left dMFC answered questions about their post-operative, subjective experiences of volition in relation to symptoms. In eight cases, resections were performed as part of glioma surgery, and in the ninth case, a meningioma adjacent to the dMFC was resected. In addition, a QoL questionnaire was administrated before and after surgery. RESULTS: None of the patients perceived the transient disabilities related to surgery as associated with a loss or absence of volition. No declines in QoL were detected after surgery. Two QoL domains showed improved function (motor dysfunction and future uncertainty). CONCLUSIONS: The subjective sense of volition is not contingent on dMFC activity. Surgical resections of this area are not typically associated with declines in QoL.


Assuntos
Neoplasias Encefálicas/psicologia , Neoplasias Encefálicas/cirurgia , Lobo Frontal/cirurgia , Glioma/psicologia , Glioma/cirurgia , Adulto , Idoso , Estudos de Coortes , Avaliação da Deficiência , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos dos Movimentos/epidemiologia , Transtornos dos Movimentos/etiologia , Complicações Pós-Operatórias/psicologia , Desempenho Psicomotor , Qualidade de Vida , Distúrbios da Fala/epidemiologia , Distúrbios da Fala/etiologia , Inquéritos e Questionários , Volição
19.
J Laryngol Otol ; 134(3): 247-251, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32172693

RESUMO

OBJECTIVES: The primary goal of rhinoplasty is patient satisfaction and improved quality of life. The present study was conducted to assess patient satisfaction with face and nose appearance, and quality of life after rhinoplasty. METHODS: Patients presenting for rhinoplasty completed the FACE-Q survey. This is a new instrument that measures patient-reported outcomes in those undergoing aesthetic procedures. The FACE-Q scales include satisfaction with facial appearance overall, satisfaction with the nose, psychological well-being, psychosocial distress and social function. RESULTS: Sixty-five patients completed the FACE-Q at pre-operative and at post-operative follow-up visits. Post-operative scores increased significantly in terms of: satisfaction with facial appearance (p < 0.0001, t = 15.639, degrees of freedom = 64); social function (p < 0.0001, t = 12.208, degrees of freedom = 64); psychosocial distress (p < 0.0001, t = 13.864, degrees of freedom = 64); psychological function (p < 0.0001, t = 12.681, degrees of freedom = 64); and satisfaction with nose (p < 0.0001, t = 16.421, degrees of freedom = 64). Most patients reported more than 79 per cent satisfaction with the post-operative outcome. CONCLUSION: The FACE-Q is an adequate instrument for determining successful aesthetic surgery based on patient satisfaction.


Assuntos
Satisfação do Paciente , Complicações Pós-Operatórias/psicologia , Qualidade de Vida , Rinoplastia/psicologia , Estresse Psicológico/psicologia , Adolescente , Adulto , Imagem Corporal/psicologia , Face/cirurgia , Feminino , Humanos , Índia , Masculino , Nariz/cirurgia , Medidas de Resultados Relatados pelo Paciente , Complicações Pós-Operatórias/diagnóstico , Período Pós-Operatório , Estudos Prospectivos , Escalas de Graduação Psiquiátrica , Comportamento Social , Estresse Psicológico/diagnóstico , Resultado do Tratamento , Adulto Jovem
20.
Transplant Proc ; 52(3): 873-880, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32139276

RESUMO

BACKGROUND: Living donor liver transplantation (LDLT) is an accepted option for patients with end-stage liver disease. However, it potentially carries the risk of donor morbi-mortality, as well as long-term functional impairment. Cholecystectomy is performed routinely in the donor intervention, but the long-term effect on gastrointestinal (GI)-related quality of life (QoL) has never been explored previously. This study evaluated living donors' overall, abdominal wall-related, activity-level, and GI-related QoL. MATERIALS AND METHODS: In total, 21 living liver donors (LLD) (57% women, mean age 45 ± 9 years) were compared to a control group (29 patients) undergoing cholecystectomy for gallbladder polyps (45% women, mean age of 46 ± 7 years). LLD and controls (Ctl) were divided into 2 age groups: LLD-Y and Ctl-Y (25-45 years); and LLD-O and Ctl-O (46-65 years). Generic SF-36, Gastrointestinal Quality of Life Index, EuraHS for abdominal wall status assessment, and International Physical Activity Questionnaire were performed. Standard age-adjusted Portuguese population SF-36 scores were used. RESULTS: Global QoL results were better than Portuguese population scores and not inferior when compared to controls, scoring higher in the LLD-Y group in domains as vitality and mental health (P < .05). The abdominal wall impact was minimal among LLD. The activity level was significantly higher in LLD-Y than in Ctl-Y. Overall GI-related QoL was very close to the maximum score, and GI symptoms were significantly less in LLD-O compared with Ctl-O. CONCLUSION: LDLT had no impact on donors' general, abdominal wall-related QoL or activity level. The performance of cholecystectomy apparently had no impact on the development of GI-related symptoms.


Assuntos
Colecistectomia/efeitos adversos , Gastroenteropatias/psicologia , Doadores Vivos/psicologia , Complicações Pós-Operatórias/psicologia , Qualidade de Vida/psicologia , Coleta de Tecidos e Órgãos/efeitos adversos , Parede Abdominal , Adulto , Colecistectomia/métodos , Colecistectomia/psicologia , Feminino , Gastroenteropatias/etiologia , Humanos , Transplante de Fígado , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Coleta de Tecidos e Órgãos/métodos , Coleta de Tecidos e Órgãos/psicologia , Resultado do Tratamento
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA