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1.
Spine (Phila Pa 1976) ; 46(3): 184-190, 2021 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-33399438

RESUMO

STUDY DESIGN: Retrospective review. OBJECTIVE: The aim of this study was to examine the association between preoperative depression and patient satisfaction in the outpatient spine clinic after lumbar surgery. SUMMARY OF BACKGROUND DATA: The Clinician and Group Assessment of Healthcare Providers and Systems (CG-CAHPS) survey is used to measure patient experience in the outpatient setting. CG-CAHPS scores may be used by health systems in physician incentive programs and quality improvement initiatives or by prospective patients when selecting spine surgeons. Although preoperative depression has been shown to predict poor patient-reported outcomes and less satisfaction with the inpatient experience following lumbar surgery, its impact on patient experience with spine surgeons in the outpatient setting remains unclear. METHODS: Patients who underwent lumbar surgery and completed the CG-CAHPS survey at postoperative follow-up with their spine surgeon between 2009 and 2017 were included. Data were collected on patient demographics, Patient Health Questionnaire 9 (PHQ-9) scores, and Patient-Reported Outcome Measurement Information System Global Health Physical Health (PROMIS-GPH) subscores. Patients with preoperative PHQ-9 scores ≥10 (moderate-to-severe depression) were included in the depressed cohort. The association between preoperative depression and top-box satisfaction ratings on several dimensions of the CG-CAHPS survey was examined. RESULTS: Of the 419 patients included in this study, 72 met criteria for preoperative depression. Depressed patients were less likely to provide top-box satisfaction ratings on CG-CAHPS metrics pertaining to physician communication and overall provider rating (OPR). Even after controlling for patient-level covariates, our multivariate analysis revealed that depressed patients had lower odds of reporting top-box OPR (odds ratio [OR]: 0.19, 95% confidence interval [CI]: 0.06-0.63, P = 0.007), feeling that their spine surgeon provided understandable explanations (OR: 0.32, 95% CI: 0.11-0.91, P = 0.032), and feeling that their spine surgeon provided understandable responses to their questions or concerns (OR: 0.19, 95% CI: 0.06-0.63, P = 0.007). CONCLUSION: Preoperative depression is independently associated with lower OPR and satisfaction with spine surgeon communication in the outpatient setting after lumbar surgery.Level of Evidence: 3.


Assuntos
Procedimentos Cirúrgicos Ambulatórios/psicologia , Depressão/psicologia , Vértebras Lombares/cirurgia , Medidas de Resultados Relatados pelo Paciente , Satisfação do Paciente , Cuidados Pré-Operatórios/psicologia , Idoso , Procedimentos Cirúrgicos Ambulatórios/tendências , Depressão/complicações , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Cuidados Pós-Operatórios/psicologia , Cuidados Pós-Operatórios/tendências , Cuidados Pré-Operatórios/tendências , Estudos Prospectivos , Estudos Retrospectivos , Cirurgiões/psicologia , Cirurgiões/tendências , Inquéritos e Questionários
2.
Anaesthesia ; 76(1): 82-90, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32761611

RESUMO

Prehabilitation aims to increase the endurance capacity of patients who are awaiting major surgery. However, there are no studies investigating the implementation of this demanding and expensive intervention in low-income countries. This study aimed to assess the impact of a 4-week trimodal prehabilitation program on the physical and psychological health of patients waiting for colorectal surgery compared with a control group managed according to enhanced recovery after surgery principles supplemented by nutritional care. This study was a single-centre, randomised controlled trial. The primary outcome measures for the physical aspects were 6-minute walking distance (6MWD) and incentive spirometry, whereas the psychological elements were measured using the 36-item short form survey questionnaire and the hospital anxiety and depression score. In total, data from 149 patients were analysed (77 in the prehabilitation group and 72 in the control group). At the time of surgery, patients in the prehabilitation group had improved 6MWD and incentive spirometry compared with the control group (median (IQR [range]) percentage improvement 131% (112-173 [68-376]) vs. 107% (99-120 [63-163]); p < 0.001 and 113% (100-125 [75-200]) vs. 100% (100-112 [86-167]); p < 0.001 respectively). Patients in the prehabilitation group also had reduced anxiety scores compared with the control group (mean (SD) anxiety score (4 (3) vs. 5 (3) respectively; p = 0.032). However, these effects did not translate into improvements in postoperative mortality and morbidity, or a reduction in duration of hospital stay. Trimodal (physical, emotional and nutritional) prehabilitation is able to improve functional status as well as some parameters of emotional and physical well-being of patients waiting for colorectal surgery.


Assuntos
Cirurgia Colorretal/psicologia , Nível de Saúde , Saúde Mental , Cuidados Pré-Operatórios/métodos , Idoso , Idoso de 80 Anos ou mais , Ansiedade/prevenção & controle , Ansiedade/psicologia , Depressão/prevenção & controle , Depressão/psicologia , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Estado Nutricional , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/mortalidade , Cuidados Pré-Operatórios/psicologia , Espirometria , Inquéritos e Questionários , Resultado do Tratamento
3.
Rev. Hosp. Ital. B. Aires (2004) ; 40(4): 164-170, dic. 2020. tab
Artigo em Espanhol | LILACS | ID: biblio-1145436

RESUMO

Introducción: como profesionales de la salud hemos observado distintas conductas en los pacientes pediátricos, sin psicoprofilaxis, que ingresan para ser intervenidos quirúrgicamente de urgencia; pacientes que, según su edad, su entorno social, familiar y cultural, podrán manifestar dichas conductas interpretadas como estrés, de distintas maneras. Objetivo: se midió el estrés prequirúrgico de los niños que fueron intervenidos quirúrgicamente de urgencia, los sábados y domingos por Guardia, en el Hospital de Niños Sor María Ludovica en la ciudad de La Plata. Materiales y métodos: hemos realizado un estudio piloto de diseño observacional, descriptivo, de corte transversal, aplicando para la recolección de datos la escala de YALE modificada (EAPY-m). Resultados: reclutamos 16 pacientes, de los cuales 10 fueron varones (62,50%), que ingresaron para ser tratados quirúrgicamente por las especialidades de traumatología y cirugía general en partes iguales. La mediana en edad fue de 7 años y la mediana en escolarización obligatoria de 6 años. Dentro de la muestra obtenida, un 56,25% concurrían a la escuela primaria y el 25% se encontraban en la etapa preescolar. La mitad de los niños tomaron como referente a su madre como la persona que lo calma y que les gustaría que estuviese presente en el momento previo a la cirugía. La conjunción de los resultados obtenidos ha superado los valores referenciales mínimos para la medición del estrés prequirúrgico: un 80% de los niños sufría de estrés prequirúrgico. Conclusiones: el estrés prequirúrgico es un hecho presente en los pacientes pediátricos que han sido incluidos en la realización del estudio, quedando en evidencia que la cirugía es un factor estresante para los niños. (AU)


Introduction: As health professionals, we have observed different behaviors in pediatric patients, without psychoprophylaxis, who are admitted for emergency surgery; patients who, according to their age, their social, family and cultural environment may manifest such behaviors interpreted as stress, in different ways. Objective: Therefore, the general objective of our research was to measure the presurgical stress of children who would undergo emergency surgery, on Saturdays and Sundays by guard, at the Sor María Ludovica children's hospital in the city of La Plata. Materials and methods: We have conducted a pilot study of observational, descriptive, cross-sectional design; applying the modified YALE scale (EArPY-m) for data collection. Results: We recruited 16 patients of which 10 were male (62.50%), who were admitted to be treated surgically by the specialties of traumatology and general surgery in equal parts. The median in age was 7 years and the median in compulsory schooling was 6 years. Within the sample obtained 56.25% attended primary school and 25% were in the preschool stage. 50% of the participants indicated that the mother was the one who calms them when they are nervous; while 43.75% was the mother who would like to be present at the time before surgery. The combination of the results obtained has exceeded the minimum reference values for the measurement of presurgical stress, 80% of children suffered from presurgical stress. Conclusions: We conclude that presurgical stress is a fact present in pediatric patients who have been included in the study, making it clear that surgery is a stressful factor for children. (AU)


Assuntos
Humanos , Masculino , Feminino , Criança , Estresse Psicológico/etiologia , Procedimentos Cirúrgicos Operatórios/psicologia , Ansiedade/diagnóstico , Ansiedade/etiologia , Argentina , Estresse Psicológico/diagnóstico , Cuidados Pré-Operatórios/psicologia , Estudos Transversais , Procedimentos Cirúrgicos Ambulatórios/psicologia
4.
Medicine (Baltimore) ; 99(46): e23102, 2020 Nov 13.
Artigo em Inglês | MEDLINE | ID: mdl-33181675

RESUMO

BACKGROUND: Colonoscopy is considered a safe and effective tool for detecting colorectal cancer. Nevertheless, the proportion of patients are hesitating to receive colonoscopy. Smartphone education may decrease the barrier of colonoscopy. The aim of this study is to examine the effectiveness of smartphone education in colonoscopy. METHODS: We conducted a prospective, double-blinded, randomized, controlled study to examine the effectiveness of smartphone education on embarrassment, bowel preparation, and satisfaction in colonoscopy. The patients' embarrassment was measured by the colonoscopy embarrassment scale. The quality of the bowel preparation was evaluated by gastroenterologists according to the Aronchik Scale. The satisfaction of colonoscopy care was assessed by a satisfaction scale developed by the authors. RESULTS: A total of 150 patients were analyzed in the smartphone education and control groups (n = 75 in each group). The smartphone education group reported fewer embarrassment (B = -2.78, P = .02) than those of the control group, the patients who were older (B = .15, P = .001) and who were male (B = 2.91, P = .003) showed higher embarrassment. Additionally, smartphone education group were likely to have better colon preparation (odds ratio = 2.46, 95% confidence interval: 1.20-5.02) than that of the control group. Smartphone education also improved the satisfaction with care (ß = 4.60, P < .001), and above normal body mass index decreased the satisfaction with care (ß = -0.19, P < .05). CONCLUSION: Smartphone education improves embarrassment, bowel preparation, and satisfaction with care in patients receiving colonoscopy.


Assuntos
Colonoscopia/psicologia , Neoplasias Colorretais/diagnóstico , Instrução por Computador , Cooperação do Paciente/psicologia , Cuidados Pré-Operatórios , Smartphone , Colonoscopia/métodos , Instrução por Computador/instrumentação , Instrução por Computador/métodos , Método Duplo-Cego , Constrangimento , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde , Educação de Pacientes como Assunto/métodos , Satisfação Pessoal , Cuidados Pré-Operatórios/métodos , Cuidados Pré-Operatórios/psicologia
6.
Spine (Phila Pa 1976) ; 45(15): 1067-1072, 2020 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-32675614

RESUMO

STUDY DESIGN: Cross-sectional, pre-post patient survey. OBJECTIVE: The aim of this study was to determine what factors affect a patient's decision to undergo elective surgery following a surgical consultation. SUMMARY OF BACKGROUND DATA: The surgical consultation is an important step in selecting and preparing patients for elective surgery. Despite the proven effectiveness and low risk of complications, many spine procedure candidates may still choose to forgo surgery after an appropriate discussion and clear surgical indications. METHODS: Survey and open-response questions regarding pre- and post-consultation surgical concerns and overall willingness to undergo surgery were collected and analyzed from 124 patients deemed surgical candidates. Demographics, surgical willingness, and patient concerns were analyzed. Open-ended response data were tallied for surgical concerns and responses were analyzed line-by-line to assess for main themes. Sub-analysis was included on patients who reconsidered their willingness post-consultation. RESULTS: Qualitative thematic analysis of patient's concerns regarding surgery uncovered six major themes: Interference on quality of life (QOL), fear, physical concerns, success, risk, and concerns regarding the surgeon (CS). Success and risk were most commonly mentioned pre-consultation (27%, 26%); risk and QOL were most commonly mentioned post-consultation (22%, 21%). Of 124 patients, 103 were willing to have surgery before consultation and remained willing post-consultation; six patients became unwilling. Twenty-one patients were unwilling to consider surgery before consultation; only five remained unwilling. No differences were found between degenerative and deformity patients regarding initial willingness or changes thereafter. CONCLUSION: The decision to undergo surgery is a multifactorial and complex process with a variety of patient concerns. We grouped these concerns into six categories to aid in future discussion with patients. 87% of patients have made up their mind before attending their surgical consultation. Appropriate understanding of patient-specific willingness and concerns should help facilitate necessary discussion and aid in a more efficient and useful shared decision-making process. LEVEL OF EVIDENCE: 4.


Assuntos
Tomada de Decisão Clínica/métodos , Relações Médico-Paciente , Cuidados Pré-Operatórios/métodos , Cuidados Pré-Operatórios/psicologia , Cirurgiões/psicologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Estudos Transversais , Procedimentos Cirúrgicos Eletivos/métodos , Procedimentos Cirúrgicos Eletivos/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Encaminhamento e Consulta , Inquéritos e Questionários , Adulto Jovem
7.
J Wound Ostomy Continence Nurs ; 47(2): 137-139, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32150139

RESUMO

PURPOSE: The purpose of this study was to determine if patients undergoing presurgical ostomy education and routine postoperative education experienced less postsurgical anxiety than patients undergoing routine preoperative education. DESIGN: Quantitative, prospective, comparison cohort study. SUBJECTS AND SETTING: The sample comprised 30 participants divided into 2 groups; one group received preoperative ostomy education and stoma site marking, along with postoperative ostomy education, while the other received only postoperative ostomy education. Each group had an equal number of males (n = 11) and females (n = 4). The mean age for the groups was 65.27 (SD = 9.97) and 61.87 (SD = 17.56) years, respectively; this difference was not statistically significant (P > .05). The intervention group included 9 patients who underwent colostomy, 4 who underwent ileostomy, and 2 who underwent urostomy. The comparison group comprised 10 patients with colostomies, 4 with ileostomies, and 1 with a urostomy. The study setting was a 385-bed tertiary hospital in Northern California. Data collection occurred from November 2, 2018, to February 22, 2019. METHODS: Postoperative anxiety levels were evaluated in both groups during their postoperative ostomy education session. Anxiety level was measured using the anxiety domain of the Hospital Anxiety and Depression Survey (HADS), which was administered during their postoperative educational session. Analysis of variance was used to compare the difference between the HADS anxiety domain scores between the groups. RESULTS: Patients who received preoperative ostomy education had statistically significant lower postsurgical anxiety scores than patients who had standard education (P < .001). CONCLUSIONS: Study findings suggest that preoperative ostomy education, when offered in addition to routine preoperative education, significantly lowers anxiety when compared to patients managed by routine preoperative education alone.


Assuntos
Ansiedade/prevenção & controle , Estomia/métodos , Educação de Pacientes como Assunto/normas , Cuidados Pré-Operatórios/psicologia , Idoso , Ansiedade/psicologia , California , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Educação de Pacientes como Assunto/métodos , Cuidados Pré-Operatórios/métodos , Cuidados Pré-Operatórios/normas , Estudos Prospectivos , Qualidade de Vida/psicologia , Inquéritos e Questionários
8.
Clin Exp Hypertens ; 42(6): 553-558, 2020 Aug 17.
Artigo em Inglês | MEDLINE | ID: mdl-32009491

RESUMO

PURPOSE: Anxiety is one of the most important causes of hypertension, increasing direct blood pressure and affecting postoperative morbidity and mortality. The aim of this study was to investigate the effects of showing the operating room on preoperative anxiety and hemodynamics among patients with hypertension. METHODS: We enrolled 90 patients with hypertension undergoing cholecystectomy in this trial. Patients were randomly divided into two groups using a sealed-envelope system. Group STOR was shown the operating room the day before surgery, while Group No STOR was not shown the operating room. RESULTS: State-Trait Anxiety Inventory scores measured on the day of surgery were lower for Group STOR (43.2 ± 6.0) than Group No STOR (49.8 ± 7.9) (p = .001). Systolic (p = .001, p = .006, respectively), diastolic (p = .001, p = .004, respectively), and heart rate (p = .018, p = .031, respectively) values in the operation room and preoperative unit were lower in Group STOR than in Group No STOR. The number of postponed operations in Group STOR was lower than in Group No STOR (p = .043), and the patient satisfaction score in Group STOR was higher than in Group No STOR (p = .031). CONCLUSION: In patients with hypertension, preoperative anxiety, blood pressure, heart rate, and respiratory rate all increase in the preoperative unit and operation room. Our findings indicate that showing the operating room to patients with hypertension decreases preoperative anxiety, as well as blood pressure and heart rate inside the operating room and preoperative unit. It also reduces the number of postponed operations and increases patient satisfaction.


Assuntos
Ansiedade , Colecistectomia , Hemodinâmica , Hipertensão , Salas Cirúrgicas , Cuidados Pré-Operatórios , Ansiedade/etiologia , Ansiedade/fisiopatologia , Ansiedade/prevenção & controle , Colecistectomia/métodos , Colecistectomia/psicologia , Informação de Saúde ao Consumidor/métodos , Feminino , Humanos , Hipertensão/fisiopatologia , Hipertensão/prevenção & controle , Hipertensão/psicologia , Masculino , Pessoa de Meia-Idade , Preferência do Paciente , Cuidados Pré-Operatórios/métodos , Cuidados Pré-Operatórios/psicologia
9.
A A Pract ; 14(5): 140-143, 2020 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-31904626

RESUMO

A 32-year-old man undergoing awake craniotomy for tumor resection was previously diagnosed with post-traumatic stress disorder (PTSD)-typically a relative contraindication for awake craniotomy. Preoperative neurocognitive assessment and counseling by a neuroanesthesiologist and neuropsychologist were undertaken to characterize his PTSD, identify triggers, and prepare him for the intraoperative events. Dexmedetomidine and remifentanil were used as intraoperative anxiolytics and analgesics. With an emphasis on open communication, the patient tolerated the awake craniotomy without complications. This case highlights the importance of multidisciplinary approach and meticulous perioperative preparation in successfully managing a patient who might otherwise be contraindicated for awake craniotomy.


Assuntos
Neoplasias Encefálicas/cirurgia , Sedação Consciente/métodos , Cuidados Pré-Operatórios/psicologia , Transtornos de Estresse Pós-Traumáticos/psicologia , Adulto , Craniotomia/psicologia , Dexmedetomidina/administração & dosagem , Humanos , Masculino , Remifentanil/administração & dosagem , Resultado do Tratamento
10.
BJOG ; 127(6): 738-745, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-31957130

RESUMO

OBJECTIVES: To evaluate the impact of preoperative Music Therapy (MT) on pain in first-trimester termination of pregnancy (TOP) under local anaesthesia. DESIGN: Randomised controlled trial comparing women undergoing a first-trimester TOP under local anaesthesia with or without a preoperative MT session. SETTING: University Hospital of Angers from November 2016 to August 2017. POPULATION: Women who underwent first-trimester TOP under local anaesthesia. METHODS: Women allocated to the MT group underwent a preoperative 20-minute session of MT. MAIN OUTCOME MEASURES: Pain was assessed using a visual analogue scale (VAS) just before the procedure, during the procedure, at the end of the procedure and upon returning to the ward. RESULTS: A total of 159 women were randomised (80 in the MT group, and 79 in the control group). Two women were excluded from the control group and six from the MT group. Therefore, 77 women were analysed in the control group and 74 in the MT group. The intensity of pain was similar in the two groups just before the procedure (VAS 4.0 ± 2.9 versus 3.6 ± 2.5; P = 0.78), during the procedure (VAS 5.3 ± 2.5 versus 4.9 ± 2.9; P = 0.78), at the end of the procedure (VAS 2.7 ± 2.4 versus 2.6 ± 2.4; P = 0.43) and upon returning to the ward (VAS 1.8 ± 2.0 versus 1.5 ± 2.0; P = 0.84). The difference in pain between entering the department and returning to the room after the procedure was similar between the MT and control groups (difference in VAS 0.3 ± 2.5 versus 0.3 ± 2.4; P = 0.92). CONCLUSION: An MT session before a TOP under local anaesthesia procedure resulted in no improvement in patient perception of pain during a first-trimester TOP. TWEETABLE ABSTRACT: Music therapy before first-trimester termination of pregnancy under local anaesthesia did not improve the perception of pain.


Assuntos
Aborto Induzido/efeitos adversos , Musicoterapia/métodos , Dor Pós-Operatória/prevenção & controle , Primeiro Trimestre da Gravidez/psicologia , Cuidados Pré-Operatórios/métodos , Aborto Induzido/métodos , Aborto Induzido/psicologia , Adulto , Anestesia Local , Feminino , Humanos , Medição da Dor , Dor Pós-Operatória/etiologia , Dor Pós-Operatória/psicologia , Gravidez , Cuidados Pré-Operatórios/psicologia , Resultado do Tratamento
11.
BMC Musculoskelet Disord ; 21(1): 42, 2020 Jan 18.
Artigo em Inglês | MEDLINE | ID: mdl-31954407

RESUMO

BACKGROUND: Carpal tunnel syndrome is a common upper-limb nerve compression disease. Carpal tunnel syndrome can lead to several symptoms such as tingling or numbness, pain in the hand or wrist, and reduced grip strength. Based on demographic characteristics, patient reported outcome measures, and with special attention to pain catastrophizing, the purpose of this study was to identify risk factors for low patient-reported satisfaction following surgical treatment of idiopathic carpal tunnel syndrome. METHODS: A total of 417 hands from 417 patients (64. 5% females) with a mean age of 58. 0 years were included in this 1-year prospective follow-up study. We collected preoperative data on disability using the Disability of the Arm, Shoulder and Hand questionnaire (DASH), quality of life using the EuroQol-5D (EQ-5D), pain catastrophizing using the Pain Catastrophizing Scale (PCS) and distal motor latency. Data on DASH score, EQ-5D, and patient satisfaction was collected 12 months postoperatively. Wilcoxon matched-pairs signed-rank test was used to test for difference in preoperative and postoperative DASH and EQ-5D score. Risk factors for low postoperative patient reported satisfaction was examined using stepwise multiple logistic regression analysis. RESULTS: We found a general improvement in patients' DASH scores (12.29 [95% CI: 10.65-13.90], p < 0.001) and EQ-5D (0.14 [95% CI: 0.13-0.16], p < 0.001) from preoperative to 12 months postoperative. In the fully adjusted multiple regression analysis we found a statistically significant effect of preoperative PCS on patient reported satisfaction with OR = 1.05 (p = 0.022), for a one unit increase in preoperative PCS. There was no statistically significant predictive effect of preoperative EQ-5D (p = 0.869), DASH (p = 0.076), distal motor latency (p = 0.067), age (p = 0.505) or gender (p = 0.222). CONCLUSIONS: Patients improved in both DASH and EQ-5D from preoperative to 12 months postoperative. Higher preoperative PCS seems to have a negative effect on postoperative patient reported satisfaction after carpal tunnel release.


Assuntos
Síndrome do Túnel Carpal/psicologia , Catastrofização/psicologia , Medição da Dor/psicologia , Satisfação do Paciente , Cuidados Pré-Operatórios/psicologia , Síndrome do Túnel Carpal/diagnóstico , Síndrome do Túnel Carpal/cirurgia , Catastrofização/diagnóstico , Catastrofização/cirurgia , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor/métodos , Cuidados Pré-Operatórios/métodos , Estudos Prospectivos , Fatores de Risco , Resultado do Tratamento
12.
Gynecol Obstet Invest ; 85(2): 178-183, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31940645

RESUMO

INTRODUCTION: Nowadays, the resection of submucosal myomas is usually performed by hysteroscopy. No previous study has investigated the use of preoperative hormonal therapy before outpatient hysteroscopic myomectomy. OBJECTIVE: To compare the usefulness of 3-month preoperative treatment with ulipristal acetate (UPA) before outpatient hysteroscopic myomectomy in patients with FIGO (International Federation of Gynecology and Obstetrics) type 0-1 myomas. STUDY DESIGN: This prospective patient preference study included women requiring hysteroscopic resection of single FIGO type 0-1 myoma with the largest diameter <2 cm. Patients underwent either preoperative treatment with UPA (5 mg/day) for 3 months or direct surgery. Outpatient myomectomy was performed using the bipolar electrosurgical Versapoint system (Ethicon Gynecare, USA). The primary objective of the study was to compare the rate of complete resections in the 2 study groups. The secondary objective of the study was to compare the operative time and the volume of fluid infused/absorbed. The tertiary objective of the study was to assess the surgical appearance of the myomas in patients treated with UPA. RESULTS: The study included 38 women treated with UPA and 45 women who underwent direct surgery. UPA treatment significantly decreased the volume of uterine myomas (p < 0.001). The percentage of complete resection was higher in patients treated with UPA (89.5%) than in those who underwent direct surgery (68.9%; p = 0.046). Preoperative UPA treatment decreased the operative time (p < 0.001) and the volume of fluid infused (p = 0.016), but it did not significantly affect the volume of fluid absorbed (p = 0.874). The texture of the myoma was not significantly affected by UPA treatment (p = 0.142). CONCLUSIONS: Three-month UPA treatment improves the chance of single-step complete outpatient hysteroscopic resection of single FIGO type 0-1 myoma. Future randomized studies with a larger sample size should confirm these preliminary findings.


Assuntos
Contraceptivos Hormonais/administração & dosagem , Histeroscopia/métodos , Leiomioma/terapia , Norpregnadienos/administração & dosagem , Cuidados Pré-Operatórios/métodos , Miomectomia Uterina/métodos , Neoplasias Uterinas/terapia , Adulto , Procedimentos Cirúrgicos Ambulatórios/métodos , Terapia Combinada , Feminino , Humanos , Pessoa de Meia-Idade , Duração da Cirurgia , Preferência do Paciente , Gravidez , Cuidados Pré-Operatórios/psicologia , Estudos Prospectivos , Resultado do Tratamento
13.
Anesthesiology ; 132(1): 159-169, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31770142

RESUMO

BACKGROUND: Compassionate behavior in clinicians is described as seeking to understand patients' psychosocial, physical and medical needs, timely attending to these needs, and involving patients as they desire. The goal of our study was to evaluate compassionate behavior in patient interactions, pain management, and the informed consent process of anesthesia residents in a simulated preoperative evaluation of a patient in pain scheduled for urgent surgery. METHODS: Forty-nine Clinical Anesthesia residents in year 1 and 16 Clinical Anesthesia residents in year 3 from three residency programs individually obtained informed consent for anesthesia for an urgent laparotomy from a standardized patient complaining of pain. Encounters were assessed for ordering pain medication, for patient-resident interactions by using the Empathic Communication Coding System to code responses to pain and nausea cues, and for the content of the informed consent discussion. RESULTS: Of the 65 residents, 56 (86%) ordered pain medication, at an average of 4.2 min (95% CI, 3.2 to 5.1) into the encounter; 9 (14%) did not order pain medication. Resident responses to the cues averaged between perfunctory recognition and implicit recognition (mean, 1.7 [95% CI, 1.6 to 1.9]) in the 0 (less empathic) to 6 (more empathic) system. Responses were lower for residents who did not order pain medication (mean, 1.2 [95% CI, 0.8 to 1.6]) and similar for those who ordered medication before informed consent signing (mean, 1.9 [95% CI, 1.6 to 2.1]) and after signing (mean, 1.9 [95% CI, 1.6 to 2.0]; F (2, 62) = 4.21; P = 0.019; partial η = 0.120). There were significant differences between residents who ordered pain medication before informed consent and those who did not order pain medication and between residents who ordered pain medication after informed consent signing and those who did not. CONCLUSIONS: In a simulated preoperative evaluation, anesthesia residents have variable and, at times, flawed recognition of patient cues, responsiveness to patient cues, pain management, and patient interactions.


Assuntos
Anestesiologia/educação , Empatia , Consentimento Livre e Esclarecido/psicologia , Internato e Residência/métodos , Relações Médico-Paciente , Cuidados Pré-Operatórios/psicologia , Anestesiologia/métodos , Competência Clínica/estatística & dados numéricos , Feminino , Humanos , Masculino , Simulação de Paciente , Cuidados Pré-Operatórios/métodos
14.
Support Care Cancer ; 28(8): 3945-3953, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31863214

RESUMO

PURPOSE: Time for preoperative optimisation prior to colorectal cancer surgery is limited and older people tend to decline exercise interventions. This study sought to describe attitudes towards, and perceptions of, preoperative physical activity and exercise in older people prior to colorectal cancer surgery. METHODS: This is a qualitative interview study, analysed with inductive content analysis. Seventeen participants scheduled for colorectal surgery were recruited as a purposeful sample from two hospitals in Stockholm, Sweden. Individual semi-structured interviews were conducted, face-to-face (n = 8) or by telephone (n = 9). RESULTS: Nine participants were male, median age was 75 years (range 70-91). The theme, 'a gap between awareness and action', was identified based on two main categories: 'Attitudes towards preoperative physical exercise have a multifactorial base' and 'Preoperative physical exercise is possible with a push in the right direction'. The material described a gap between awareness of the benefits of physical activity and reports of performing physical activity. The reasons for the gap between thoughts and action in this respect seem to be multifactorial. Support from others emerged as an important possibility for overcoming the gap. CONCLUSIONS: A gap between the patients' awareness and action appeared in our material. Understanding this can guide healthcare professionals (HCPs) as to the support needed preoperatively. Advice on physical exercise before surgery should be specific, and individually tailored support for action should be offered. This support should also consider the individual's current physical activity and preoperative attitude towards physical exercise.


Assuntos
Atitude Frente a Saúde , Neoplasias Colorretais/psicologia , Terapia por Exercício/psicologia , Exercício Físico/psicologia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Neoplasias Colorretais/cirurgia , Terapia por Exercício/métodos , Humanos , Masculino , Cuidados Pré-Operatórios/métodos , Cuidados Pré-Operatórios/psicologia , Pesquisa Qualitativa , Suécia
15.
Spine (Phila Pa 1976) ; 45(10): 649-656, 2020 May 15.
Artigo em Inglês | MEDLINE | ID: mdl-31809467

RESUMO

STUDY DESIGN: Retrospective review of prospectively-collected registry data. OBJECTIVE: To compare the patient-reported outcomes, satisfaction, and return to work among a large cohort of patients stratified by preoperative myelopathy severity undergoing Anterior Cervical Discectomy and Fusion (ACDF) for Degenerative Cervical Myelopathy. SUMMARY OF BACKGROUND DATA: Recent clinical practice guidelines noted a lack of studies stratifying their sample based on preoperative disease severity. The benefits of early surgical intervention for patients with mild myelopathy remain uncertain. METHODS: A prospectively-maintained registry was retrospectively reviewed for all patients who underwent primary ACDF for Degenerative Cervical Myelopathy. Patients were stratified based on severity of preoperative myelopathy symptoms according to the Japanese Orthopaedic Association (JOA) scale: mild (>13), moderate (9-13), or severe (<9). Patients were prospectively followed for at least 2 years. RESULTS: In total, 219 patients were included: 74 mild, 94 moderate, and 51 severe cases. The mild group had significantly better Neurogenic Symptoms (NS), Neck Disability Index (NDI), SF-36 Physical (PCS), and Mental Component Summary at baseline (P < 0.05). Neck and arm pain scores were similar at all time points. At 2 years, the severe group still had significantly worse patient-reported outcomes and lower rates of satisfaction, expectation fulfilment and return to work. However, they had significantly greater improvement in JOA, Neurogenic Symptoms, NDI, PCS, and Mental Component Summary, and a larger proportion attained minimal clinically important difference (MCID) for NDI and PCS. All three groups had similar proportions attaining MCID for JOA. CONCLUSION: Patients with severe myelopathy experienced a greater improvement after ACDF. Although fewer patients attained MCID, early surgical intervention for patients with mild myelopathy should also be considered, as this may allow patients to maintain their higher functional status. They also had high rates of postoperative satisfaction and return to work. The clinical trajectory outlined in this study may provide valuable prognostic information for patients. LEVEL OF EVIDENCE: 3.


Assuntos
Discotomia/psicologia , Satisfação do Paciente , Cuidados Pré-Operatórios/psicologia , Retorno ao Trabalho/psicologia , Doenças da Medula Espinal/psicologia , Fusão Vertebral/psicologia , Adulto , Idoso , Vértebras Cervicais/cirurgia , Discotomia/tendências , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cervicalgia/psicologia , Cervicalgia/cirurgia , Cuidados Pré-Operatórios/tendências , Estudos Prospectivos , Estudos Retrospectivos , Retorno ao Trabalho/tendências , Índice de Gravidade de Doença , Doenças da Medula Espinal/cirurgia , Fusão Vertebral/tendências , Resultado do Tratamento
16.
Neurosurgery ; 86(6): 778-782, 2020 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-31504831

RESUMO

BACKGROUND: Unrealistic expectations of the outcomes of peripheral nerve surgery reduce patient satisfaction. Most clinicians can recall patients with unrealistic expectations despite verbal preoperative education. OBJECTIVE: To assess patients' baseline level of understanding regarding nerve surgery and appropriate expectations. Additionally, we tested the effect of a written, preoperative educational handout on the patients' retention of knowledge. METHODS: This cross-sectional survey recruited patients scheduled to undergo peripheral nerve surgery at a single institution in 2016 to 2017. During the preoperative visit, a specialized nurse practitioner reviewed perioperative protocols, risks and benefits of the surgery, and postoperative care. Patients immediately completed a survey to assess their preoperative understanding of the verbally reviewed information. During the same visit, an additional written handout was given to patients in a randomized fashion. At their first postoperative visit, all patients completed the survey again. RESULTS: A total of 60 patients (mean age 52 yr) were enrolled of which 62% were male. Immediately following verbal instruction, 31% of patients had erroneous (unrealistic) expectations regarding pain, 30% had erroneous expectations regarding postoperative motor outcome, and 41% had erroneous expectations regarding the timing of postoperative recovery. There was no significant difference between patients who received the written handout vs those who did not, on retesting in the postoperative period. CONCLUSION: Patients undergoing peripheral nerve procedures demonstrated a high baseline level of unrealistic expectations despite standard in-person verbal counseling by specialty providers. A written handout did not have clear benefit in the retention of preoperative surgical teaching. Further investigation into more effective preoperative patient counseling is needed.


Assuntos
Motivação , Procedimentos Neurocirúrgicos/psicologia , Satisfação do Paciente , Cuidados Pré-Operatórios/psicologia , Inquéritos e Questionários , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Motivação/fisiologia , Procedimentos Neurocirúrgicos/métodos , Cuidados Pós-Operatórios/métodos , Cuidados Pós-Operatórios/psicologia , Cuidados Pré-Operatórios/métodos , Adulto Jovem
17.
Spine (Phila Pa 1976) ; 45(4): E236-E243, 2020 Feb 15.
Artigo em Inglês | MEDLINE | ID: mdl-31513117

RESUMO

STUDY DESIGN: Retrospective. OBJECTIVE: To demonstrate whether preoperative mental health status can be predictive of postoperative functional outcomes as measured by Patient-Reported Outcome Measurement Information System Physical Function (PROMIS PF) following minimally invasive transforaminal lumbar interbody fusion (MIS TLIF). SUMMARY OF BACKGROUND DATA: There is a paucity of scientific investigations into the association between preoperative mental health as evaluated by a validated questionnaire such as the Short Form-12 Mental Health Composite Score (SF-12 MCS) and postoperative outcomes following MIS TLIF. METHODS: Patients undergoing a primary MIS TLIF were retrospectively reviewed and stratified into cohorts based on preoperative SF-12 MCS scores. The Physical Function scores of PROMIS, of which there are other domains including Pain Interference, Sexual Function, and Cognitive Function, were compared between the cohorts. In addition, the improvement in PROMIS scores based on preoperative SF-12 MCS scores following MIS TLIF was analyzed using multivariate linear regression. RESULTS: One hundred seventy-two patients were included: 85 patients (49.4%) had a preoperative SF-12 MCS score <50 and 87 (50.6%) had a preoperative SF-12 MCS score ≥50. Patients with poorer mental health demonstrated significantly worse PROMIS PF scores preoperatively (33.8 vs. 36.5, P < 0.001), as well as at all postoperative timepoints: 6-weeks (35.1 vs. 38.4, P < 0.001), 3-months (38.9 vs. 42.9, P < 0.001), 6-months (41.4 vs. 45.5, P < 0.001), and 1-year (42.4 vs. 47.6, P < 0.001). However, at the 1-year timepoint, patients with worse mental health reported experiencing significantly less improvement from baseline (postoperative change of 8.6 vs. 11.1, P = 0.002). CONCLUSION: Patients with worse preoperative mental health not only demonstrated worse preoperative PROMIS PF scores, but also continued to have significantly worse postoperative outcomes. However, the postoperative improvement experienced by patients was similar in the short-term following surgery regardless of preoperative mental health status. Patients with poor mental health experienced significantly less postoperative improvement only at the 1-year timepoint. LEVEL OF EVIDENCE: 3.


Assuntos
Vértebras Lombares/cirurgia , Saúde Mental/normas , Procedimentos Cirúrgicos Minimamente Invasivos/psicologia , Medidas de Resultados Relatados pelo Paciente , Cuidados Pré-Operatórios/psicologia , Fusão Vertebral/psicologia , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/tendências , Cuidados Pré-Operatórios/tendências , Estudos Prospectivos , Estudos Retrospectivos , Fusão Vertebral/tendências , Inquéritos e Questionários , Resultado do Tratamento
18.
Anesth Analg ; 130(4): 991-1001, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-30633058

RESUMO

BACKGROUND: Perioperative music interventions have been shown to reduce anxiety and pain in adults. This inexpensive, easily applicable intervention could be of benefit to children as well. Our objective was to determine the effects of music interventions on distress, anxiety, and postoperative pain in infants undergoing surgery. METHODS: The Music Under Surgery In Children study was designed as a parallel, single-blind, randomized controlled trial with an a priori formulated hypothesis. Data were collected between August 2015 and October 2016 in a single tertiary care children's hospital. There was a 24-hour follow-up with blind primary outcome assessment. A random sample of 432 eligible 0-3 years of age infants admitted for orchidopexy, hypospadias, or inguinal hernia repair receiving general anesthesia and caudal block were asked for participation. Subjects were assigned to a preoperative music intervention, pre- and intraoperative music intervention, or no music intervention (control) via random allocation using a computer-generated list with the use of opaque envelopes. The main outcome measure was the postoperative level of distress assessed with the COMFORT-Behavior scale, which is an observational scale; furthermore, preoperative level of distress, preoperative anxiety, and physiological measurements such as heart rate (HR) and blood pressure were measured. The trial was registered at the Dutch Trial Register, number NTR5402 (www.trialregister.nl). RESULTS: One hundred ninety-five infants with median age 6.9 months (interquartile range, 3.3-11.1) were randomized, 178 of whom were included in the primary analysis. A nonsignificant difference in COMFORT-Behavior scale scores between the pre- and intraoperative music intervention group and control group at 4 hours after surgery was found (mean difference, -1.22; 95% CI, 2.60-0.17; P = .085). Additional analysis showed weak nonsignificant evidence for an interaction effect between music exposure and COMFORT-Behavior score at baseline (P = .027 with a Bonferroni-adjusted significance level of .025). General linear modeling showed a statistically significantly reduced HR after the preoperative music intervention in the holding area in the combined preoperative music intervention and intraoperative music intervention group compared to the control group (P = .003). The differences in HR among the 3 study arms at all time points were not statistically significant (P = .069). CONCLUSIONS: Music interventions do not seem to benefit all young infants undergoing surgery. The potential benefits of music interventions in the preoperative period and in more distressed children warrant further exploration.


Assuntos
Cuidados Intraoperatórios/métodos , Cuidados Intraoperatórios/psicologia , Musicoterapia , Anestesia , Ansiedade/prevenção & controle , Ansiedade/psicologia , Pressão Sanguínea , Comportamento Infantil , Pré-Escolar , Feminino , Frequência Cardíaca , Humanos , Lactente , Masculino , Conforto do Paciente , Cuidados Pré-Operatórios/métodos , Cuidados Pré-Operatórios/psicologia , Método Simples-Cego , Resultado do Tratamento
19.
Obes Surg ; 30(1): 238-243, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31377993

RESUMO

BACKGROUND: Esophagogastroduodenoscopy is a preoperative examination commonly required for candidates to bariatric surgery (BS). Overweight individuals have a greater risk of cardiorespiratory complications during endoscopy under sedation. This study aimed to investigate the feasibility, tolerance, and cardiovascular stress of transnasal endoscopy (TNE) without sedation in obese patients eligible for BS. METHODS: This prospective study enrolled obese adult patients with indication for BS that consented to undergo unsedated preoperative TNE. All examinations were carried out in an outpatient center. The outcomes assessed were endoscopic findings, procedural success, patients' tolerance according to a visual analogic scale, cardiovascular stress estimated by double product (i.e., systolic blood pressure × heart rate) and adverse events. Statistical analyses were used to compare each patient's double product among different examination periods. RESULTS: Ninety-four patients (77.6% female) completed the study, with an average body mass index (BMI) of 53 kg/m2 (range, 35-73.4 kg/m2). There were 63 super-obese individuals (67%), with BMI > 50 kg/m2. In 93 patients (98.9%), unsedated TNE was successfully completed up to the second part of the duodenum. TNE failed in one patient. Tolerance was rated as excellent or good in 95.7%. Minimal cardiovascular stress was noted in obese individuals, whereas the double product remained stable throughout the procedure in super-obese patients. Three patients (3.2%) had self-limited epistaxis. CONCLUSIONS: Unsedated TNE for preoperative endoscopic evaluation of obese patients is feasible, safe, and well tolerated and should be preferentially considered when examining super-obese patients.


Assuntos
Cirurgia Bariátrica , Endoscopia do Sistema Digestório/métodos , Nariz/diagnóstico por imagem , Obesidade Mórbida/diagnóstico , Obesidade Mórbida/cirurgia , Cuidados Pré-Operatórios/métodos , Adulto , Idoso , Cirurgia Bariátrica/métodos , Fenômenos Fisiológicos Cardiovasculares , Endoscopia do Sistema Digestório/psicologia , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade Mórbida/fisiopatologia , Satisfação do Paciente , Cuidados Pré-Operatórios/psicologia , Prognóstico , Estresse Fisiológico/fisiologia , Escala Visual Analógica
20.
Rev Col Bras Cir ; 46(5): e20192267, 2019.
Artigo em Português, Inglês | MEDLINE | ID: mdl-31778394

RESUMO

Surgical approach is the main form of treatment for several diseases of the abdominal cavity. However, surgical procedure itself is a stressor that may lead to adverse effects unrelated to the treatment goal. Prehabilitation has emerged as a multifactorial preoperative health conditioning program, which promotes improvement in functional capacity and postoperative evolution. The present study reviews literature using MEDLINE, Ovid, Google Scholar, and Cochrane databases in order to determine the concept of prehabilitation program and the indications and means of patient selection for it, as well as to suggest ways to implement this program in cases of major abdominal surgeries.


Assuntos
Abdome/cirurgia , Procedimentos Cirúrgicos Eletivos , Complicações Pós-Operatórias/prevenção & controle , Cuidados Pré-Operatórios/métodos , Procedimentos Cirúrgicos Eletivos/psicologia , Exercício Físico , Feminino , Humanos , Masculino , Apoio Nutricional , Período Pós-Operatório , Cuidados Pré-Operatórios/psicologia , Psicoterapia , Recuperação de Função Fisiológica , Fatores de Risco
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