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BMC Cancer Dec 2023Prehabilitation and recovery programmes aim to optimise patients' physical fitness and mental well-being before, during and after cancer treatment. This paper aimed to...
BACKGROUND
Prehabilitation and recovery programmes aim to optimise patients' physical fitness and mental well-being before, during and after cancer treatment. This paper aimed to understand the impact of such a programme on emotional well-being in individuals undergoing cancer surgery. The programme was multi-modal, containing physical activity, well-being and nutritional support.
METHODS
Qualitative interviews were conducted with 16 individuals who participated in a prehabilitation and recovery programme. Twenty-four health care staff involved in referral completed an online survey. An inductive, thematic analysis was conducted, integrating perspectives of patients and staff, structured with the Framework approach.
RESULTS
Patients seemed to experience emotional benefits from the programme, appearing less anxious and more confident in their ability to cope with treatment. They seemed to value having something positive to focus on and control over an aspect of treatment. Ongoing, implicit psychological support provided by Exercise Specialists, who were perceived as expert, available and caring, seemed valued. Some patients appeared to appreciate opportunities to talk about cancer with peers and professionals. Discomfort with talking about cancer with other people, outside of the programme, was expressed.
CONCLUSIONS
Participation in a prehabilitation and recovery programme appeared to yield valuable emotional well-being benefits, even without referral to specialist psychological support.
STUDY REGISTRATION
The study protocol was uploaded onto the Open Science Framework 24 September 2020 ( https://osf.io/347qj/ ).
Topics: Humans; Preoperative Exercise; Preoperative Care; Exercise; Physical Fitness; Exercise Therapy; Neoplasms
PubMed: 38097972
DOI: 10.1186/s12885-023-11717-1 -
European Urology Focus Jan 2024In several surgical specialities, exercise as part of a prehabilitation program enhances recovery. However, for uro-oncological patients, evidence up to 2020 did not... (Review)
Review
In several surgical specialities, exercise as part of a prehabilitation program enhances recovery. However, for uro-oncological patients, evidence up to 2020 did not demonstrate significant benefits in terms of postoperative complications or hospital length of stay (LOS). We reviewed the literature from 2020 to 2023 and screened 205 reports, of which four full texts were included. Two retrospective cohort studies, despite having potential confounding risks, indicated that preoperative exercise might reduce LOS. One of these studies also suggested a lower likelihood of complications. Present evidence hints at the potential benefits of embedding exercise in prehabilitation for uro-oncological patients, particularly for short-term functional results. However, evidence on a direct effect on postoperative complications and LOS is still inconclusive. Future research should prioritise identification of specific exercises (eg, anaerobic vs aerobic, strength training, endurance, or respiratory exercises) that yield the most cost-effective benefits. PATIENT SUMMARY: Recent studies suggest that exercising before surgery might help people with urological cancers to improve their short-term fitness. More research is needed to see if exercise before surgery shortens hospital stays or reduces complications.
Topics: Humans; Preoperative Exercise; Preoperative Care; Sweat; Retrospective Studies; Postoperative Complications
PubMed: 37940390
DOI: 10.1016/j.euf.2023.10.022 -
Revue Neurologique Jun 2024Neuropsychological assessment is a mandatory part of the pre- and post-operative evaluation in pediatric epilepsy surgery. The neuropsychology task force of the ILAE -... (Review)
Review
Neuropsychological assessment is a mandatory part of the pre- and post-operative evaluation in pediatric epilepsy surgery. The neuropsychology task force of the ILAE - French Chapter aims to define a neuropsychological procedure consensus based on literature review and adapted for French practice. They performed a systematic review of the literature published between 1950 and 2023 on cognitive evaluation of individuals undergoing presurgical work-up and post-surgery follow-up and focused on the pediatric population aged 6-16. They classified publications listed in the PubMed database according to their level of scientific evidence. The systematic literature review revealed no study with high statistical power and only four studies using neuropsychological scales in their French version. Afterwards, the experts defined a neuropsychological consensus strategy in pediatric epilepsy surgery according to the psychometric determinants of cognitive tests, specificity of epilepsy, surgery context, French culture and literature reports. A common French neuropsychological procedure dedicated to pediatric epilepsy surgery is now available. This procedure could serve as a guide for the pre- and post-surgical work-up in French centers with pediatric epilepsy surgery programs. The main goal is to anticipate the functional risks of surgery, to support the postoperative outcome beyond the seizure-related one, while taking into consideration the plasticity and vulnerability of the immature brain and allowing the possibility of collaborative studies.
Topics: Humans; Child; Epilepsy; France; Neuropsychological Tests; Consensus; Adolescent; Neurosurgical Procedures; Pediatrics; Preoperative Care
PubMed: 37949750
DOI: 10.1016/j.neurol.2023.08.019 -
Supportive Care in Cancer : Official... Dec 2023To evaluate the effects of unimodal or multimodal prehabilitation on patients undergoing surgery for esophagogastric cancer. (Meta-Analysis)
Meta-Analysis Review
PURPOSE
To evaluate the effects of unimodal or multimodal prehabilitation on patients undergoing surgery for esophagogastric cancer.
METHODS
We conducted a systematic search of the PubMed, Embase, CINAHL, Web of Science, and Cochrane Library (CENTRAL) databases from database inception to May 5, 2023, for randomized controlled trials (RCTs) and cohort studies that investigated prehabilitation in the context of esophagogastric cancer. A random-effects model was used for meta-analysis.
RESULTS
We identified 2,994 records and eventually included 12 studies (6 RCTs and 6 cohort studies) with a total of 910 patients. According to random-effects pooled estimates, prehabilitation reduced the incidence of all complications (RR = 0.79, 95% CI: 0.66 to 0.93, P = 0.006), pulmonary complications (RR = 0.61, 95% CI: 0.47 to 0.79, P = 0.0002), and severe complications (RR = 0.63, 95% CI: 0.47 to 0.84, P = 0.002), and shortened the length of stay (MD = -1.92, 95% CI: -3.11 to -0.73, P = 0.002) compared to usual care. However, there were no statistically significant differences in 30-day readmission rates or in-hospital mortality. Subgroup analysis showed that multimodal prehabilitation was effective in reducing the risk of all complications and severe complications, while unimodal prehabilitation was not.
CONCLUSIONS
Our findings suggested that prehabilitation may be beneficial in reducing postoperative complications and length of stay. We recommend preoperative prehabilitation to improve postoperative outcomes and hasten recovery following esophagogastric cancer surgery, and multimodal prehabilitation seems to be more advantageous in reducing complications. However, further studies are needed to confirm these results.
Topics: Humans; Preoperative Exercise; Postoperative Complications; Neoplasms; Hospital Mortality; Postoperative Period; Preoperative Care; Length of Stay
PubMed: 38060053
DOI: 10.1007/s00520-023-08229-w -
Journal of Perianesthesia Nursing :... Aug 2023In our previous study, hypokalemia incidence was high in patients scheduled for laparoscopic colorectal resection. This trial was conducted to verify the effects of... (Randomized Controlled Trial)
Randomized Controlled Trial
Effects of Preoperative Oral Carbohydrate Electrolyte Drinks on Preoperative Hypokalemia Incidence in Patients Scheduled for Laparoscopic Colorectal Resection: A Three-Arm Randomized Clinical Trial.
PURPOSE
In our previous study, hypokalemia incidence was high in patients scheduled for laparoscopic colorectal resection. This trial was conducted to verify the effects of preoperative carbohydrate drinks containing potassium in these patients.
DESIGN
A three-arm randomized controlled design was used.
METHODS
Patients were randomly assigned to control, placebo, and treatment groups. In the control group, patients fasted from midnight. In the placebo group, patients fasted from midnight and received carbohydrate drinks 2 to 3 hours before surgery. In the treatment group, patients fasted from midnight and received carbohydrate drinks containing potassium supplementation 2 to 3 hours before surgery. The primary outcome was the incidence and severity of preoperative hypokalemia. Other outcomes included postoperative gastrointestinal function, including the time to postoperative first flatus (FFL) and first feces (FFE), and other complications.
FINDINGS
The final analysis included 122 participants. The incidence of preoperative hypokalemia in the treatment group was significantly lower than that in the control and placebo groups (50% vs 88.1% vs 77.5%, P < .001). The severity of hypokalemia in the control and placebo groups was greater than that in the treatment group. No regurgitation or aspiration occurred in the three groups. No significant differences were observed among the three groups regarding time to FFL and FFE.
CONCLUSIONS
Preoperative carbohydrate drinks containing potassium significantly reduced the incidence of preoperative hypokalemia and improved preoperative thirst and hunger, but did not reduce the postoperative time to FFL and FFE or length of hospital stay. However, as part of the enhanced recovery after surgery protocol, preoperative carbohydrate drinks containing potassium should be considered, as early as first admittance to hospital.
Topics: Humans; Hypokalemia; Incidence; Preoperative Care; Carbohydrates; Laparoscopy; Potassium; Electrolytes; Colorectal Neoplasms
PubMed: 36732123
DOI: 10.1016/j.jopan.2022.09.011 -
Anesthesiology Clinics Mar 2024Over the past few decades, obesity rates in the United States have risen drastically, and with this, there has been a rising demand for bariatric surgery. As such,... (Review)
Review
Over the past few decades, obesity rates in the United States have risen drastically, and with this, there has been a rising demand for bariatric surgery. As such, anesthesiologists need to be familiar with the challenges presented by patients seeking bariatric surgery. Obesity causes pathophysiologic changes which may affect decision-making during the management of these patients. Patients seeking bariatric surgery also have a long, prescribed preoperative course that offers anesthesiologists the opportunity to be involved earlier during the pre-surgical evaluation and optimization process.
Topics: Humans; United States; Bariatric Surgery; Obesity; Preoperative Care; Perioperative Care; Anesthesiologists; Obesity, Morbid
PubMed: 38278588
DOI: 10.1016/j.anclin.2023.07.005 -
The Journal of Heart and Lung... Apr 2024
Topics: Humans; Plasmapheresis; Preoperative Care
PubMed: 38220123
DOI: 10.1016/j.healun.2024.01.007 -
Journal of Digestive Diseases Oct 2023Traditional preoperative reminding services have been applied to enhance the quality of bowel preparation for colonoscopy. In this study we aimed to evaluate the... (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVES
Traditional preoperative reminding services have been applied to enhance the quality of bowel preparation for colonoscopy. In this study we aimed to evaluate the effectiveness of an automated electronic reminder system (E-reminder) on improving bowel preparation and the quality of preoperative education before colonoscopy.
METHODS
From August 2021 to March 2022, 833 outpatients aged 50-75 years who underwent colonoscopy were included and randomly assigned to the E-reminder group and the control group. While the control group received routine preoperative education. The E-reminder group received automatic phone call, text message reminders and web services regarding the details of bowel preparation before the colonoscopic examination. The quality of bowel preparation was evaluated by the Boston Bowel Preparation Scale (BBPS) score and the previously validated objective evaluation scale of automatic BBPS (e-BBPS).
RESULTS
In manual assessment, the rate of adequate bowel preparation was improved in the E-reminder group of intention-to-treat population using BBPS (60.7% vs 54.5%, P = 0.01). The percentage of objective evaluated adequate bowel preparation using e-BBPS in the E-reminder group of per-protocol population was significantly higher than that in the control group (76.9% vs 69.2%, P = 0.02).
CONCLUSIONS
E-reminder was an effective tool to improve the quality of bowel preparation and compliance with medical instructions. It may be regarded as an efficient and convenient education tool, improving the quality of medical service.
Topics: Humans; Reminder Systems; Cathartics; Colonoscopy; Preoperative Care; Prospective Studies
PubMed: 37610349
DOI: 10.1111/1751-2980.13222 -
Hand Clinics Nov 2023Perioperative optimization in upper extremity fracture care must balance the need for timely treatment with the benefits of medical optimization. Care pathways directed... (Review)
Review
Perioperative optimization in upper extremity fracture care must balance the need for timely treatment with the benefits of medical optimization. Care pathways directed at optimizing glycemic control, chronic anticoagulation, smoking history, nutrition, and frailty can reduce surgical risk in upper extremity fracture care. The development of multidisciplinary approaches that tie risk modification with risk stratification is needed.
Topics: Humans; Fractures, Bone; Preoperative Care; Arm Injuries; Smoking; Upper Extremity
PubMed: 37827614
DOI: 10.1016/j.hcl.2023.05.009 -
Annals of Palliative Medicine Jan 2024Hepatocellular carcinoma (HCC) is a leading cause of cancer deaths. Patients with HCC are often significantly affected by sarcopenia and cancer cachexia.... (Review)
Review
BACKGROUND AND OBJECTIVE
Hepatocellular carcinoma (HCC) is a leading cause of cancer deaths. Patients with HCC are often significantly affected by sarcopenia and cancer cachexia. Prehabilitation, a multimodal pre-operative exercise and nutritional intervention, has been implemented with varying degrees of success in enhancing outcomes among other gastrointestinal (GI) malignancies. However, remarkably little is described how prehabilitation may be beneficial in improving outcomes among those with HCC. Thus, a narrative review is warranted to examine previously developed prehabilitation models and determine how interventions affected sarcopenia as a prognosticator in HCC and other GI malignancies. This article seeks to offer guidance on how prehabilitation may be implemented for those with HCC based on available data published on other GI malignancies and serve as a call for additional research specific to the value of prehabilitation in HCC.
METHODS
Independent key-term searches were conducted by all authors of various databases (PubMed, ScienceDirect, Google Scholar) for relevant articles examining role, safety, and efficacy of prehabilitation in HCC and/or other GI malignancies. Relevant articles pertaining to sarcopenia, Enhanced Recovery After Surgery (ERAS) guidelines, and prehabilitation models were collected and analyzed. Review authors held multiple meetings to ensure coherence of narrative review process and final product.
KEY CONTENT AND FINDINGS
Patients with HCC often suffer from sarcopenia and/or cachexia, which are known to be associated with poorer outcomes. The benefits of a prehab program in patients with HCC are not well described in current literature, but in referencing the benefits of prehab programs in other GI malignancies and ERAS protocols on patients undergoing liver resection and liver transplant, there is potential for a similar multimodal program to yield similar benefits and healthcare cost-savings. However, further investigation is needed as HCC has multiple etiologies and affects a wide variety of people.
CONCLUSIONS
A multimodal prehabilitation program emphasizing regular aerobic and resistance exercise, nutritional optimization, lifestyle modifications, mental health and wellness practices, with a nurse and rehabilitation physician's oversight may improve outcomes in patients undergoing treatment for HCC. However further investigation into specific exercise models, optimal nutrition regimens and benefit/cost analysis of a multimodal prehabilitation program within this complex patient population is needed.
Topics: Humans; Preoperative Care; Carcinoma, Hepatocellular; Preoperative Exercise; Cachexia; Sarcopenia; Liver Neoplasms; Gastrointestinal Neoplasms; Postoperative Complications
PubMed: 37993401
DOI: 10.21037/apm-23-175