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Journal of Surgical Oncology Jun 2024Goals of care discussions are infrequently documented in the preoperative period. Furthermore, documentation does not consistently address what matters most to patients,...
BACKGROUND
Goals of care discussions are infrequently documented in the preoperative period. Furthermore, documentation does not consistently address what matters most to patients, although patient values (PV) are central to person-centered care.
METHODS
A multidisciplinary working group was formed. An electronic note comprised of (1) topics of discussion, (2) PV, and (3) advance care planning (ACP), was created and embedded into existing note templates for Gynecologic Surgical Oncology. Surgeons and advanced practice providers (APPs) were educated to conduct and document these conversations in preoperative clinic for patients undergoing cancer surgery for a pilot period. Data were collected regarding usage of the template. Focus groups with surgeons, APPs, and patients were conducted. Qualitative analysis was performed on transcripts.
RESULTS
During the pilot, 7 surgeon/APP teams utilized the template on a total of 55 notes. Average number of notes completed per surgeon was 7.8 (SD 8.5). Forty-six notes (84%) included topics of discussion, 15 (27%) included PV, 4 (7%) included ACP. Qualitative analysis of focus group transcripts revealed that clinicians and patients perceived the initiative to be useful and important, although implementation barriers were identified.
CONCLUSION
Creating a surgery-specific GOC template is feasible. Iterative revisions are needed to increase utility in clinic workflows.
Topics: Humans; Pilot Projects; Female; Patient Care Planning; Focus Groups; Advance Care Planning; Preoperative Care; Surgeons; Gynecologic Surgical Procedures; Genital Neoplasms, Female
PubMed: 38549286
DOI: 10.1002/jso.27632 -
Journal of Clinical Anesthesia Feb 2024
Topics: Humans; Exercise Test; Preoperative Care; Risk Assessment
PubMed: 37758564
DOI: 10.1016/j.jclinane.2023.111267 -
The Surgeon : Journal of the Royal... Dec 2023Prehabilitation is a multidimensional and multidisciplinary approach, to prepare patients for surgery, with the aim of improving postoperative outcomes. Worldwide,... (Review)
Review
BACKGROUND
Prehabilitation is a multidimensional and multidisciplinary approach, to prepare patients for surgery, with the aim of improving postoperative outcomes. Worldwide, healthcare systems are facing challenges with a gap between demand and supply of healthcare services. Telehealth is seen as a solution for delivering sustainable and efficient treatments. The effect of providing prehabilitation using telehealth solutions is unclear.
OBJECTIVE
This systematic review investigated the existing literature regarding the effects and feasibility of technologies for remotely supporting home-based prehabilitation compared to standard care on pre- and postoperative outcomes in adults undergoing elective major surgery.
METHODS
A literature search identified relevant studies published between 1 January 2012 and December 2022 in PubMed, PsychInfo, Cinahl and the Cochrane Library. We included RCTs, feasibility and pilot studies. The quality of studies was evaluated using Cochrane's Risk of bias assessment and by narratively rating the certainty of evidence.
RESULTS
Six randomized controlled trials and 20 pilot/feasibility studies were included. The number and content of the interventions varied, depending on context and resources. Multiple approaches in the use of digital healthcare solutions were applied and the results highlight the potential of providing health services remotely.
CONCLUSION
The use of technologies to support remote home-based prehabilitation in patients undergoing elective major surgery is feasible and has high acceptability, though telehealth is a broad term and wide-ranging strategies are used. Digital technologies for supporting home-based prehabilitation are likely to play an essential role in future health care as resources are scarce and innovative solutions are needed.
Topics: Humans; Preoperative Exercise; Preoperative Care; Digital Technology; Elective Surgical Procedures; Delivery of Health Care
PubMed: 37336649
DOI: 10.1016/j.surge.2023.05.006 -
Urologie (Heidelberg, Germany) Oct 2023Against the background of a continuous improvement of established treatment outcomes and the compatibility of health economic considerations, pre- and perioperative... (Review)
Review
Against the background of a continuous improvement of established treatment outcomes and the compatibility of health economic considerations, pre- and perioperative processes are constantly being developed and further optimized. In recent years, the concept of prehabilitation has gained increasing importance as a proactive approach to preparing patients for mostly surgical cancer treatment and improving their physical and mental health. Prehabilitation in oncology is a systematic process aimed at improving the physical, psychosocial, and nutritional condition of patients before and during cancer treatment. The goal of prehabilitation is to enhance patients' ability to cope with the physiological stress of cancer treatment and improve their overall health and well-being. In addition, prehabilitation has the potential to reduce costs for the healthcare system.
Topics: Humans; Male; Preoperative Care; Prostatectomy; Treatment Outcome; Prostatic Neoplasms; Adaptation, Psychological
PubMed: 37620505
DOI: 10.1007/s00120-023-02173-7 -
Anesthesiology Sep 2023
Topics: Humans; Postoperative Care; Preoperative Care; Postoperative Period
PubMed: 37402270
DOI: 10.1097/ALN.0000000000004637 -
American Journal of Surgery Aug 2023
Topics: Humans; Thyroid Neoplasms; Carcinoma, Papillary; Neoplasm Staging; Preoperative Care
PubMed: 37246128
DOI: 10.1016/j.amjsurg.2023.05.031 -
Methods in Molecular Biology (Clifton,... 2024Resident tissue macrophages (RTMs) are specialized phagocytes that are widely distributed throughout the body and are responsible for maintaining homeostasis. Recent...
Resident tissue macrophages (RTMs) are specialized phagocytes that are widely distributed throughout the body and are responsible for maintaining homeostasis. Recent advances in experimental techniques have enabled us to gain a greater insight into the actual in vivo biology of RTMs by observing their spatiotemporal dynamics directly in their native environment. Here, we detail a method for live tracking macrophages in a prototypical stromal tissue with high spatial and temporal resolution and great experimental versatility. Our approach builds on a custom intravital imaging platform and straightforward surgical preparation to gain access to an intact stromal compartment in order to analyze the morphological and behavioral dynamics of RTMs at single-cell resolution before and after experimental intervention. Furthermore, our versatile approach can also be utilized for live visualization of intracellular signaling and even for tracking cell organelles at subcellular resolution, and can be combined with downstream analyses such as multiplex confocal imaging, providing a unique insight into macrophage biology in vivo.
Topics: Humans; Macrophages; Phagocytes; Diagnostic Imaging; Homeostasis; Preoperative Care
PubMed: 37639133
DOI: 10.1007/978-1-0716-3437-0_22 -
Journal of Gastrointestinal Cancer Jun 2024While surgery is the primary curative treatment for resectable gastric and gastroesophageal junction (GEJ) cancer, rates of locoregional and distant recurrence remain... (Review)
Review
PURPOSE
While surgery is the primary curative treatment for resectable gastric and gastroesophageal junction (GEJ) cancer, rates of locoregional and distant recurrence remain high with surgery alone, especially in more advanced disease. Multimodal approaches with perioperative therapy including chemotherapy and/or radiation therapy (RT) have thus evolved as ways to reduce the rates of disease recurrence and improve survival outcomes. This review article provides a comprehensive literature review on the role of preoperative RT for resectable gastric and GEJ cancer.
METHODS
A literature review on the role of preoperative RT for resectable gastric and GEJ cancer was conducted.
RESULTS
Preoperative RT has the potential to facilitate tumor downstaging and improved R0 resection, allowing for better locoregional control and thereby survival. For resectable locally advanced GEJ cancer, preoperative chemoradiotherapy (CRT) is currently a standard of care option along with perioperative chemotherapy, based on evidence from randomized trials. In resectable gastric cancer, however, the role of preoperative CRT is less defined with no randomized data to date, although phase II single-arm studies have shown promising results. Current standard of care for gastric cancer remains perioperative chemotherapy, with consideration for preoperative CRT in select cases.
CONCLUSION
Results from ongoing and future randomized controlled trials are expected to help define the role of preoperative CRT compared to perioperative chemotherapy alone as well as postoperative CRT for gastric and GEJ cancer.
Topics: Humans; Stomach Neoplasms; Esophagogastric Junction; Preoperative Care; Neoadjuvant Therapy; Gastrectomy
PubMed: 38353901
DOI: 10.1007/s12029-023-00985-6 -
British Journal of Anaesthesia Jan 2024Preoperative fasting guidelines published in 2022 by the European Society of Anaesthesiology and Intensive Care represent a paradigm shift in the preoperative...
Preoperative fasting guidelines published in 2022 by the European Society of Anaesthesiology and Intensive Care represent a paradigm shift in the preoperative preparation of children undergoing general anaesthesia. Schmitz and colleagues report the results from a multi-institutional prospective cohort study to determine if application of the recent guidelines increased the risk of regurgitation and pulmonary aspiration. This study provides support for the concept of reducing real fasting times by allowing clear fluids until 1 h before induction of anaesthesia. Although the study cohort was large, further prospective multicentre studies with even greater sample sizes are warranted to provide definitive evidence for the safety of the new fasting rules.
Topics: Child; Humans; Prospective Studies; Pneumonia, Aspiration; Preoperative Care; Intraoperative Complications; Fasting
PubMed: 37996274
DOI: 10.1016/j.bja.2023.11.005 -
Pain Management Nursing : Official... Aug 2023Surgical treatment is a major cause of hospitalization in ovarian cancer. In this process, physical problems, such as pain and changes in respiratory functions, and... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Surgical treatment is a major cause of hospitalization in ovarian cancer. In this process, physical problems, such as pain and changes in respiratory functions, and psychological problems, such as anxiety and stress, may develop.
AIM
This study aims to investigate the effects of the Relaxation-Focused Nursing Program on pain, anxiety, lung volume, level of knowledge, and nursing care satisfaction in ovarian cancer surgery.
METHOD
A randomized controlled trial in which participants were randomly assigned to either the experimental (preoperative relaxation exercises and education; n = 24) or control (usual nursing care; n =22) groups. The intervention consisted of practicing four sessions of relaxation exercises and education in the hospital for two days before surgery. Data were collected using the Trait and State Anxiety Inventory, Surgical Information Form, and Perioperative Assessment Form. The results were analyzed using the Friedman and Wilcoxon tests.
RESULTS
The findings showed significant reductions in pain (p = .045) and anxiety scores (p < .001). The level of knowledge means scores were higher in the experimental group, but there was no significant difference between mean scores of spirometer volume and care satisfaction.
CONCLUSIONS
The program was more effective than usual nursing care in preoperative anxiety, pain, and level of knowledge. Although there was no difference between the care satisfaction scores of the patients, the reasons for care satisfaction were different in the program. Developing and implementing care that combines stress reduction interventions and preoperative education can improve the preoperative outcomes of patients.
Topics: Humans; Female; Anxiety; Preoperative Care; Hospitalization; Ovarian Neoplasms; Pain
PubMed: 37045690
DOI: 10.1016/j.pmn.2023.03.006