Psychological interventions for acute pain after open heart surgery.
Ontology highlight
ABSTRACT:
SUBMITTER: Ziehm S
PROVIDER: S-EPMC6432747 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:Few epidemiological studies have prospectively investigated preoperative and surgical risk factors for acute postoperative pain after surgery for breast cancer. We investigated demographic, psychological, pain-related and surgical risk factors in women undergoing resectional surgery for breast cancer.Primary outcomes were pain severity, at rest (PAR) and movement-evoked pain (MEP), in the first postoperative week.In 338 women undergoing surgery, those with chronic preoperative pain were three times more likely to report moderate to severe MEP after breast cancer surgery (OR 3.18, 95% CI 1.45-6.99). Increased psychological 'robustness', a composite variable representing positive affect and dispositional optimism, was associated with lower intensity acute postoperative PAR (OR 0.63, 95% CI 0.48-0.82) and MEP (OR 0.71, 95% CI 0.54-0.93). Sentinel lymph node biopsy (SLNB) and intraoperative nerve division were associated with reduced postoperative pain. No relationship was found between preoperative neuropathic pain and acute pain outcomes; altered sensations and numbness postoperatively were more common after axillary sample or clearance compared with SLNB.Chronic preoperative pain, axillary surgery and psychological robustness significantly predicted acute pain outcomes after surgery for breast cancer. Preoperative identification and targeted intervention of subgroups at risk could enhance the recovery trajectory in cancer survivors.
| S-EPMC3464763 | biostudies-other
Project description:BackgroundMotor development delay is the first neurodevelopmental impairment that becomes apparent in infants with congenital heart disease (CHD). Early interventions have addressed high-risk groups like infants born preterm, but little is known about interventions to improve motor outcome in CHD infants at risk of motor delay. The purpose of this review was to systematically review the literature on type and effect of motor intervention applied during the first year of life in infants with CHD following open-heart surgery.MethodsScoping searches were performed in May 2020 and April 2023 via MEDLINE, Embase, CINAHL, Cochrane, PsycINFO, PEDro, and Scopus. The review included studies published in English from 2015 to 2022. Primary outcome was infants' motor development measured by standardized and non-standardized motor assessments, and if available, infants' language and cognitive development, and any parental quality-of-life assessments as secondary outcomes. The studies' quality was evaluated with a modified Newcastle-Ottawa scale.ResultsFour papers with low to high methodological quality met inclusion criteria. All studies investigated the influence of early physiotherapy. Four studies involved parents, and three studies used standardized tools to assess motor outcomes. No conclusion can be drawn about any positive effect of early motor interventions.ConclusionsEarly motor intervention in CHD infants may improve motor development; however, the few existing studies do not provide clear evidence. Thus, more prospective early intervention studies are needed.Trial registrationPROSPERO CRD42020200981.
| S-EPMC10463862 | biostudies-literature
Project description:BACKGROUND: Children with congenital heart defects (CHD) requiring open-heart surgery are a group at high risk for health-related sequelae. Little consensus exists regarding their long-term psychological adjustment (PA) and health-related quality of life (QoL). Thus, we conducted a systematic review to determine the current knowledge on long-term outcome in this population. METHODS: We included randomized controlled trials, case control, or cohort studies published between 1990-2008 evaluating self- and proxy-reported PA and QoL in patients aged between two and 17 years with a follow-up of at least two years after open heart surgery for CHD. RESULTS: Twenty-three studies assessing psychological parameters and 12 studies assessing QoL were included. Methodological quality of the studies varied greatly with most studies showing a moderate quality. Results were as follows: (a) A considerable proportion of children experienced psychological maladjustment according to their parents; (b) studies on self-reported PA indicate a good outcome; (c) the studies on QoL suggest an impaired QoL for some children in particular for those with more severe cardiac disease; (d) parental reports of psychological maladjustment were related to severity of CHD and developmental delay. CONCLUSION: A significant proportion of survivors of open-heart surgery for CHD are at risk for psychological maladjustment and impaired QoL. Future research needs to focus on self-reports, QoL data and adolescents.
| S-EPMC2642822 | biostudies-other
Project description:Acute kidney Injury (AKI) following open-heart surgery with cardiopulmonary bypass (CPB) is associated with an increased morbidity and mortality. The goal of this study is to explore patterns of gene expression in human AKI following CPB. This prospective observational study was approved by the Institutional Review Board Human Subjects Committee. Design and methods: Peripheral blood RNA samples were collected prospectively from a cohort of 30 patients at Caritas St. Elizabeths Medical Center in Boston, MA, undergoing CPB at time points immediately prior, and two and 24 hours following CPB. Gene expression patterns of four patients who developed AKI (cases) following CPB will be compared with six patients matched for clinical characteristics, who did not develop AKI (controls). AKI was defined by an incremental increase in serum creatinine of 30% within 72 hours following CPB. For peripheral blood RNA sampling, 2.5 ml of venous whole blood was collected into PAXgene Blood RNA Tube collection tubes (PreAnalytiX GmbH, Hombrechtikon, CH). Whole blood RNA was extracted with the PAXgene Blood RNA extraction Kit according to the manufacturers instructions (PAXgene RNA Kit Handbook, 06/2005). All biological samples are stored at 80° C.
2009-12-12 | E-TABM-595 | biostudies-arrayexpress
Project description:Purpose of reviewPatients with cancer who have high levels of psychological distress have poor treatment compliance and worse outcomes. This "review of reviews" provides a narrative synthesis of the impact of psychological prehabilitation interventions on individuals awaiting cancer surgery.Recent findingsTwenty reviews of prehabilitation with psychological interventions were identified. There is a trend towards improved psychological outcomes following intervention, particularly when psychologist-led. However, there was considerable heterogeneity within interventions, outcome measures, and timing of assessment precluding numeric synthesis. Methodological limitations including non-blinding, absence of stratification, and underpowered studies were also pervasive.SummaryProviding psychological support early in the cancer pathway and prior to surgery has the potential to improve psychological health and outcomes. The application of existing knowledge in psycho-oncology, including distress screening, is needed in the prehabilitation setting. Consistent outcome assessments, accurate reporting of intervention components and delivery methods, and a consideration of effective systems and economical implementation strategies would facilitate advancements in this field.Supplementary informationThe online version contains supplementary material available at 10.1007/s40140-021-00505-x.
| S-EPMC8801554 | biostudies-literature
Project description:In cases of iatrogenic coronary embolism during cardiac surgery or percutaneous coronary intervention, small air bubbles or foreign bodies are directly injected, which usually result in serious adverse events if not treated promptly. We herein describe the case of a patient who developed acute myocardial infarction resulting in shock due to BioGlue® (CryoLife, Atlanta, GA, USA)-induced coronary embolism during the surgical repair of aortic dissection and was treated for retrieval of the material using a thrombectomy catheter. <Learning objective: Coronary embolism caused by surgical adhesives is a rare but potentially life-threatening complication. It is important for surgeons to promptly recognize and treat this serious condition in consultation with cardiologists.>.
| S-EPMC6281730 | biostudies-literature
Project description:Pain catastrophizing is a significant risk factor for patients with knee osteoarthritis (KOA) and thus is a target for many psychological interventions for pain. This study examined if interventions targeting sleep found to be effective in improving sleep in KOA also reduce pain catastrophizing measured as a trait through the pain catastrophizing scale and measured as a daytime and nocturnal state through daily diaries. Secondary analyses were conducted on data collected as part of a randomized controlled trial assessing the effectiveness of cognitive behavioral therapy for insomnia in patients with KOA at 5 different time points: pretreatment, midtreatment and posttreatment and at 3- and 6-month follow-up. One hundred patients diagnosed with KOA and insomnia were randomized to receive either 8 sessions of cognitive behavioral therapy for insomnia or a placebo intervention of behavioral desensitization. Multilevel modeling revealed that both intervention groups showed a significant reduction pretreatment to posttreatment in all 3 measures of pain catastrophizing and maintained stable levels through the 6-month follow-up. Increased sleep continuity early in treatment (pretreatment to midtreatment), but not reductions in pain, was associated with a reduction in trait and nocturnal catastrophizing later in treatment (midtreatment to posttreatment). These results suggest that short interventions focusing on sleep can significantly reduce pain catastrophizing even in a clinical population with low baseline levels of catastrophizing, possibly through improving sleep continuity.
| S-EPMC5640483 | biostudies-literature
Project description:Chronic pain can be best understood from a biopsychosocial perspective through which pain is viewed as a complex, multifaceted experience emerging from the dynamic interplay of a patient's physiological state, thoughts, emotions, behaviors, and sociocultural influences. A biopsychosocial perspective focuses on viewing chronic pain as an illness rather than disease, thus recognizing that it is a subjective experience and that treatment approaches are aimed at the management, rather than the cure, of chronic pain. Current psychological approaches to the management of chronic pain include interventions that aim to achieve increased self-management, behavioral change, and cognitive change rather than directly eliminate the locus of pain. Benefits of including psychological treatments in multidisciplinary approaches to the management of chronic pain include, but are not limited to, increased self-management of pain, improved pain-coping resources, reduced pain-related disability, and reduced emotional distress - improvements that are effected via a variety of effective self-regulatory, behavioral, and cognitive techniques. Through implementation of these changes, psychologists can effectively help patients feel more in command of their pain control and enable them to live as normal a life as possible despite pain. Moreover, the skills learned through psychological interventions empower and enable patients to become active participants in the management of their illness and instill valuable skills that patients can employ throughout their lives.
| S-EPMC3218789 | biostudies-other
Project description:BackgroundBreast cancer is the most common cancer type among women worldwide with over a million new cases each year. More than 40% of these women will struggle with chronic pain and fatigue after surgery, regardless of surgical procedure. These consequences are detrimental and result in distress and disability, including work disability. Few attempts have been made to prevent chronic pain and fatigue after surgery by applying a psychological approach, despite psychological risk factors being crucial in the development of both chronic pain and fatigue. In this study, we aim to develop and test an easily implementable strategy of preventing chronic pain and fatigue after breast cancer surgery. The intervention strategy involves a pre-operative hypnosis session and a web-based post-operative Acceptance and Commitment Therapy (ACT). The hypnosis has previously been found effective in alleviating acute post-operative pain and fatigue in breast cancer patients, while ACT is well suited to cancer populations as it offers a model of healthy adaptation to difficult circumstances. Together they form an intervention strategy with both a preventive and a rehabilitative focus.Methods/designThis randomized controlled trial aims to estimate the effects of the pre- and post- operative interventions compared to attentional control and treatment as usual (TAU) and will also include a qualitative process evaluation. Participants will be randomized to receive either a pre-operative brief hypnosis session and a post-operative web-based psychological intervention (iACT) or a pre-operative one-session mindfulness through an audio file and post-operative TAU. Self-reported questionnaire data and biomarker data will be assessed pre-surgery, post-surgery and 3 and 12 months after surgery. In addition, we will assess registry data on sick leave and prescriptions until 2-year follow-up. In the qualitative process evaluation, data will be collected from participants from both study arms (through interviews and a diary) and two different analyses performed (socio-narrative and Grounded Theory) with the objective to describe the development of chronic post-surgical pain and fatigue and the potential influence of the interventions on these processes. The study is set-up to demonstrate a minimum difference in pain of 1 point on NRS (0-10) and 3 points on FACIT-F (0-52) between the groups at 3-months follow-up by including 200 breast cancer patients in total.DiscussionThis trial will be the first study to estimate the effect of a combined pre-operative hypnosis with a post-operative iACT to prevent pain and fatigue after breast cancer surgery. The results from our study might i) help the large group of women affected by chronic pain and fatigue after breast cancer surgery, ii) shed light on the mechanisms involved in chronic pain and fatigue development, and iii) serve as a model for other surgical procedures.Trial registrationClinicaltrials.gov, registration number NCT04518085. Registered on January 29th, 2020. https://clinicaltrials.gov/ct2/show/NCT04518085.
| S-EPMC9269362 | biostudies-literature
Project description:Background Postoperative transcatheter interventions (TCIs) are performed after congenital heart surgery to treat residual or recurrent anatomic lesions. We used the Society of Thoracic Surgeons Congenital Heart Surgery Database to evaluate rates of postoperative TCIs, center variability, and to determine whether center approaches to postoperative TCI might be associated with outcomes. Methods and Results Patients <18 years undergoing an index operation (2010-2016) were included. We determined predischarge postoperative TCI rates and used multivariable modeling, adjusting for patient factors and case complexity, to evaluate the association between center risk-adjusted postoperative TCI rates and risk-adjusted outcomes (operative mortality, post-TCI mortality, and failure-to-rescue). Postoperative TCI was performed after 2615/105 742 (2.5%) index operations and after 1443/25 416 (5.7%) highest complexity operations (STAT [Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery Mortality Score] Mortality Category 4 and 5). Median (interquartile range) age of patients undergoing TCI was 2.7 (0.2-8.0) months with 43% performed in neonates. There was a wide center variability across the 107 included centers with risk-adjusted rates of postoperative TCI ranging from 0.0% to 8.0% overall and 0.0% to 20.7% for STAT 4 and 5 cases. Postoperative TCI was associated with higher risk-adjusted odds of operative mortality (odds ratio, 4.06; 95% CI, 3.60-4.58). Centers with higher postoperative TCI rates had higher overall operative mortality ( R2=0.23; P=0.02) but did not have higher post-TCI mortality ( P=0.10). There was no correlation between center TCI rates and failure-to-rescue ( P=0.19). Conclusions Patients undergoing postoperative TCI represent a high-risk cohort. Wide center variability suggests the potential for improving outcomes, but further study is necessary to better understand optimal approaches.
| S-EPMC6705420 | biostudies-literature