Preoperative Educational Intervention Research Articles

Influence of Preoperative Educational Intervention for Patients Undergoing Fecal Ostomy Surgery: A Comparison Cohort Study.

This aim of this study was to compare the impact on hospital stay and short-term overall complications prior to and following the introduction of an outpatient preoperative ostomy education program to an existing inpatient ostomy education program. A comparison cohort study. One hundred thirty-eight consecutive patients undergoing ostomy surgery were included. One group (n = 65, 47%) was given an experimental preoperative ostomy education intervention, along with standard care including a postoperative educational intervention during the initial hospital course. A second group (n = 73, 53%) received the same standardized education in the postoperative period. Data were collected from a single tertiary center located in Seville, Spain, during a 12-month period between July 2014 and June 2015. Data were collected in 2 phases. Data from participants undergoing postoperative (standard) education were collected retrospectively. Data for the group receiving preoperative education were collective prospectively. Outcome variables were postoperative length of stay, surgical complications (severity was assessed by the Clavien-Dindo grading system), subsequent interventions, and readmission rates. Analysis indicated no differences between the average length of postoperative hospital stay (12.32 days in the preoperative education group vs 12.76 days in the postoperative education group, P = .401). In contrast, overall complications, mortality, and readmission rates were significantly higher in the preoperative education program group (P = .027, P = .047, and P = .046, respectively). Delivering a standardized educational intervention during the preoperative period versus postoperative education delivery during the ostomy surgery hospital course did not reduce length of stay. Analysis indicated that overall complications, mortality, and readmission rates were significantly higher in the preoperative education program group but we hypothesize that intervening factors may have influenced these outcomes.

Supporting patients to prepare for total knee replacement: Evidence-, theory- and person-based development of a 'Virtual Knee School' digital intervention.

Digital delivery of pre-operative total knee replacement (TKR) education and prehabilitation could improve patient outcomes pre- and post-operatively. Rigorously developing digital interventions is vital to help ensure they achieve their intended outcomes whilst mitigating their potential drawbacks. To develop a pre-operative TKR education and prehabilitation digital intervention, the 'Virtual Knee School' (VKS). The VKS was developed using an evidence-, theory- and person-based approach. This involved a mixed methods design with four phases. The first three focused on planning the VKS. The final phase involved creating a VKS prototype and iteratively refining it through concurrent think-aloud interviews with nine patients who were awaiting/had undergone TKR. Meta-inferences were generated by integrating findings from all the phases. ISRCTN registration of the overall project was obtained on 24 April 2020 (ISRCTN11759773). Most participants found the VKS prototype acceptable overall and considered it a valuable resource. Conversely, a minority of participants felt the prototype's digital format or content did not meet their individual needs. Participants'feedback was used to refine the prototype's information architecture, designand content. Two meta-inferences were generated and recommend: 1. Comprehensive pre-operative TKReducation and prehabilitation support should be rapidly accessible in digital and non-digital formats. 2. Pre-operative TKR digital interventions should employ computer- and self-tailoring to account for patients'individual needs and preferences. Integrating evidence, theoryand stakeholders'perspectives enabled the development of a promising VKS digital intervention for patients awaiting TKR. The findings suggest future research evaluating the VKS is warranted and provide recommendations for optimising pre-operative TKRcare. Patient and Public Involvement (PPI) was central throughout the project. For example, PPI representatives contributed to the project planning, were valued members of the Project Advisory Group, had key roles in developing the VKS prototypeand helped disseminate the project findings.

The Effectiveness of Patient Education on Laparoscopic Surgery Postoperative Outcomes to Determine Whether Direct Coaching Is the Best Approach: Systematic Review of Randomized Controlled Trials.

As of 2022, patient adherence to postoperative guidelines can reduce the risk of complications by up to 52.4% following laparoscopic abdominal surgery. With the availability of various preoperative education interventions (POEIs), understanding which POEI results in improvement in patient outcomes across the procedures is imperative. This study aims to determine which POEI could be the most effective on patient outcomes by systematically reviewing all the POEIs reported in the literature. In total, 4753 articles investigating various POEIs (eg, videos, presentations, mobile apps, and one-on-one education or coaching) were collected from the PubMed, Embase, and Scopus databases. Inclusion criteria were adult patients undergoing abdominal laparoscopic surgery, randomized controlled trials, and studies that provided postoperative outcomes. Exclusion criteria included studies not published in English and with no outcomes reported. Title and abstract and full-text articles with POEI randomized controlled studies were screened based on the above criteria through a blinded, dual review using Covidence (Veritas Health Innovation). Study quality was assessed through the Cochrane Risk of Bias tool. The included articles were analyzed for educational content, intervention timing, intervention type, and postoperative outcomes appropriate for a particular surgery. Only 17 studies matched our criteria, with 1831 patients undergoing laparoscopic cholecystectomy, bariatric surgery (gastric bypass and gastric sleeve), and colectomy. In total, 15 studies reported a statistically significant improvement in at least 1 patient postoperative outcome. None of these studies were found to have an overall high risk of bias according to Cochrane standards. In total, 41% (7/17) of the included studies using direct individual education improved outcomes in almost all surgery types, while educational videos had the greatest statistically significant impact for anxiety, nausea, and pain postoperatively (P<.01). Direct group education demonstrated significant improvement in weight, BMI, exercise, and depressive symptoms in 33% (2/6) of the laparoscopic gastric bypass studies. Direct education (individual or group based) positively impacts postoperative laparoscopic surgery outcomes. PROSPERO CRD42023438698; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=438698.

Predicting surgical outcome and sagittal alignment change in patients with cervical spondylosis and degenerative kyphosis after anterior cervical discectomy and fusion

The aim of this study was to forecast the risk factors of poor outcomes and postoperative loss of lordosis or recurrence of kyphosis. In this retrospective study, 101 patients with cervical spondylosis and preoperative kyphosis who underwent anterior cervical discectomy and fusion (ACDF) were enrolled, between June 2015 and June 2019. Patients were grouped according to the recovery rate of Japanese Orthopaedic Association (JOA) score whether more than 50%, and the change of postoperative cervical Cobb angle. There were 22 cases with less than 50% of recovery rate and 35 cases with the worsening of postoperative sagittal alignment (WPSA). Multivariate linear-regression analysis was conducted with the data. Advanced age (p = 0.019), longer duration of symptoms (p = 0.003) and loss of local Cobb angle (LCA) after surgery (p = 0.031) was significantly associated with a poor clinical outcome. A whole kyphosis (p = 0.009), aggravated neck pain after surgery (p = 0.012), preoperative lower thoracic 1 (T1) (p < 0.001), bigger change of C2-7 sagittal vertical axis (SVA) (p = 0.008) and adjacent segment degeneration (ASD) (p = 0.024) was significantly associated with the WPSA. Preoperative health education, nutritional support and early postoperative rehabilitation intervention, in perioperative period, were recommended for patients with advance age, longer duration of symptoms, whole cervical kyphosis and lower T1. Postoperative sagittal malalignment was related to neck pain and ASD after surgery.

Preoperative expectations, postoperative satisfaction and patient directed priorities for clinical burn research

IntroductionBurn patients receiving split thickness skin grafting are left with scarring and chronically dysfunctional grafted skin. Given evidence that patients’ preoperative expectations mediate postoperative outcomes and satisfaction, we described burn patients’ experience, expectations, and satisfaction with their skin graft, their views towards a cell based clinical trial to improve their graft and identified graft outcome measures for use in future studies. MethodsData were collected via questionnaires preoperatively, one, and three months postoperatively. Longitudinal analyses assessed change over time. ResultsExpectations of graft function were consistent pre- and postoperatively. Expectations of graft appearance showed significant decrease over time (β1 = −0.290, p = 0.008). Significant improvements in skin function (β1 = 0.579, p = 0.000) and appearance (β1 = 0.247, p = 0.025) at the wound site during recovery were observed. Patients noted great difference between grafted and normal skin. Patient satisfaction with their graft did not change significantly over time. Patients were willing to participate in a cell based clinical trial to improve graft symptomology and prioritized improvements in scarring, redness, sensation, and elasticity. ConclusionsOutcome measures in trials advancing skin grafting should reflect chronic, patient prioritized limitations. We recommend preoperative educational interventions for burn patients receiving grafting to improve postoperative satisfaction.

Effectiveness of Preoperative Education and Music Intervention on Postoperative Outcomes among Patients Undergoing Abdominal Surgery: A Quasi-experimental Study

Introduction: The preoperative phase includes various procedures that aim at the patient’s physical and psychological preparation to promote postoperative recovery. Preoperative education and music intervention may play an important role in improving the postoperative outcomes. Aim: To study the effectiveness of preoperative education and music intervention on postoperative outcomes, such as anxiety and pain, and to assess the satisfaction of patients, regarding surgical experience on discharge. Study also aims to initiate early feeding and its effects on postoperative recovery. Materials and Methods: A quasi-experimental study was conducted in Surgical Wards of Yenepoya Medical College Hospital, Mangaluru, Karnataka, India, between January 2021. A total of 52 patients undergoing major abdominal surgery were selected and divided into intervention and control groups. Two days before the surgery, patients in the intervention group were given preoperative education and were encouraged to listen to preferred music in the evening. Music intervention was given for two days before the surgery and continued in the postoperative phase for three days. Immediately after the music intervention, the anxiety was assessed by State-Trait Anxiety Inventory (STAI) and severity of pain using numerical rating scale. Early feeding was initiated postoperatively and the patients were observed for discomfort and complications. The patients satisfaction was evaluated for their surgical experience on discharge using a patient satisfaction questionnaire. An independent t-test and Mann-Whitney U test were used to compare the variables between the groups. Results: The mean age in the intervention group was 43.46±14.89 years and control group 44.07±12.64 years. The majority of subjects in the both groups were males. A reduction in anxiety scores was observed among patients in the intervention group that was statistically significant (p&lt;0.05) at preoperative day 1, 2, postoperative day 1, 2 and 3. The mean pain scores decreased from preoperative day 1 to postoperative day 3 in the intervention group than in the control group. In the intervention group, 7.7% of the patients received oral feed within an hour of surgery whereas, 26.9% were in the fourth hour and 26.9% were in the sixth hour of surgery. They did not report discomfort and complications such as nausea and vomiting. In the intervention group, the mean satisfaction was 60.30±5.00, indicating a higher level of satisfaction among patients. Conclusion: Preoperative education and music intervention reduces the severity of anxiety and pain. Early oral feeding is safer and effective in patients undergoing elective abdominal surgery. These interventions help in improving the postoperative outcomes and satisfaction with surgical experience.

The Effect of Preoperative Educational Intervention on Anxiety and Pain of Patients Undergoing Spinal Decompression Surgery: A Pilot Randomized Controlled Study.

Background: Preoperative patient education is an effective intervention of the healthcare team, which has been used to promote patient recovery and well-being.Aim: The aim of this study was to investigate the effect of a nursing preoperative educational intervention on the anxiety and pain of patients undergoing spinal decompression surgery.Methods: In this pilot randomized controlled study, patients (n=40) undergoing spinal decompression surgery, were randomized into an intervention group (underwent educational intervention, n=23) and a control group (n=17). The preoperative educational intervention included an oral briefing and a leaflet with perioperative care information as well as post-discharge care. Participants completed the Amsterdam Preoperative Anxiety and Information Scale (APAIS), the subscale “State” of the State and Trait Anxiety Inventory (STAI-S), the Numerical Rating Scale, and a questionnaire about demographic characteristics, the day before surgery (T0) and the first post-operation day (T1). Data analysis was conducted using SPSS 22.0. The statistical significance level was set at p<0.05.Results. A significant reduction was found in pain intensity before and after surgery in both groups. Pain levels, after surgery, were significantly lower in the intervention group compared to pain levels in the control group (t=2.174, p=0.036). In both groups, high state anxiety scores on the STAI-S scale before surgery were confirmed by high anxiety scores in APAISsurgery. Additionally, in both groups after surgery, high state anxiety scores on the STAI-S scale were associated with high pain levels. There were no statistically significant group differences with regard to scores of STAI-S before and after surgery.Conclusions. Nursing preoperative educational intervention in patients undergoing spinal decompression surgery had a positive impact on reducing the intensity of pain after surgery. These results indicated that nurses and health care providers should integrate patient education and health literacy into their daily clinical practice.

The Role of Preoperative Educational Intervention in Reducing Parental Anxiety.

Background and objectiveThe parents of pediatric patients admitted for elective surgery exhibit significant levels of anxiety. The reduction in parental anxiety is directly proportional to the information and counseling provided to the parents preoperatively. The parenting style in South Asian culture is different from that of western cultures and may influence the response to these interventions. In this study, we aimed to compare the mean anxiety levels between parents of children (aged three to eight years) undergoing outpatient infraumbilical surgery equipped with standardized preoperative parental education and those without.MethodsThis was a randomized, controlled, and blinded trial. Parents of 72 pediatric patients (aged three to eight years) undergoing elective infraumbilical daycare surgery were enrolled and were divided into two groups: an intervention (Group I) and a non-intervention (Group NI) group. Both groups received routine verbal counseling at the preoperative clinic, but a standardized brochure was provided only to Group I. Parental anxiety was measured by using the Visual Analog Scale (VAS) at three different time points: in the outpatient surgery suite on the day of surgery, in the preoperative area 10 minutes before shifting the child to the operating room, and finally in the recovery room.ResultsThe baseline mean VAS score was significantly higher in Group I compared to Group NI (p=0.017). After the intervention, the mean pain score significantly decreased from baseline in Group I as compared to Group NI (mean ±SD: 4.08 ±1.6 vs. 6.08 ±1.66; p=0.0005).ConclusionThe information provided through standardized written material to the parents on the day of surgery before anesthesia helped to significantly attenuate preoperative parental anxiety.

A Randomized Controlled Trial Evaluating the Effect of an Educational Video on Patient Understanding of Midurethral Sling.

The primary objective was to evaluate the use of a novel video for enhancing patient knowledge of midurethral sling compared with standard handout. Participants scheduled for midurethral sling were randomized to 1 of 2 preoperative educational interventions, either video or standard handout. The primary outcome was change in knowledge measured via a 15-question questionnaire completed immediately before and after the intervention. Secondary outcomes were knowledge retention, urinary symptoms, decision satisfaction, and regret measured via validated questionnaires at 2 and 6 weeks postoperatively. Data are presented as median (interquartile range) and comparisons between intervention groups made using non-parametric statistics. A sample size of 16 per arm was calculated to detect a 20% effect size. Thirty-eight participants, 19 per site, were randomized from August 2019 to October 2020 and 37 (97%) completed the primary outcome per protocol. Median age was 51 years (18 years), and there were no significant demographic differences between groups. Participants randomized to video demonstrated greater change in knowledge than those randomized to handout (+8.5 (3) vs +2.0 (4), P < 0.0001). Those randomized to video demonstrated improved 6 week postoperative urinary symptoms (Urogenital Distress Inventory-6, 0.0 [8.3] vs 14.6 [26.0]; P = 0.02; Incontinence Severity Index, 0.0 [2] vs 3.0 [4]; P = 0.005). There were no differences in satisfaction with decision (5.0 [0] video vs 5.0 [0.9] handout; P = 0.48) or decision regret (1.0 [0.5] video vs 1.0 [0.8] handout; P = 0.80) at 6 weeks postoperatively. A preoperative educational video improved knowledge and urinary symptoms after midurethral sling compared with a standard handout.

A Preoperative Spinal Education intervention for spinal fusion surgery designed using the Rehabilitation Treatment Specification System is safe and could reduce hospital length of stay, normalize expectations, and reduce anxiety : a prospective cohort study.

AimsPsychoeducative prehabilitation to optimize surgical outcomes is relatively novel in spinal fusion surgery and, like most rehabilitation treatments, they are rarely well specified. Spinal fusion patients experience anxieties perioperatively about pain and immobility, which might prolong hospital length of stay (LOS). The aim of this prospective cohort study was to determine if a Preoperative Spinal Education (POSE) programme, specified using the Rehabilitation Treatment Specification System (RTSS) and designed to normalize expectations and reduce anxieties, was safe and reduced LOS.MethodsPOSE was offered to 150 prospective patients over ten months (December 2018 to November 2019) Some chose to attend (Attend-POSE) and some did not attend (DNA-POSE). A third independent retrospective group of 150 patients (mean age 57.9 years (SD 14.8), 50.6% female) received surgery prior to POSE (pre-POSE). POSE consisted of an in-person 60-minute education with accompanying literature, specified using the RTSS as psychoeducative treatment components designed to optimize cognitive/affective representations of thoughts/feelings, and normalize anxieties about surgery and its aftermath. Across-group age, sex, median LOS, perioperative complications, and readmission rates were assessed using appropriate statistical tests.ResultsIn all, 65 (43%) patients (mean age 57.4 years (SD 18.2), 58.8% female) comprised the Attend-POSE, and 85 (57%) DNA-POSE (mean age 54.9 years (SD 15.8), 65.8% female). There were no significant between-group differences in age, sex, surgery type, complications, or readmission rates. Median LOS was statistically different across Pre-POSE (5 days ((interquartile range (IQR) 3 to 7)), Attend-POSE (3 (2 to 5)), and DNA-POSE (4 (3 to 7)), (p = 0.014). Pairwise comparisons showed statistically significant differences between Pre-POSE and Attend-POSE LOS (p = 0.011), but not between any other group comparison. In the Attend-POSE group, there was significant change toward greater surgical preparation, procedural familiarity, and less anxiety.ConclusionPOSE was associated with a significant reduction in LOS for patients undergoing spinal fusion surgery. Patients reported being better prepared for, more familiar, and less anxious about their surgery. POSE did not affect complication or readmission rates, meaning its inclusion was safe. However, uptake (43%) was disappointing and future work should explore potential barriers and challenges to attending POSE.Cite this article: Bone Jt Open 2022;3(2):135–144.

The effectiveness of preoperative education interventions on improving perioperative outcomes of adult patients undergoing cardiac surgery: a systematic review and meta-analysis.

Cardiac surgeries pose as an emotional experience for patients. Preoperative education is known to positively alter people's perceptions, emotions, and mitigate surgical distress. However, this intervention's effectiveness in improving perioperative outcomes among patients undergoing cardiac surgery lacked rigorous statistical synthesis and remains inconclusive. The aim was to synthesize the effectiveness of preoperative education on improving perioperative outcomes [anxiety, depression, knowledge, pain intensity, pain interference with daily activities, postoperative complications, length of hospitalization, length of intensive care unit (ICU) stay, satisfaction with the intervention and care, and health-related quality of life] among patients undergoing cardiac surgery. This systematic review and meta-analysis conducted a comprehensive search of nine electronic databases (PubMed, EMBASE, Scopus, MEDLINE, CINAHL, Cochrane CENTRAL, Web of Science, PsycINFO, and ERIC) and grey literature for randomized controlled trials examining the preoperative educational interventional effects on patients undergoing cardiac surgery from inception to 31 December 2020. The studies' quality was evaluated using Cochrane Risk-of-Bias Tool 1 (RoB1). Meta-analyses via RevMan 5.4 software synthesized interventional effects. Twenty-two trials involving 3167 participants were included. Preoperative education had large significant effects on reducing post-intervention preoperative anxiety (P = 0.02), length of ICU stay (P = 0.02), and improving knowledge (P &lt; 0.00001), but small significant effect sizes on lowering postoperative anxiety (P &lt; 0.0001), depression (P = 0.03), and enhancing satisfaction (P = 0.04). This review indicates the feasibility of preoperative education in clinical use to enhance health outcomes of patients undergoing cardiac surgery. Future studies need to explore knowledge outcomes in-depth and more innovative technologies in preoperative education delivery.

Educational and Psychological Support Combined with Minimally Invasive Surgical Technique Reduces Perioperative Depression and Anxiety in Patients with Bladder Cancer Undergoing Radical Cystectomy.

Radical cystectomy (RC) for muscle-invasive bladder cancer (MIBC) is an extensive and morbid operation, often associated with permanent alteration of body image and disability. Combined with the aggressive malignant potential of MIBC and considerable risk of complications, it poses a serious threat to the psychological well-being of patients. Educational deficiencies causing uncertainty and confusion aggravate surgery-related anxiety and may lead to depression along with further social disability. We conceived a preoperative supportive program named “Cystocare” held by urologists, psychologists, stoma therapists and cancer survivors to facilitate patients’ adaptation and coping. We aimed to evaluate whether participation in Cystocare meetings would alleviate emotional distress in patients undergoing RC. We included 95 consecutive patients who filled Hospital Anxiety and Depression Score questionnaires before RC and on discharge. The intervention arm (A) comprised 32 Cystocare participants. The remaining 63 patients who received standard preparation constituted the control arm (B). Whilst there were no differences in median anxiety and depression scores preoperatively, in postoperative measurement, the intervention arm showed a lower median depression score than controls: 3 vs. 8 points, p = 0.015. On multivariate analysis we confirmed lower risk of postoperative depression in Cystocare participants: OR = 0.215 (95%CI: 0.066–0.699), p = 0.011, along with lower odds of preoperative anxiety in patients undergoing laparoscopic RC: OR = 0.365 (95%CI: 0.136–0.978), p = 0.045, and higher risk of prolonged hospital stay in patients experiencing postoperative anxiety OR = 17.114 (95%CI: 1.283–228.234) p = 0.032. Preoperative educational and supportive intervention complements laparoscopic RC in the alleviation of surgery-related anxiety and depression. The support group meetings provide an attractive and cost-effective opportunity to moderate emotional response in patients undergoing RC, and as such, deserve widespread adoption.

Preoperative pain neurophysiology education for lumbar radiculopathy: A randomized-controlled trial.

Objectives This study aims to investigate the postoperative short-term effectiveness of preoperative pain neurophysiology education on pain severity, kinesiophobia, and disability in patients undergoing lumbar surgery for radiculopathy. Patients and methods Between April 2019 and August 2019, a total of 41 patients (22 males, 19 females; mean age 52.1±9.5 years; range, 37 to 64 years) scheduled for lumbar radiculopathy surgery were randomized to receive either preoperative routine education only (control group, n=20) or a 70-min pain neurophysiology education in addition to preoperative routine education (intervention group, n=21). The patients were evaluated for the following outcomes prior to surgery (baseline) and at 12 weeks after surgery: low back pain and leg pain using Numeric Pain Rating Scale, disability using Oswestry Disability Index), and kinesiophobia using Tampa Scale for Kinesiophobia. Results There were no statistically significant differences in low back pain (p=0.121), leg pain (p=0.142), and the length of stay hospital (p=0.110) between the groups. However, the interaction effects of intervention group were superior to control group regarding disability (p=0.042) and kinesiophobia (p<0.001). Conclusion The addition of pain neurophysiology education to routine education following lumbar radiculopathy surgery yields significant improvements for disability and kinesiophobia, although no additional benefits is seen regarding the pain severity and length of stay in hospital in the short-term.

Comparison of a fast track protocol and standard care after hip arthroplasty in the reduction of the length of stay and the early weight-bearing resumption: study protocol for a randomized controlled trial

BackgroundTo date, hip arthroplasty is one of the most commonly performed surgical procedures, with growing worldwide demand. In recent decades, major progress made in terms of surgical technique, biomechanics, and tribology knowledge has contributed to improve the medical and functional management of the patient. This study aims to assess if the application of a fast track protocol, consisting of a preoperative educational intervention, adequate postoperative pain control, and intensive rehabilitation intervention, reduces the length of stay (LOS) and allows the early functional recovery compared to standard clinical practice for patients undergoing hip arthroplasty.MethodsThe study population consists of 90 patients with primary arthrosis of the hip with an anterior indication of hip arthroplasty. The exclusion criteria are older than 70 years, a contraindication to performing spinal anesthesia, and bone mass index (BMI) greater than 32. Participants, 45 for each group, are randomly allocated to one of two arms: fast track clinical pathway or standard care protocol. During allocation, baseline parameters such as Harris Hip Score (HHS) and Western Ontario and McMaster Universities (WOMAC) index are collected. On the third postoperative day, the functional autonomy for each patient is assessed by the Iowa Level of Assistance (ILOA) scale, and it is expected the discharge for patients in the fast track group (primary outcome). On the other hand, standard care patient discharge is expected after 5–7 days after surgery. During follow-up fixed at 6 weeks and 3, 6, and 12 months, HHS and WOMAC scores are collected for each patient (secondary outcomes).DiscussionAlthough total hip replacement has become a widespread standardized procedure, to the authors’ knowledge, only few randomized controlled trials were performed to evaluate the effectiveness of fast track pathway vs. standard care procedure in the reduction of the LOS after hip arthroplasty. It is expected that our results collected by the application of minimally invasive surgical interventions with concomitant management of perioperative pain and bleeding and early functional rehabilitation will contribute to enriching the understanding of clinical and organizational aspects linked to fast track arthroplasty.Trial registrationClinicalTrials.gov NCT03875976. Registered on 15 March 2019—“retrospectively registered”.

Effects of a Video-Based Preoperative Educational Intervention Plus Nurse-Led Reinforcement Discussion on Knowledge, Self-Efficacy, and Resilience in Patients Undergoing Major Surgery.

This study aimed to verify the feasibility of a video-based preoperative educational intervention plus one-to-one, nurse-led reinforcement discussion in patients undergoing elective major surgery and to assess the impact of this combined intervention on patient- and nurse-perceived patient knowledge, self-efficacy, and resilience. Patients received written material at pre-admission and were offered the intervention at admission. Patients reported their knowledge and self-efficacy at pre-admission and after the intervention, and resilience at pre-admission and discharge. Nurses assessed patients' knowledge and self-efficacy after the intervention. In all, 88/97 (90.7%) patients completed the intervention. The 80 patients with complete data reported a significant increase in their knowledge (p < .001) and self-efficacy (p < .001), but no difference in resilience (p = .72). Nurse-perceived patient knowledge agreed with patients' perceptions (p = .57) but nurses scored patients' self-efficacy lower (p < .001). The combined intervention was feasible, and patients perceived an improvement in their knowledge and self-efficacy. Nurses' assessment partially agreed with patients' perceptions.

Virtual reality, the start of a new era for patient education in cardiology?

Abstract Background Anxiety, perceived in patients undergoing percutaneous cardiac intervention is a known problem, which is negatively correlated with quality of life, adherence to recommended clinical practice and medication, health promoting behavior, hospitalization, and patient experience and satisfaction. Hence, preprocedural interventions to alleviate anxiety are interesting. While preoperative education interventions were proven to be effective as anxiety reduction modality, especially those modalities that provide immersive experience appeared to be even more effective within this context. Given the non-invasive nature of these modalities and the introduction of innovative techniques such as Virtual Reality (VR), the question arises whether VR can be successfully introduced as an effective tool to alleviate anxiety in cardiology patients undergoing PFO or ASD closure. Purpose The purpose of the study was to alleviate pre-procedural anxiety in patients undergoing percutaneous PFO or ASD closure using a VR film as an innovative and immersive patient education modality. Methods Patients were randomized to either the VR-group or the control group. The control group received traditional patient information by their cardiologist. The intervention group additionally viewed a 4-minute VR-film, that was designed to create a representative patient-experience of the day of the procedure. The primary outcome was patient anxiety in the VR group compared to the control group, as measured with anxiety scores derived from the State Trait Anxiety Inventory (STAI) questionnaire. Measurements were performed directly after the informed consent visit and one week prior to the procedure. Secondary outcome measure was the duration of anesthesia during the procedure. Results In total 40 patients have been included (mean age = 45 yrs ± 11, male = 21), mean FU duration = 37 days ± 23). So far, 27 patients (VR-group n=14; Control group n=13) completed follow-up. At baseline the control and intervention group were equally anxious (37±9 vs 38±14). During follow-up we found a significant increase in anxiety in the control group (37±9 vs 46±12; p=0.034; figure 1), whereas anxiety in the VR-group remained unchanged (38±14 vs 36±9; figure 1). One week prior to the procedure, the control group was significantly more anxious compared to the VR group (+ 11±4; p=0.012; figure 2). The mean duration of the anesthesia was significantly shorter within the VR-group in comparison with the control group (57±10 min vs 71±18 min; p=0,029). This may be an indication that decreased anxiety could have beneficial effects on the complete duration of anesthesia. Conclusion Our results demonstrate that immersive VR patient education is both innovative and effective in alleviating anxiety prior to a cardiological procedure and may have beneficial effects on patient experience and anesthesia duration. Funding Acknowledgement Type of funding source: None

The Relationship between Preoperative Educational Session and Anxiety Level among Women Undergoing Cesarean Section: A Scoping Review

Context: Anxiety is felt in women undergoing elective cesarean section. In obstetric patients, literature has reported a higher level of preoperative anxiety than the general surgical population. One of the commonest surgical procedures in obstetrics is Caesarean section (CS). Preoperative anxiety has been described as being associated with several adverse physiological and psychological effects.&#x0D; Aim: This review aimed to determine the relationship between preoperative educational sessions and anxiety levels among women undergoing cesarean section.&#x0D; Methods: The search strategy of this study relies on some of the electronic bibliographic databases under the Medicine, Nursing, and Health Sciences departments. Various databases have been used to include different perspectives in the findings, CINAHL, Ovid MEDLINE, Pub Med, and Embase databases used to collect primary articles for this study.&#x0D; Results: The current review of the literature included seven quantitative studies that fulfill the inclusion criteria. The included studies revealed the intervention used as mental health training (one study), video is used in three studies, and health instruction in five studies. Two studies used both video and health instruction. In terms of the effect of preoperative sessions on anxiety level, four out of seven studies reported a decrease in the anxiety level. In comparison, the remaining three studies reported a non-significant educational intervention effect in decreasing the women’s anxiety.&#x0D; Conclusion: Most of the reviewed studies indicated that preoperative education intervention could positively impact anxiety levels among women undergoing CS. This makes the reviewed theme open for further randomized control intervention studying.

The Effects of Preoperative Education for Patients With Cancer: A Systematic Review and Meta-analysis.

The results of previous experimental studies have been inconsistent in the effect of preoperative education on postoperative outcomes, and there have been no meta-analyses focusing solely on preoperative education for patients with cancer. To identify the magnitude and direction of the effects of preoperative education and to investigate the influence of moderators on postoperative outcomes for patients undergoing cancer-related surgery. A systematic review and meta-analysis was conducted following the Cochrane guidelines. Electronic databases were searched until October 2019 using Cochrane database, MEDLINE, EMBASE, and CINAHL for randomized controlled trials and quasi-experimental studies on preoperative education interventions. Ten studies with 45 effect sizes were analyzed in this meta-analysis, and the standardized mean difference was calculated based on Hedges' g as an effect size. Meta-analysis showed that the overall effect size of preoperative education was moderate. Preoperative education improved cancer patients' knowledge and satisfaction and reduced pain. The effects of preoperative education were greater in younger age groups when delivered using verbal or combined educational methods. This meta-analysis demonstrated the importance of preoperative educational interventions not only in terms of their surgery-related cognitive aspects but also in terms of the physical and psychological aspects linked to the cancer surgery. Interventions to provide the most effective preoperative education for patients with cancer in the hospital setting are required, and this information can be used to develop evidence-based education strategies for patients undergoing cancer-related surgery.

Reducing Opioid Use in Endocrine Surgery Through Patient Education and Provider Prescribing Patterns

BackgroundPostoperative opioid use can lead to dependence, contributing to the opioid epidemic in the United States. New persistent opioid use after minor surgeries occurs in 5.9% of patients. With increased documentation of persistent opioid use postoperatively, surgeons must pursue interventions to reduce opioid use perioperatively. MethodsWe performed a prospective cohort study to assess the feasibility of a preoperative intervention via patient education or counseling and changes in provider prescribing patterns to reduce postoperative opioid use. We included adult patients undergoing thyroidectomy and parathyroidectomy from January 22, 2019 to February 28, 2019 at a tertiary referral, academic endocrine surgery practice. Surveys were administered to assess pain and patient satisfaction postoperatively. Prescription, demographic, and comorbidity data were collected from the electronic health record. ResultsSixty six patients (74.2% women, mean age 58.6 [SD 14.9] y) underwent thyroidectomy (n = 35), parathyroidectomy (n = 24), and other cervical endocrine operations (n = 7). All patients received a preoperative educational intervention in the form of a paper handout. 90.9% of patients were discharged with prescriptions for nonopioid pain medications, and 7.6% were given an opioid prescription on discharge. Among those who received an opioid prescription, the median quantity of opioids prescribed was 135 (IQR 120-150) oral morphine equivalents. On survey, four patients (6.1%) reported any postoperative opioid use, and 94.6% of patients expressed satisfaction with their preoperative education and postoperative pain management. ConclusionsClear and standardized education regarding postoperative pain management is feasible and associated with high patient satisfaction. Initiation of such education may support efforts to minimize unnecessary opioid prescriptions in the population undergoing endocrine surgery.

Impact of a Preoperative Video-Based Educational Intervention on Postoperative Outcomes in Elective Major Abdominal Surgery: a Randomized Controlled Trial

Impact of a Preoperative Video-Based Educational Intervention on Postoperative Outcomes in Elective Major Abdominal Surgery: a Randomized Controlled Trial