Psychosocial factors and surgical outcomes: an evidence-based literature review.
ABSTRACT The influence of psychosocial factors on clinical outcomes after surgery has been investigated in several studies. This review is limited to surgical outcomes studies published between 1990 and 2004 that include (1) psychosocial variables (eg, depression, social support) as predictors of outcome and that focus on (2) clinical outcomes (eg, postoperative pain, functional recovery) using (3) specific multivariate analytic techniques with (4) relevant clinical variables (eg, presurgical health status) included as covariates. Twenty-nine studies met these criteria. Results indicate that psychosocial factors play a significant role in recovery and are predictive of surgical outcome, even after accounting for known clinical factors. Attitudinal and mood factors were strongly predictive; personality factors were least predictive. The results suggest that preoperative consideration of attitudinal and mood factors will assist the surgeon in estimating both the speed and extent of postoperative recovery.
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ABSTRACT: Limited published data exploring patients' emotional recovery after day case foot surgery are available. The aim of the present study was to explore the changes in patient mood from preoperatively to 8 weeks postoperatively after outpatient forefoot surgery. The patients completed the Profile of Mood States-Bipolar™ questionnaire, Speilberger State-Trait Anxiety Inventory, and a 10-cm visual analog scale to measure pain preoperatively and again at 1, 2, and 8 weeks postoperatively. Of the 6 mood subscales, 3 showed statistically significant improvements by 8 weeks postoperatively: composed–anxious (Student's t test, t = −5.319; df = 84; p = .05); confident–unsure (t = −2.074; df = 84; p = .02); and clearheaded–confused (t = −2.46; df = 84; p = .007). Furthermore, the decrease in anxiety and pain was statistically significant after foot surgery. These findings have contributed to the understanding of patients' psychological needs in relation to outpatient day case foot surgery, and foot and ankle surgeons' understanding of patients' mood and anxiety levels can contribute to improving patient care and enhancing patient–practitioner relationships, which, in turn, could improve patients' perceived outcomes of their surgery.The Journal of foot and ankle surgery: official publication of the American College of Foot and Ankle Surgeons 05/2014;
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ABSTRACT: Introduction The holistic approach in medicine is a framework that considers and treats all aspects of a patient’s needs, as it relates to their health. The goal of such an approach is to prevent illness, and to maximise the well-being of individuals and families. Holistic medicine is also referred to as integrative, which has been interpreted by some professionals as the combination of evidence-based medicine and complementary medicine. The problem The speciality of Family Medicine (FM) is often referred to as General Practice (GP), a terminology which emphasises the holistic nature of that discipline. Furthermore, GP/FM professional bodies in some countries have incorporated the holistic and integrative approach into curricula and guidelines for doctors in training, which reflects its acceptance as a component of medical training. However, despite this validation, and despite research showing the effectiveness of such strategies in enhancing the outcomes of surgery, a holistic framework or integrative approach has not been equally integrated into speciality training for would-be surgeons. Conclusion We argue that it would be advisable to include holistic approaches into surgical training and help surgeons to recognise their role in the continuum of care.Arab Journal of Urology. 03/2014; 12(1):21–24.
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ABSTRACT: SUMMARY Osteoarthritis (OA) is a major cause of pain and is characterized by loss of articular cartilage integrity, synovitis and remodeling of subchondral bone. However, OA pain mechanisms remain incompletely understood. Pain severity does not always correlate with the extent of joint damage. Furthermore, many people with OA continue to experience pain despite optimal use of standard therapies that target the joints, including joint-replacement surgery. There is compelling evidence that altered central pain processing plays an important role in maintaining pain and increasing pain severity in some people with OA. A key challenge is to identify this subgroup of patients with abnormal central pain processing in order to improve their clinical outcomes by developing and targeting specific analgesic treatments.Pain management. 01/2014; 4(1):45-56.