The Impact of Weight Normalization on Quality of Recovery in Anorexia Nervosa

2009 ◽  
Vol 28 (4) ◽  
pp. 397-404 ◽  
Author(s):  
Céline Meguerditchian ◽  
Catherine Samuelian-Massat ◽  
René Valéro ◽  
Audrey Begu-Le Corroller ◽  
Isabelle Fromont ◽  
...  
Keyword(s):  
Anorexia Nervosa ◽  
Quality Of Recovery ◽  
The Impact

scholarly journals The impact of multimodal analgesia based enhanced recovery protocol on quality of recovery after laparoscopic gynecological surgery: a randomized controlled trial

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Zhiyu Geng ◽  
Hui Bi ◽  
Dai Zhang ◽  
Changji Xiao ◽  
Han Song ◽  
...  
Keyword(s):  
Enhanced Recovery ◽  
Controlled Trial ◽  
Bowel Function ◽  
Multimodal Analgesia ◽  
Study Group ◽  
Gynecological Surgery ◽  
Quality Of Recovery ◽  
Enhanced Recovery Protocol ◽  
The Impact

Abstract Background Our objective was to evaluate the impact of multimodal analgesia based enhanced recovery protocol on quality of recovery after laparoscopic gynecological surgery. Methods One hundred forty female patients scheduled for laparoscopic gynecological surgery were enrolled in this prospective, randomized controlled trial. Participants were randomized to receive either multimodal analgesia (Study group) or conventional opioid-based analgesia (Control group). The multimodal analgesic protocol consists of pre-operative acetaminophen and gabapentin, intra-operative flurbiprofen and ropivacaine, and post-operative acetaminophen and celecoxib. Both groups received an on-demand mode patient-controlled analgesia pump containing morphine for rescue analgesia. The primary outcome was Quality of Recovery-40 score at postoperative day (POD) 2. Secondary outcomes included numeric pain scores (NRS), opioid consumption, clinical recovery, C-reactive protein, and adverse events. Results One hundred thirty-eight patients completed the study. The global QoR-40 scores at POD 2 were not significantly different between groups, although scores in the pain dimension were higher in Study group (32.1 ± 3.0 vs. 31.0 ± 3.2, P = 0.033). In the Study group, NRS pain scores, morphine consumption, and rescue analgesics in PACU (5.8% vs. 27.5%; P = 0.0006) were lower, time to ambulation [5.0 (3.3–7.0) h vs. 6.5 (5.0–14.8) h; P = 0.003] and time to bowel function recovery [14.5 (9.5–19.5) h vs.17 (13–23.5) h; P = 0.008] were shorter, C-reactive protein values at POD 2 was lower [4(3–6) ng/ml vs. 5 (3–10.5) ng/ml; P = 0.022] and patient satisfaction was higher (9.8 ± 0.5 vs. 8.8 ± 1.2, P = 0.000). Conclusion For minimally invasive laparoscopic gynecological surgery, multimodal analgesia based enhanced recovery protocol offered better pain relief, lower opioid use, earlier ambulation, faster bowel function recovery and higher patient satisfaction, while no improvement in QoR-40 score was found. Trial registration ChiCTR1900026194; Date registered: Sep 26,2019.

scholarly journals Influence of catastrophizing, anxiety, and depression on in-hospital opioid consumption, pain, and quality of recovery after adult spine surgery

2018 ◽  
Vol 28 (1) ◽  
pp. 119-126 ◽  
Author(s):  
Lauren K. Dunn ◽  
Marcel E. Durieux ◽  
Lucas G. Fernández ◽  
Siny Tsang ◽  
Emily E. Smith-Straesser ◽  
...  
Keyword(s):  
Spine Surgery ◽  
Rating Scale ◽  
Psychological Intervention ◽  
Opioid Consumption ◽  
Anxiety And Depression ◽  
Opioid Use ◽  
Quality Of Recovery ◽  
Pain Scores ◽  
The Impact

OBJECTIVEPerception of perioperative pain is influenced by various psychological factors. The aim of this study was to determine the impact of catastrophizing, anxiety, and depression on in-hospital opioid consumption, pain scores, and quality of recovery in adults who underwent spine surgery.METHODSPatients undergoing spine surgery were enrolled in this study, and the preoperatively completed questionnaires included the verbal rating scale (VRS), Pain Catastrophizing Scale (PCS), Hospital Anxiety and Depression Scale (HADS), and Oswestry Disability Index (ODI). Quality of recovery was assessed using the 40-item Quality of Recovery questionnaire (QoR40). Opioid consumption and pain scores according to the VRS were recorded daily until discharge.RESULTSOne hundred thirty-nine patients were recruited for the study, and 101 completed the QoR40 assessment postoperatively. Patients with higher catastrophizing scores were more likely to have higher maximum pain scores postoperatively (estimate: 0.03, SE: 0.01, p = 0.02), without increased opioid use (estimate: 0.44, SE: 0.27, p = 0.11). Preoperative anxiety (estimate: 1.18, SE: 0.65, p = 0.07) and depression scores (estimate: 1.06, SE: 0.71, p = 0.14) did not correlate with increased postoperative opioid use; however, patients with higher preoperative depression scores had lower quality of recovery after surgery (estimate: −1.9, SE: 0.56, p < 0.001).CONCLUSIONSCatastrophizing, anxiety, and depression play important roles in modulating postoperative pain. Preoperative evaluation of these factors, utilizing a validated tool, helps to identify patients at risk. This might allow for earlier psychological intervention that could reduce pain severity and improve the quality of recovery.

scholarly journals Study protocol of comprehensive risk evaluation for anorexia nervosa in twins (CREAT): a study of discordant monozygotic twins with anorexia nervosa

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Maria Seidel ◽  
Stefan Ehrlich ◽  
Lauren Breithaupt ◽  
Elisabeth Welch ◽  
Camilla Wiklund ◽  
...  
Keyword(s):  
Anorexia Nervosa ◽  
Risk Evaluation ◽  
Monozygotic Twins ◽  
Control Design ◽  
Brain Structure And Function ◽  
Specific Factors ◽  
And Function ◽  
The Impact ◽  
Mz Twins

Abstract Background Anorexia nervosa (AN) is a severe disorder, for which genetic evidence suggests psychiatric as well as metabolic origins. AN has high somatic and psychiatric comorbidities, broad impact on quality of life, and elevated mortality. Risk factor studies of AN have focused on differences between acutely ill and recovered individuals. Such comparisons often yield ambiguous conclusions, as alterations could reflect different effects depending on the comparison. Whereas differences found in acutely ill patients could reflect state effects that are due to acute starvation or acute disease-specific factors, they could also reflect underlying traits. Observations in recovered individuals could reflect either an underlying trait or a “scar” due to lasting effects of sustained undernutrition and illness. The co-twin control design (i.e., monozygotic [MZ] twins who are discordant for AN and MZ concordant control twin pairs) affords at least partial disambiguation of these effects. Methods Comprehensive Risk Evaluation for Anorexia nervosa in Twins (CREAT) will be the largest and most comprehensive investigation of twins who are discordant for AN to date. CREAT utilizes a co-twin control design that includes endocrinological, neurocognitive, neuroimaging, genomic, and multi-omic approaches coupled with an experimental component that explores the impact of an overnight fast on most measured parameters. Discussion The multimodal longitudinal twin assessment of the CREAT study will help to disambiguate state, trait, and “scar” effects, and thereby enable a deeper understanding of the contribution of genetics, epigenetics, cognitive functions, brain structure and function, metabolism, endocrinology, microbiology, and immunology to the etiology and maintenance of AN.

scholarly journals Comparison of the impact of propofol versus sevoflurane on early postoperative recovery in living donors after laparoscopic donor nephrectomy: a prospective randomized controlled study

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Sangbin Han ◽  
Jaesik Park ◽  
Sang Hyun Hong ◽  
Soojin Lim ◽  
Yong Hyun Park ◽  
...  
Keyword(s):  
Postoperative Recovery ◽  
Living Donors ◽  
Randomized Controlled Study ◽  
Controlled Study ◽  
Sevoflurane Group ◽  
Quality Of Recovery ◽  
Randomized Controlled ◽  
Hospitalization Period ◽  
The Impact

Abstract Background Enhancing postoperative recovery of the donor is important to encourage living kidney donation. We investigated the effects of anesthetic agents (intravenous [IV] propofol versus inhaled [IH] sevoflurane) on the quality of early recovery of healthy living kidney donors after hand-assisted laparoscopic nephrectomy (HALN) under analgesic intrathecal morphine injection. Methods This single-center, prospective randomized controlled study enrolled 80 living donors undergoing HALN from October 2019 to June 2020 at Seoul St. Mary’s Hospital. Donors were randomly assigned to the IV propofol group or IH sevoflurane group. To measure the quality of recovery, we used the Korean version of the Quality of Recovery-40 questionnaire (QoR-40 K) on postoperative day (POD) 1, and ambulation (success rate, number of footsteps) 6–12 h after surgery and on POD 1. The pain score for the wound site, IV opioid requirement, postoperative complications including incidences of nausea/vomiting, and length of in-hospital stay were also assessed. Results The global QoR-40 K score and all subscale scores (physical comfort, emotional state, physical independence, psychological support, and pain) were significantly higher in the IV propofol group than in the IH sevoflurane group. The numbers of footsteps at all time points were also higher in the IV propofol group. Donors in the IV propofol group had a lower incidence of nausea/vomiting, and a shorter hospitalization period. Conclusions Total IV anesthesia with propofol led to better early postoperative recovery than that associated with IH sevoflurane. Trial registration Clinical Research Information Service, Republic of Korea (approval number: KCT0004351) on October 18, 2019.

Post-operative Quality of Recovery Scale: the impact of assessment method on cognitive recovery

2013 ◽  
Vol 57 (10) ◽  
pp. 1308-1312 ◽  
Author(s):  
M. LINDQVIST ◽  
C. ROYSE ◽  
M. BRATTWALL ◽  
M. WARRÉN-STOMBERG ◽  
JAN JAKOBSSON
Keyword(s):  
Assessment Method ◽  
Cognitive Recovery ◽  
Quality Of Recovery ◽  
The Impact ◽  
Operative Quality

scholarly journals Holistically addressing motivation and maladaptive traits in anorexia nervosa: Impact on prognosis and treatment outcomes

2019 ◽  
Vol 46 (1) ◽  
Author(s):  
Athena Milios
Keyword(s):  
Quality Of Life ◽  
Body Weight ◽  
Anorexia Nervosa ◽  
Weight Gain ◽  
Patient Outcomes ◽  
Eating Pathology ◽  
Individual Characteristics ◽  
Motivation To Change ◽  
The Impact

Anorexia Nervosa (AN) is a serious psychiatric disorder, characterized by restriction of energy intake, low body weight, intense fear of weight gain, and a disturbance in body weight self-perception. Severe and Enduring AN (SE-AN) is a long-lasting (typically 5-7 or more years and marked by several unsuccessful treatment attempts) form of AN. Traditional treatments, centering on weight restoration and core eating pathology, may be part of the reason rates of treatment dropout are high and long-term outcomes are poor, particularly in SE-AN. For SE-AN patients, who have a past marked by failed traditional treatment attempts, multidimensional treatments, addressing motivation to change and maladaptive traits, may improve a range of patient outcomes outside of eating-related symptoms, such as quality of life and interpersonal functioning.The objective of this narrative review is to briefly examine motivation-related factors (e.g., hope and readiness to change), experiential avoidance, perfectionism, and obsessive-compulsiveness, and the impact of treatment approaches incorporating these individual characteristics on various patient outcomes. In conclusion, a holistic, multidimensional, person-centred recovery approach that accounts for (a) illness severity/ chronicity, (b) individual traits, and (c) motivational factors (with a secondary focus on weight gain/eating pathology), could improve quality of life outcomes, particularly in SE-AN. Additionally, integrating patient perspectives, insights, and values into developing/testing novel person-centred interventions is paramount in order to holistically address the underlying biopsychosocial causes and perpetuating factors of AN, and to better understand the trajectory of chronicity.

scholarly journals Quality of life following Minimally Invasive Direct Coronary Artery Bypass Grafting (MIDCABG) versus Conventional Open-Heart Coronary Artery Bypass Grafting (CABG): A 3-year data from a single centre

2021 ◽  
Vol 6 (2) ◽  
pp. 36-42
Author(s):  
ADLI AZAM MOHAMMAD RAZI ◽  
Muhammad 'Abid Amir ◽  
Mohd Zamrin Dimon
Keyword(s):  
Quality Of Life ◽  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Bypass Grafting ◽  
Artery Bypass Grafting ◽  
Quality Of Recovery ◽  
The Impact

Introduction: In Malaysia, MIDCABG started in 3 centers developing the technique. As the technique is gaining traction in the country, this study aims to compare the quality of life following MIDCABG compared with conventional CABG in one of the centers actively developing this technique. Methods: A retrospective cohort study was performed involving 30 post CABG patients which consists of 15 MIDCABG and 15 conventional CABG from January 2015 to May 2018. 15 from 21 post-MIDCABG patients were included and selected, based on EuroSCORE II less than 5. Modified Post-Operative Quality of Recovery Scale was used to assess and compare the quality of life following respective approaches. Data were analyzed using SPSS version software and comparison using mean rank with p 0.05. Conclusion: There is no significant difference in quality of recovery following MIDCABG compared to conventional CABG. Modified PostOPQRS system can be a useful assessment tool to evaluate the impact of an intervention in relation of quality of life.

scholarly journals Mixed-methods evaluation of the Perioperative Medicine Service for High-Risk Patients Implementation Pilot (POMSHIP): a study protocol

BMJ Open ◽  
2018 ◽  
Vol 8 (10) ◽  
pp. e021647 ◽  
Author(s):  
David Walker ◽  
Duncan Wagstaff ◽  
Dermot McGuckin ◽  
Cecilia Vindrola-Padros ◽  
Nicholas Swart ◽  
...  
Keyword(s):  
High Risk ◽  
Perioperative Medicine ◽  
High Risk Patients ◽  
Quality Of Recovery ◽  
Mixed Methods Evaluation ◽  
Medicine Service ◽  
Before And After ◽  
Risk Patients ◽  
The Impact

IntroductionPerioperative complications have a lasting effect on health-related quality of life and long-term survival. The Royal College of Anaesthetists has proposed the development of perioperative medicine (POM) services as an intervention aimed at improving postoperative outcome, by providing better coordinated care for high-risk patients. The Perioperative Medicine Service for High-risk Patients Implementation Pilot was developed to determine if a specialist POM service is able to reduce postoperative morbidity, failure to rescue, mortality and cost associated with hospital admission. The service involves individualised objective risk assessment, admission to a postoperative critical care unit and follow-up on the surgical ward by the POM team. This paper introduces the service and how it will be evaluated.Methods and analysis of the evaluationA mixed-methods evaluation is exploring the impact of the service. Clinical effectiveness of the service is being analysed using a ‘before and after’ comparison of the primary outcome (the PostOperative Morbidity Score). Secondary outcomes will include length of stay, validated surveys to explore quality of life (EQ-5D) and quality of recovery (Quality of Recovery-15 Score). The impact on costs is being analysed using ‘before and after’ data from the Patient-Level Information and Costing System and the National Schedule of Reference Costs. The perceptions and experiences of staff and patients with the service, and how it is being implemented, are being explored by a qualitative process evaluation.Ethics and disseminationThe study was classified as a service evaluation. Participant information sheets and consent forms have been developed for the interviews and approvals required for the use of the validated surveys were obtained. The findings of the evaluation are being used formatively, to make changes in the service throughout implementation. The findings will also be used to inform the potential roll-out of the service to other sites.

scholarly journals The Anorexia Nervosa Care Pathway: Closing the Treatment Gap to Improve Care for Patients Admitted to Medical Hospitals

2021 ◽  
Author(s):  
Kathryn Allen ◽  
Kate O Brien ◽  
Marese O'Reilly ◽  
Deirbhile Henderson ◽  
Siobhan Machale ◽  
...  
Keyword(s):  
Anorexia Nervosa ◽  
Quality Of Care ◽  
Care Pathway ◽  
High Rate ◽  
Medical Complications ◽  
Hospital Inpatient ◽  
Improve Quality ◽  
Medical Monitoring ◽  
The Impact

Introduction: Medical complications of malnutrition and refeeding account for approximately half of deaths in anorexia nervosa (AN). The AN Care Pathway (ANCP) was introduced at our institution in 2016 to improve quality of care of patients admitted for medical observation and management. We report results from our review of medical complications and report the impact and adoption of the ANCP. Methods: The ANCP was developed in response to a need to improve quality of medical monitoring of patients with severe AN using Squire Guidelines and the Plan-Do-Study-Act cycle. All patients admitted to a medical hospital with AN between 2010-2020 were included after hospital inpatient enquiry and medical records were reviewed. Descriptive statistics were calculated using Stata (Statcorp). Results: Fifty-one patients (63 admissions) were included. Median BMI was 13.8 kg/m2 (11.9-22.5). After ANCP implementation in 2016, compliance with recommended daily ECG, thiamine and blood tests improved from 30% (n=8/27) to 86% (n=21/36). We report a high rate of medical complications of severe AN including anaemia (n=24, 47%), neutropoenia (n=18, 35%), abnormal liver bloods (n=15, 29%) and half developed refeeding syndrome. One-third patients had cardiovascular compromise including reduced cardiac contractility (n=13, 25%), pericardial effusion (n=7, 14%) and one death. Low BMI was associated with cardiovascular complications (mean BMI 13.5 kg/m2 vs 15.5 kg/m2, p=0.01) and neutropoenia (mean BMI 13.4 kg/m2 vs 15.4 kg/m2, p=0.02). Conclusion: Introduction of the ANCP improved quality of care during medical stabilisation. We report a high rate of medical complications of severe AN in patients admitted to a medical hospital. Use of multidisciplinary care protocols may contribute to quality improvement and improved consistency of care for this vulnerable population.

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