Pre-existing psychiatric disorders, psychological reactions to stress and the recovery of burn survivors. The effects of rivaroxaban on the complications of surgery after total hip or knee replacement: results from the RECORD programme. Influence of yoga on postoperative outcomes and wound healing in early operable breast cancer patients undergoing surgery Pain and wound healing in surgical patients Psychological Factors and the Development of Chronic Whiplash–associated Disorder(s): A Systematic Review A brief relaxation intervention reduces stress and improves surgical wound healing response: A randomised trial Psychological intervention for older hip fracture patients. Effect of early postoperative enteral immunonutrition on wound healing in patients undergoing surgery for gastric cancer. Short- and long-term anxiety and depression in women recalled after breast cancer screening. Acceptance and mindfulness-based stress management for support staff caring for individuals with intellectual disabilities. The development of psychological changes following whiplash injury Randomized-controlled trial of mindfulness-based cancer recovery versus supportive expressive group therapy among distressed breast cancer survivors (MINDSET): long-term follow-up results. Somatic and Psychologic Predictors of Long-term Unfavorable Outcome After Surgical Intervention Enhanced wound healing after emotional disclosure intervention. Timing of Renal Replacement Therapy for Severe Acute Kidney Injury in Critically Ill Patients Preoperative anxiety in ambulatory surgery: The impact of an empathic patient-centered approach on psychological and clinical outcomes. The effects of different nutritional measurements on delayed wound healing after hip fracture in the elderly. Evaluation of transvaginal slings using different materials in the management of female stress urinary incontinence Perioperative normothermia to reduce the incidence of surgical-wound infection and shorten hospitalization. Study of Wound Infection and Temperature Group. The effect of fatigue, sleep deprivation and onerous working hours on the physical and mental wellbeing of pre-registration house officers Prolonged reduction of salivary immunoglobulin A (sIgA) after a major academic exam. Mindfulness based stress reduction provides psychological benefit and restores immune function of women newly diagnosed with breast cancer: A randomized trial with active control Fast-track hip and knee replacement — what are the issues?
This study aim ed to investigate whether previous findings from a small retrospective study could be replicated prospect ively . The previous study showed that patients with an existing diagnosis of psychosis or depression , admitted to a burns service , had longer hospital stays and longer wound healing times when compared with controls matched for burn injury but without a pre-existing psychiatric condition [ 1 ] . In this study it was hypothesised that those patients without pre-existing psychiatric diagnosis , but with high levels of psychological distress after burn would also show a similar pattern of delayed recovery to those with a pre-existing psychiatric illness . In addition , we examined potential mechanisms for slowed recovery , including ; adherence with treatment ; delayed discharge on social grounds and psychological distress . It was hypothesised that patients with pre-existing psychiatric diagnosis would exhibit poorer adherence and delayed placement due to social reasons , compared to patients without pre-existing psychiatric diagnoses . 107 consecutive admissions to a burns service over a seven-month period were included in the study . Psychiatric history and level of psychological distress post-burn were collected for all patients as part of routine psychological screening . Patients were compared on the following outcome variables : number of days spent in hospital and number of procedures required .  24 % ( n=27 ) were found to have a pre-existing psychiatric diagnosis . This group were also found to have significantly longer hospital stays ( Mann-Whitney U=585.50 , p<0.01 ) and required more surgical procedures than the group without a psychiatric history ( Mann-Whitney U=569.00 , p=<0.001 ) . The pattern of results for the group with high psychological distress but without pre-existing psychiatric diagnoses mirrored that of the group with pre-existing psychiatric diagnoses , suggesting that heightened psychological distress alone , has a significant delaying effect upon the rate of recovery ( Kruskal-Wallis X=24.75 , p<0.01 ) . An exploratory model entering all the variables stepwise at the same stage identified poor adherence and delayed discharge issues as making significant contributions to the final model ( r=0.81 adjusted r(2)=62.9 , F ( 4 , 42)=20.48 , p<0.001 ) . In conclusion , this study supports the role of psychosocial factors , such as pre-existing psychiatric diagnosis and in hospital psychological distress , in contributing the recovery of survivors of burns . This suggests that identifying and working with these difficulties may impact not only on psychosocial , but also physical aspects of recovery Post-operative complications after total hip or knee replacement can delay recovery , prolong hospitalisation , increase rates of re-admission and , in the most severe cases , lead to long-term disability or even death . In this analysis of pooled data from four large , r and omised , phase III clinical trials that compared the oral , direct Factor Xa inhibitor rivaroxaban with subcutaneous enoxaparin for the prevention of venous thromboembolism after total hip or knee replacement ( n = 12,729 ) , the incidence of complications , including bleeding and adverse events related to surgery ( such as wound infection , wound dehiscence and haemarthrosis ) are reported . Interventions and procedures relating to surgery are also compared between the groups . Bleeding events , including excessive wound haematoma and surgical-site bleeding , occurred at similar rates in the rivaroxaban and enoxaparin groups . Over the total study duration , adverse surgical events occurred at a similar rate in the rivaroxaban group compared with the enoxaparin group after total knee replacement ( 2.26 % vs. 2.69 % , respectively ) and total hip replacement ( 1.48 % vs. 1.65 % , respectively ) . Blood loss , wound drainage and transfusion requirements were also similar between the two groups . This analysis shows that the incidence of adverse surgical events with rivaroxaban was similar to enoxaparin Context : Pre- and postoperative distress in breast cancer patients can cause complications and delay recovery from surgery . Objective : The aim of our study was to evaluate the effects of yoga intervention on postoperative outcomes and wound healing in early operable breast cancer patients undergoing surgery . Methods : Ninety-eight recently diagnosed stage II and III breast cancer patients were recruited in a r and omized controlled trial comparing the effects of a yoga program with supportive therapy and exercise rehabilitation on postoperative outcomes and wound healing following surgery . Subjects were assessed at the baseline prior to surgery and four weeks later . Sociodemographic , clinical and investigative notes were ascertained in the beginning of the study . Blood sample s were collected for estimation of plasma cytokines — soluble Interleukin (IL)-2 receptor ( IL-2R ) , tumor necrosis factor (TNF)-alpha and interferon (IFN)-gamma . Postoperative outcomes such as the duration of hospital stay and drain retention , time of suture removal and postoperative complications were ascertained . We used independent sample s t test and nonparametric Mann Whitney U tests to compare groups for postoperative outcomes and plasma cytokines . Regression analysis was done to determine predictors for postoperative outcomes . Results : Sixty-nine patients contributed data to the current analysis ( yoga : n = 33 , control : n = 36 ) . The results suggest a significant decrease in the duration of hospital stay ( P = 0.003 ) , days of drain retention ( P = 0.001 ) and days for suture removal ( P = 0.03 ) in the yoga group as compared to the controls . There was also a significant decrease in plasma TNF alpha levels following surgery in the yoga group ( P < 0.001 ) , as compared to the controls . Regression analysis on postoperative outcomes showed that the yoga intervention affected the duration of drain retention and hospital stay as well as TNF alpha levels . Conclusion : The results suggest possible benefits of yoga in reducing postoperative complications in breast cancer patients Background : Human and animal laboratory studies have shown that stress delays healing of st and ardized punch biopsy wounds . Purpose : This 5-week prospect i ve study of 17 women who underwent elective gastric bypass surgery  addressed the association between postsurgical pain intensity and subsequent healing of a st and ard 2.0-mm punch biopsy wound . Methods : Participants were assessed 1 week before surgery , within 3 hr before surgery , 1 to 3 days postsurgery , and at weekly intervals for 4 weeks following surgery . Results : Patient ratings of greater acute postsurgical pain , averaged over Days 1 and 2 postsurgery , and greater persistent postsurgical pain , averaged over 4 weekly postsurgery pain ratings , were significantly associated with subsequent delayed healing of the punch biopsy wound . Presence of depressive symptoms on the day of surgery , pre-existing persistent pain , and medical complications following initial discharge from the hospital were not related to wound healing . Depressive symptoms on the day of surgery and pre-existing persistent pain did predict persistent postsurgical pain intensity . Conclusions : These findings extend the previous laboratory models of wound healing to a surgical population , providing the first evidence that pain plays an important role in postsurgery wound healing , a key variable in postsurgical recovery Objectives : To assess which psychological factors are important in the development of chronic whiplash symptoms . Methods : Search es were conducted across PubMed , CINAHL , Scopus , and PsychINFO up until March 2017 . Studies were included if they investigated psychological prognostic factors in association with recovery from a whiplash injury . Studies also had to be prospect i ve , cohort , follow-up or observational studies , have a 6 month follow-up and published in English . Quality assessment s were conducted by 2 independent review ers . Thirty-one articles were included investigating 34 psychological factors . Results : Poor expectations of recovery , posttraumatic stress symptoms and passive coping emerged as the most consistent prognostic factors of chronic neck pain and /or disability after a whiplash injury . Anxiety , travel anxiety , depression , personality , precollision distress , general psychological distress , and avoidance behavior were not associated with chronic whiplash problems Psychological stress has been shown to impair wound healing , but experimental research in surgical patients is lacking . This study investigated whether a brief psychological intervention could reduce stress and improve wound healing in surgical patients . This r and omised controlled trial was conducted at a surgical centre . Inclusion criteria were English-speaking patients over 18 years booked to undergo elective laparoscopic cholecystectomy ; exclusion criteria were cancellation of surgery , medical complications , and refusal of consent . Seventy five patients were r and omised and 15 patients were excluded ; 60 patients completed the study ( 15 male , 45 female ) . Participants were r and omised to receive st and ard care or st and ard care plus a 45-min psychological intervention that included relaxation and guided imagery with take-home relaxation CDs for listening to for 3 days before and 7 days after surgery . In both groups ePTFE tubes were inserted during surgery and removed at 7 days after surgery and analysed for hydroxyproline as a measure of collagen deposition and wound healing . Change in perceived stress from before surgery to 7-day follow-up was assessed using question naires . Intervention group patients showed a reduction in perceived stress compared with the control group , controlling for age . Patients in the intervention group had higher hydroxyproline deposition in the wound than did control group patients ( difference in means 0.35 , 95 % CI 0.66 - 0.03 ; t(43)=2.23 , p=0.03 ) . Changes in perceived stress were not associated with hydroxyproline deposition . A brief relaxation intervention prior to surgery can reduce stress and improve the wound healing response in surgical patients . The intervention may have particular clinical application for those at risk of poor healing following surgery 1 . Although there are sophisticated surgical procedures for hip fracture repair , a substantial proportion of patients never return to pre-fracture levels of physical function . Factors that influence the recovery of older hip fracture patients represent important areas to study in order to more precisely predict outcome . 2 . Research findings suggest that elevated depressive symptoms and cognitive impairment may negatively affect recovery , while mental alertness , emotional stability , and social involvement positively affect recovery . Thus , hip fracture and its subsequent disability must be studied as a biopsychosocial phenomenon , rather than merely as a physiological event . 3 . Older hip fracture patients may be at higher risk for psychological problems related to the traumatic nature of the injury . A comprehensive psychological assessment at admission can assist the nursing staff to determine which patients are at higher risk for emotional distress BACKGROUND & AIMS One of the most frequent complications in patients with cancer and malnutrition is the surgical wound healing delay or failure . Some studies have shown that arginine improves wound healing in rodents and in healthy human beings . The main objective of this study was to assess the effect of early postoperative enteral immunonutrition on the wound healing process in patients undergoing surgery for gastric cancer . METHODS Sixty six patients with gastric cancer were r and omized to receive early postoperative enteral immunonutrition ( formula supplemented with arginine , omega-3 fatty acids and ribonucleic acid ( RNA ) ) or an isocaloric-isonitrogenous control . Assessment of wound healing process : ( 1 ) Quantification of hydroxyproline deposition in a subcutaneously placed catheter , ( 2 ) occurrence of surgical wound healing complications . RESULTS Sixty patients were analyzed . Patients fed with immunonutrition ( n=30 ) showed higher local hydroxyproline levels ( 59.7 nmol ( 5.0 - 201.8 ) , vs. 28.0 nmol ( 5.8 - 89.6 ) P=0.0018 ) and significantly lower episodes of surgical wound healing complications ( 0 vs. 8 ( 26.7 % ) P=0.005 ) when compared to patients fed with the control formula ( n=30 ) . CONCLUSIONS Early postoperative enteral nutrition with a formula supplemented with arginine , omega 3 fatty acids and RNA increased hydroxyproline synthesis and improved surgical wound healing in patients undergoing gastrectomy for gastric cancer The aim was to investigate the psychological consequences of further investigation after breast cancer screening . Study participants include 509 women ( 61 % ) recalled due to suspicious findings on screening mammograms , and a matched control group of 285 women ( 68 % ) with normal mammograms .  Psychological distress was prospect ively assessed with the Hospital Anxiety and Depression Scale ( HADS ) . 46 % of the women reported borderline or clinical ly significant anxiety prior to the recall visit . A few days after the visit , anxiety and depression had decreased significantly ( P<0.01 ) in women informed about normal or benign results at the recall clinic , while reported distress remained at relatively high levels in women referred to surgical biopsy . The results demonstrate the adverse short-term effect of a delay in receiving false-positive results , but do not indicate that the recall experience results in long-term anxiety or depression for a majority of women UNLABELLED Support staff working with individuals with intellectual disability ( ID ) and challenging behaviour experience high levels of work-related stress . Preliminary theoretical and experimental research has highlighted the potential suitability of acceptance and mindfulness approaches for addressing support staff stress . This study examines the effectiveness of an acceptance and mindfulness-based stress management workshop on the levels of psychological distress and well-being of support staff working with individuals with ID and challenging behaviour . Support staff ( n=120 ) were r and omly assigned to a  workshop intervention condition ( n=66 ) or to a waiting list control condition  ( n=54 ) . Measurements were completed at three time points ( pre- , post and 6 week follow-up ) for : psychological distress , well-being , perceived work stressors , thought suppression , and emotional avoidance/psychological inflexibility . MAIN FINDINGS The intervention led to significantly greater reductions in distress in the intervention group than in the control group . This was largely maintained at 6 week follow-up . This effect was more pronounced amongst a sub sample that had shown higher levels of psychological distress at baseline . Thought suppression was found to reduce significantly in the intervention group between post intervention and follow-up , although no significant change was found in well-being or experiential avoidance/psychological inflexibility . Overall , results demonstrated support for the effectiveness of an acceptance and mindfulness-based intervention in reducing distress & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction BACKGROUND Mindfulness-based cancer recovery ( MBCR ) and supportive expressive group therapy ( SET ) are two well-vali date d psychosocial interventions , but they have not been directly compared , and little is known about long-term outcomes . This comparative effectiveness study measured the effects of these two interventions immediately following the groups and for 1 year thereafter in distressed breast cancer survivors . METHODS Two hundred fifty-two distressed Stage I-III breast cancer survivors were r and omized into either MBCR or SET . Women completed question naires addressing mood , stress symptoms , quality of life , social support , spirituality and post-traumatic growth before and after the interventions , and 6 and 12 months later . RESULTS Immediately following the intervention , women in MBCR reported greater reduction in mood disturbance ( primarily fatigue , anxiety and confusion ) and stress symptoms including tension , sympathetic arousal and cognitive symptoms than those in SET . They also reported increased emotional and functional quality of life , emotional , affective and positive social support , spirituality ( feelings of peace and meaning in life ) and post-traumatic growth ( appreciation for life and ability to see new possibilities ) relative to those in SET , who also improved to a lesser degree on many outcomes . Effect sizes of the time × group interactions were small to medium , and most benefits were maintained over 12 months of follow-up . CONCLUSIONS This study is the first and largest to demonstrate sustained benefits of MBCR in distressed breast cancer survivors relative to an active control . MBCR was superior to SET for improving psychological well-being with lasting benefits over 1 year , suggesting these women gained long-lasting and efficacious tools to cope with cancer . TRIAL REGISTRATION Registered on clinical trials.gov number NCT00390169 , October 2006 . Copyright © 2016 John Wiley & Sons , Objective : To identify somatic and psychologic predictors of pain , functional limitations , global perceived recovery , and quality of life 6 months after surgical intervention . Summary Background Data : Recent studies have indicated that chronic pain after surgical intervention is more common than previously assumed . Several demographic and somatic predictors of long-term unfavorable outcome have been identified , but little is known about the contribution of psychologic risk factors . Methods : A prospect i ve cohort study , including 625 patients undergoing elective surgery at the University Hospital Maastricht , The Netherl and s , was conducted between February and August 2003 .  Psychologic question naires were completed preoperatively and acute postoperative pain was recorded until 4 days after the operation . Six months later , all patients received follow-up question naires to assess pain , functional limitations , global perceived recovery , and quality of life . Multivariable logistic regression analyses were used to estimate relative risk of poor outcome in terms of pain , functional limitations , and global recovery . Multivariable linear regression analysis was used to assess associations with quality of life at 6 months . Results : The most important somatic predictors of unfavorable outcome were duration of the operation and high levels of acute postoperative pain . Patients reporting high levels of pain 4 days after the operation and patients undergoing an operation of longer than 3 hours were at risk for increased pain , increased functional limitations , poor global recovery , and reported lower levels of quality of life 6 months after the operation . Psychologic variables that influenced long-term outcome were preoperative fear of surgery and optimism . Fear of the long-term consequences of the operation was associated with more pain , poor global recovery , and worse quality of life 6 months later , whereas optimism was associated with better recovery and higher quality of life . Conclusions : This study was the first to identify the joint contribution of somatic and psychologic factors to chronic pain , functional limitations , and quality of life 6 months after surgical interventions . It replicates previous findings that intense acute postoperative pain is a risk factor for long-term adverse outcome and also identified additional risk factors , namely , long duration of the operation , ASA status , and preoperative fear of surgery OBJECTIVES Psychological stress is believed to impair wound healing via a down-regulation of the immune system . Since previous research suggests that disclosure of tra-umatic experiences can result in an up-regulation of immune function , the present study aim ed to investigate the impact of a disclosure intervention on the progress of wound healing . DESIGN The study used a prospect i ve , longitudinal design with r and om assignment to the control ( writing about time management ) and experimental group ( writing about a traumatic event ) . METHODS Participants ( N=36 ) completed question naires measuring perceived and emotional distress , loneliness , self-esteem , social support , dispositional optimism , and health-related behaviours . Accurate indication of the healing of a small punch biopsy wound was determined by using a high-resolution ultrasound scanner . RESULTS Repeated measures ANOVA indicated that the disclosure intervention impacted wound healing . Participants who wrote about traumatic events had significantly smaller wounds 14 and 21 days after the biopsy compared with those who wrote about time management . CONCLUSIONS It is concluded that a relatively brief and easy to administer intervention can have beneficial effects on wound healing . The potential for use in patient sample s is indicated & NA ; Acute kidney injury ( AKI ) affects many ICU patients and is responsible for increased morbidity and mortality . Although lifesaving in many situations , renal replacement therapy ( RRT ) may be associated with complications , and the appropriate timing of its initiation is still the subject of intense debate . An early initiation strategy can prevent some metabolic complications , whereas a delayed one may allow for renal function recovery in some patients without need for this costly and potentially dangerous technique . For years , most of the knowledge on this issue stemmed from observational studies or small r and omized controlled trials . Recent r and omized controlled trials have indicated that a watchful waiting strategy ( in the absence of life‐threatening conditions such as severe hyperkalemia or pulmonary edema ) during severe AKI allowed many patients to escape RRT and did not seem to adversely affect survival compared with a strategy of immediate RRT . In addition , data suggest that a delayed strategy may reduce the rate of complications ( such as catheter infection ) and favor renal function recovery . Ongoing studies will have to both confirm these conclusions and clarify to what extent the delay in initiating RRT can be prolonged . Pending those results , the bulk of evidence suggests that , in the absence of potential severe complications of AKI , delaying RRT is a valid and safe strategy that may also allow for considerable cost savings OBJECTIVE This study aims to evaluate the influence of an empathic patient-centered approach on preoperative anxiety and surgical outcomes in ambulatory surgery patients . METHODS A sample of 104 patients undergoing general ambulatory surgery was r and omly assigned to the intervention ( IG ) and the control ( CG ) groups . Before surgery , the IG received personalized information through an empathic patient-centered interview . The CG received st and ardized information on surgical procedures .  Anxiety was assessed before and after the preoperative interview and after the surgery . Wound healing , post-surgical recovery and satisfaction with the quality of preoperative information were assessed after the surgery . RESULTS The two groups were identical at baseline regarding anxiety , socio-demographic and clinical characteristics . After the patient-centered intervention , the IG showed lower levels of preoperative anxiety ( p<0.001 ) and pain ( p<0.001 ) , better surgery recovery ( p<0.01 ) and higher levels of daily activity ( p<0.001 ) and of satisfaction with the information received ( p<0.01 ) than the CG . The IG also showed better wound healing ( tissue type , p<0.01 ; local pain , p<0.01 ) . CONCLUSION An empathic patient-centered intervention can reduce preoperative anxiety and increase surgical recovery , wound healing and patient satisfaction . PRACTICE IMPLICATION S This approach is applicable in pre-surgical interviews and can potentially be used in the routine care of various surgical context BACKGROUND It has been well recognized that malnutrition causes wounds to heal inadequately and incompletely . Malnutrition is often observed in the elderly , and it appears to be more severe in patients with hip fracture than in the general aging population . Few prospect i ve studies give a detailed account of the identification and classification of nutritional status in the elderly . The objective of this study was to evaluate the effects of different nutritional measurements on wound healing status after hip fracture in the elderly . METHODS From September 2002 to December 2007 , 207 hip fracture patients older than 60 y treated surgically were review ed for preoperative nutritional status . There were 81 males and 126 females with an average age of 75.93 y ( 62 - 91 y ) ; 131 cases with femoral neck fractures , 76 cases with intertrochanteric fractures . Parameters indicative of nutritional status ( serum albumin , serum transferrin , serum pre-albumin , and total lymphocyte count levels ) at the time of admission were assessed , along with  anthropometric measurements , Rainey MacDonald nutritional index , and MNA tool . Suture removal was performed on postoperative day 14 . RESULTS Delayed wound healing complicated 46 ( 22.2 % ) of the 207 cases . The preoperative serum transferring total lymphocyte count levels , MNA total score , and Rainey MacDonald nutritional index were significantly lower for patients who subsequently had delayed wound healing . When all variables were subjected to multivariate analysis , only total lymphocyte count levels and MNA total score showed significant value in predicting which patients would have delayed wound healing . Through prophylactic antibiotics and adherence to strict aseptic pre caution s , on follow-up , wound healing was normal in all patients . CONCLUSIONS Patients at risk for delayed wound healing problems  after hip fracture can be identified using relatively inexpensive laboratory test such as TLC and MNA tool . The clinician must be aware of the risk values of both measurements . We believe this information is particularly important before planning procedures of hip fractures in the elderly Abstract Purpose : To evaluate tailored polypropylene ( prolene ) mesh , anterior rectus sheath , and vaginal wall slings positioned under the mid-urethra , to treat stress urinary incontinence ( SUI ) in women , as SUI is a common pathological condition causing considerable distress and compromising social , physical , psychological , and sexual health , and for which surgical treatment remains controversial . Patients and methods : This prospect i ve r and omised study included 32 patients with SUI , evaluated by SEAPI ( Stress , Emptying , Anatomy , Protection , and Instability ) symptom score and urodynamics . According to sling material , 12 patients had  tailored prolene mesh , 12 had anterior rectus sheath and eight had anterior vaginal wall slings . Operative variables ( intraoperative bleeding , duration , complications and hospital stay ) were documented , and postoperative complications and continence status were assessed . The follow-up was 12–18 months . Results : Patients who received tailored prolene mesh slings had a lower operative duration and hospital stay , and less intraoperative bleeding . Postoperative complications , e.g. urinary retention and urgency , were < 12 % , with no significant differences . There was no significant difference among the three studied groups in the success rate ( 75 % , 67 % and 75 % ) . Conclusions : Tailored prolene mesh , anterior rectus sheath and the vaginal wall sling are good alternatives to treat SUI in women , with comparable results in a short-term follow up . The surgeon ’s experience and the patient ’s clinical circumstances should be considered when choosing a sling material , as success rates are comparable , being slightly better for the prolene sling in operative duration , bleeding and hospital stay BACKGROUND Mild perioperative hypothermia , which is common during major surgery , may promote surgical-wound infection by triggering thermoregulatory vasoconstriction , which decreases subcutaneous oxygen tension . Reduced levels of oxygen in tissue impair oxidative killing by neutrophils and decrease the strength of the healing wound by reducing the deposition of collagen . Hypothermia also directly impairs immune function . We tested the hypothesis that hypothermia both increases susceptibility to surgical-wound infection and lengthens hospitalization . METHODS Two hundred patients undergoing colorectal surgery were r and omly assigned to routine intraoperative thermal care ( the hypothermia group ) or additional warming ( the normothermia group ) . The patient 's anesthetic care was st and ardized , and they were all given cefam and ole and metronidazole . In a double-blind protocol , their wounds were evaluated daily until discharge from the hospital and in the clinic after two weeks ; wounds containing culture-positive pus were considered infected . The patients ' surgeons remained unaware of the patients ' group assignments . RESULTS The mean ( + /- SD ) final intraoperative core temperature was 34.7 + /- 0.6 degrees C in the hypothermia group and 36.6 + /- 0.5 degrees C in the normothermia group ( P < 0.001 ) Surgical-wound infections were found in 18 of 96 patients assigned to hypothermia ( 19 percent ) but in only 6 of 104 patients assigned to normothermia ( 6 percent , P = 0.009 ) . The sutures were removed one day later in the patients assigned to hypothermia than in those assigned to normothermia ( P = 0.002 ) , and the duration of hospitalization was prolonged by 2.6 days ( approximately 20 percent ) in hypothermia group ( P = 0.01 ) . CONCLUSIONS Hypothermia itself may delay healing and predispose patients to wound infections . Maintaining normothermia intraoperatively is likely to decrease the incidence of infectious complications in patients undergoing colorectal resection and to shorten their hospitalizations The potential deleterious effects of doctors ’ long and arduous shifts have received relatively scant attention . This study addressed the effect of a 32 h on-call shift  on 16 pre- registration medical house officers in St. James ’s Hospital , Dublin . We assessed 5 psychological parameters ( Tension-Anxiety , Depression-Dejection , Vigour-Activity , Fatigue-Inertia and Confusion-Bewilderment ) as well as 5 simple tests of alertness and concentration  both pre- and post-call . The doctors were r and omly assigned to be tested either pre-or post-call . On average the doctors got 4.5 hours sleep during a 32 h shift . This long shift had an adverse effect on all the psychological parameters ( p>0.05 ) except Depression-Dejection . The total mood disturbance score , which has been shown to correlate well with general psychological well-being , deteriorated significantly after the 32 h shift , p>0.005 . Two of the simple tests of alertness and concentration ( Trail-making test and Stroop Color-Word test ) also showed a significant fall-off in performance with sleep deprivation , p>0.05 , although the remaining tests ( Delayed Story Recall , Critical Flicker Fusion and Three Minute Grammatical Reasoning Test ) were not significantly impaired by the 32 h shift . This study shows that prolonged periods of duty without sleep adversely affect junior doctors , both in their psychological well-being and in their ability to carry out simple tasks OBJECTIVE In a previous study we observed a continuous reduction of salivary IgA concentration ( [ sIgA ] ) during a period of academic stress . This reduction of sIgA concentration exceeded the stress period by at least 1 week . The present study aim ed to replicate and extend our previous finding . In particular , we wanted to examine the time of recovery of [ sIgA ] alterations associated with academic stress . METHOD Twenty-seven participants in a major medical exam and 27 controls not participating in any exam during the study provided daily saliva sample s ( immediately after awakening ) , from the 6th day prior to their last exam until the 14th day afterwards , for analysis of salivary IgA. Data were averaged for the last weeks of exams and the first and second week after exams , respectively . RESULTS A prolonged reduction of sIgA in exam students as compared to controls was observed . Fourteen days post-stress sIgA concentrations of exam students were still significantly lower than control levels ( P=0.004 ) . No recovery was observable . At the same time exam students and controls did not differ in terms of self-reported stress and recovery . CONCLUSIONS Psychological and immunological stress effects may be dissociated , the latter considerably exceeding the stress period . A closer look at the temporal dynamics of stress-induced immune alterations might increase our underst and ing of psychoimmuno relationships BACKGROUND Women newly diagnosed with breast cancer experience psychological distress , accompanied by reduced Natural Killer Cell Activity ( NKCA ) and altered levels of cytokines , which may compromise cancer control . Few studies have evaluated psycho-immune outcomes of mindfulness-based stress reduction ( MBSR ) for women newly diagnosed with breast cancer in comparison to an active control condition . OBJECTIVE The purpose of this study was to determine whether MBSR benefits psychological , behavioral , and immunological function in women recently diagnosed with breast cancer . DESIGN After confirmation of breast cancer staging , women diagnosed with early-stage breast cancer ( n = 192 ) were r and omized to an 8-week MBSR program or an 8-week active control condition ( ACC ) . The ACC consisted of a series of cancer recovery and health education classes . Both MBSR and the ACC were administered in group format . METHODS Women completed psychometric instruments and provided blood for NKCA and cytokine levels at pre- , mid- , and completion of program , as well as at 1- and 6-months post-program . One hundred and twenty four women completed all five- assessment s ( MBSR , n = 63 ; ACC , n = 61 ) . Hierarchical linear modeling was used to analyze trajectories of outcomes over time and between groups . RESULTS Compared to the ACC group , women r and omized to MBSR exhibited decreasing trajectories of perceived stress , fatigue , sleep disturbance , and depressive symptoms . Further , compared to women r and omized to ACC , MBSR women exhibited trajectories demonstrating significantly more rapid restoration of NKCA , accompanied by lower circulating TNF-alpha levels , lower IL-6 production , and greater IFN-gamma production . CONCLUSIONS These results demonstrate early provision of MBSR for women newly diagnosed with breast cancer provides not only psychological benefit , but also optimizes immune function supportive of cancer control Surgical injury is followed by pain , stress-induced catabolism , impairment of organ function , and a risk of thromboembolism and impaired cognitive function . These events may contribute to complications , a need for prolonged hospitalization , postoperative fatigue , delayed convalescence , and the need for rehabilitation . Optimization of the individual care components in perioperative care ( the fast-track methodology ) reduces the need for hospitalization , morbidity , and prolonged convalescence , with subsequent economic savings ( Kehlet and Wilmore 2008 ) . Correspondingly , improvement in perioperative care has led to a reduced stay in hospital after total hip arthroplasty ( THA ) and total knee arthroplasty ( TKA ) , which is now only about 3 days in many centers . The main question that remains to be answered is whether further improvement can be made and whether these operations can be performed on an ambulatory or semi-ambulatory basis without any increased risk of morbidity or cardiopulmonary and thromboembolic complications , long-term cognitive dysfunction , pain , and need for rehabilitation . Thus , a multidisciplinary collaboration has been established in 5 dedicated public Danish hospitals with established fast-track THA and TKA in order to optimize perioperative care to require only 1–2 days of hospitalization with no increase in post-discharge pain , morbidity , and rehabilitation requirements ( Figure ) . To this end , we concentrated on  perioperative pain management , optimization of transfusion strategies , strategies for postoperative rehabilitation , requirements for postoperative thromboembolic prophylaxis , and safety aspects ( re-admissions , hip dislocation , and knee stiffness ) . Effective postoperative pain relief is a prerequisite for a successful fast-track recovery . Although continuous peripheral nerve blocks are currently the most effective analgesic techniques ( Ilfeld et al. 2008a , b ) , they are dem and ing in terms of expertise and there is a risk of muscle paralysis . Efforts have therefore been made recently to improve local wound infiltration and infusion techniques . Although promising , more research is required to better define these techniques regarding dose-volume relationships , placement and types of catheters , duration , and safety aspects ( Rostlund and Kehlet 2007 ) . There will be more focus on post-discharge pain , which remains a problem in many patients . Furthermore , research will concentrate on mechanisms and predictors of the large inter-individual variability in the degree of postoperative pain , which may be related to the inflammatory response and genes associated with pain . Such knowledge should facilitate pain management , leading to differential use of analgesic principles in low pain responders and high-pain responders . Blood transfusion is indicated when a patient 's limit concerning — or physiological adaptation to — progressive normovolemic anemia is reached , but there are no specific data from THA and TKA . Data from hip fracture surgery have shown that postoperative anemia impedes functional mobility and that a liberal transfusion strategy reduces morbidity ( Foss et al. 2009 ) . Since modern blood transfusion is safer than before , large r and omized studies with high and low transfusion thresholds will be performed in cardiovascular high-risk patients after THA , with morbidity and functional recovery as primary outcome measures . Postoperative rehabilitation after THA and TKA has been st and ard despite the fact that there has been little evidence on the optimal type of physiotherapy , when it should be started , and for how long ( Minns Lowe et al. 2007 , 2009 ) . Previous r and omized studies have been inconclusive and they were based on relatively long-term hospitalization ( 7–12 days ) ; they are therefore not applicable to fast-track THA and TKA . Over the last decade , many industry-sponsored trials have documented the need for prolonged thromboembolic prophylaxis ( 10–30 days ) , mostly based on surrogate outcomes and with relatively small effects on clinical manifestations of thromboembolism ( Geerts et al. 2008 ) . A common characteristic of these studies has been a relatively long hospital stay ( 6–12 days or more ) . Since postoperative immobilization is a well-known risk factor for postoperative thromboembolism , the need for prolonged thromboembolic prophylaxis after implementation of fast-track surgery with early mobilization might be question ed . The fast-track group will therefore focus on a large ( n = 5,000 ) prospect i ve , detailed 90-day follow-up study with prophylaxis only until discharge ( 1–3 days ) . It is well-documented that cognitive function declines after THA and TKA in elderly patients ( Maze et al. 2008 ) . A fast-track setup may reduce cognitive dysfunction due to less postoperative sleep disturbances , less pain , and less opioid requirements , all of which may impair cognitive function . Finally , in the fast-track THA and TKA setting , safety aspects will be assessed regarding the risk of hip dislocation , and knee stiffness after TKA . In summary , despite major improvements in care and short-term outcome after THA and TKA , several issues remain to be answered in order to optimize fast-track treatment
Two-thirds of the studies found that patients who suffered surgical complications had significantly worse postoperative psychosocial outcomes even after controlling for preoperative psychosocial outcomes , clinical and demographic factors .
Surgical complications appear to be a significant and often long-term predictor of patient postoperative psychosocial outcomes .
The results highlight the importance of attending to patients ' psychological needs in the aftermath of surgical complications
OBJECTIVE Surgical complications may affect patients psychologically due to challenges such as prolonged recovery or long-lasting disability .
Psychological distress could further delay patients ' recovery as stress delays wound healing and compromises immunity .
This review investigates whether surgical complications adversely affect patients ' postoperative well-being and the duration of this impact .