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29. Designing a Perioperative Mind-Body Intervention for Peripheral Vascular Interventions

Author

Png, C. Y. Maximilian, primary, Mehta, Darshan, additional, Dua, Anahita, additional, Stephen, Antonia E, additional, Bruce, Alex M, additional, Forsythe, Aynsley, additional, Chitilian, Hovig V, additional, Bringle, Erik J, additional, Simpson, James C, additional, Parady, Katherine M, additional, McNeil, Lisa A, additional, Baim, Margaret A, additional, Eagleton, Matthew J, additional, Chang, David C, additional, and Yeh, Gloria Y, additional

Published
2024
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46. Designing a Perioperative Mind-Body Intervention for Peripheral Vascular Interventions.

Author

Png, Chien Yi Maximilian, Mehta, Darshan H., Dua, Anahita, Stephen, Antonia E, Bruce, Alex M., Forsythe, Aynsley, Chitilian, Hovig V., Bringle, Erik J., Simpson, James C., Parady, Katherine M., McNeil, Lisa A., Baim, Margaret A., Eagleton, Matthew J., Chang, David C., and Yeh, Gloria Y.

Subjects
PERIPHERAL vascular disease treatment, ANXIETY prevention, SURGERY, PATIENTS, INTERPROFESSIONAL relations, RESEARCH funding, ACADEMIC medical centers, TREATMENT effectiveness, MIND & body therapies, ANALGESIA, VISUALIZATION, PUBLIC relations, MEDITATION, DELPHI method, ANESTHESIA, PERIOPERATIVE care, HEALTH care teams
Abstract

Background: Peripheral vascular interventions (PVIs) performed under procedural sedation and analgesia (PSA) can be associated with anxiety and poor compliance with patient instructions during surgery. Mind-body interventions (MBIs) such as meditation have demonstrated the potential to decrease perioperative anxiety, though this area is understudied, and no tailored interventions have been developed for the vascular surgical patient population. Objectives: We aimed to design a perioperative MBI that specifically targeted vascular surgical patients undergoing PVIs under PSA. We sought to perform this in a scientifically rigorous, multi-disciplinary collaborative manner. Methods: Following the Obesity-Related Behavioral Intervention Trials (ORBIT) model, we designed (Phase 1a) and then refined (Phase 1b) a MBI for patients undergoing PVIs under PSA to decrease perioperative anxiety and sedation and facilitate patient intraoperative compliance. Phase 1a involved a literature review, informal information gathering and synthesis, and drafting a preliminary protocol for a perioperative MBI. Phase 1b involved assembling a multi-disciplinary expert panel of perioperative and mind-body clinicians and researchers to improve the MBI using an iterative, modified Delphi approach. Results: The modified Delphi process was completed, and a consensus was reached after three iterations. The resulting MBI consisted of two seven-minute preoperative guided meditations on the day of surgery, including diaphragmatic breathing, body scans, and guided imagery emphasizing awareness of the ipsilateral leg where the vascular surgery was performed. A document delineating the integration of the MBI into the operating room workflow was produced, including details regarding the intervention's timing, duration, and modality. Conclusion: Using a multi-specialty expert panel, we designed a novel MBI in the form of a guided meditation with elements of mindfulness and guided imagery to decrease anxiety and increase intraoperative compliance for patients undergoing PVIs under PSA. A prospective pilot study is being planned to test the program's feasibility. [ABSTRACT FROM AUTHOR]

Published
2024
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47. Racial difference in receiving computed tomography for head injury patients in emergency departments.

Author

Chen, Yuan-Hsin, Handly, Neal, Chang, David C., and Chen, Ya-Wen

Abstract

Prior studies have suggested potential racial differences in receiving imaging tests in emergency departments (EDs), but the results remain inconclusive. In addition, most prior studies may only have limited racial groups for minority patients. This study aimed to investigate racial differences in head computed tomography (CT) administration rates in EDs among patients with head injuries. Patients with head injuries who visited EDs were examined. The primary outcome was patients receiving head CT during ED visits, and the primary exposure was patient race/ethnicity, including Asian, Hispanic, Non-Hispanic Black (Black), and Non-Hispanic White (White). Multivariable logistic regression analyses were performed using the National Hospital Ambulatory Medical Care Survey database, adjusting for patients and hospital characteristics. Among 6130 patients, 51.9% received a head CT scan. Asian head injury patients were more likely to receive head CT than White patients (59.1% versus 54.0%, difference 5.1%, p < 0.001). This difference persisted in adjusted results (odds ratio, 1.52; 95% CI, 1.06–2.16, p = 0.022). In contrast, Black and Hispanic patients have no significant difference in receiving head CT than White patients after the adjustment. Asian head injury patients were more likely to receive head CT than White patients. This difference may be attributed to the limited English proficiency among Asian individuals and the fact that there is a wide variety of different languages spoken by Asian patients. Future studies should examine rates of receiving other diagnostic imaging modalities among different racial groups and possible interventions to address this difference. • Asian head injury patients were more likely to receive head CT than White patients. • This may be due to communication barriers between physicians and Asian patients. • Number of languages spoken by Asians may cause difficulty in finding translators. • Future studies should focus on the effect of improving communication services. [ABSTRACT FROM AUTHOR]

Published
2024
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