The psychosocial and emotional experiences of cancer patients during the COVID-19 pandemic: A systematic review.

BACKGROUND: COVID-19 was declared a pandemic by the World Health Organization on March 11th, 2020. Global social lockdowns were instigated to reduce spread and prevent health-services from becoming overwhelmed. People having treatment for cancer are known to have heightened psychological/emotional burden. The combined impact of managing pandemic regulations alongside this may present additional burden. The purpose of this systematic review is to examine current evidence of the psychological and emotional impact of COVID-19 on people with cancer, early in the pandemic. METHODS: Five electronic databases were searched (Embase, Global Health, HMIC, PsychINFO, CINAHL) from September 2019 to October 2021. Qualitative, quantitative and mixed-method primary research studies exploring emotional and psychological impacts of COVID-19 on cancer patients, limited to English language, were included. Quality appraisal was conducted using the MMAT. RESULTS: Fifty-one papers, with 27,356 people from 21 countries treated for cancer, were included. 43 studies were quantitative with a survey method approach, six studies qualitative and four used a mixed methods design. MMAT score was mostly two or three. Four themes were identified: Emotional aspects and Quality of Life; Psychosocial aspects; Impact of COVID-19 on self; Impact of COVID-19 on cancer, with themes overlapping. CONCLUSION: Whilst emotional/psychological impacts such as anxiety, isolation, employment fears, and uncertainty about the future were potentially universal concerns early in the pandemic, they may have been particularly acute for people living with cancer and represent complex, overlapping factors. As COVID-19 continues to impact health-services and society, it is important to focus on any ongoing impact to the experience of cancer patients. Most of the studies reviewed used tools that do not provide deeper understanding of how and why emotional states of people with cancer were affected. Further qualitative work may reveal patterns of what was unique to cancer patients during the pandemic, compared to general populations.

Quality of life after laparoscopic trans-abdominal pre-peritoneal inguinal hernia repair: spinal vs general anesthesia.

PURPOSE: The aim of the present study was to evaluate the effect of the anesthesia type on the postoperative quality of life in patients who underwent trans-abdominal pre-peritoneal (TAPP) inguinal hernia repair. METHODS: In this study, 70 patients submitted to TAPP for inguinal hernia repair, were randomized between spinal and general anesthesia. Overall, 58 patients completed the follow-up process and were, therefore, included. The quality of life evaluation was based on the SF-36 questionnaire. Significance was considered at the level of P < 0.05 RESULTS: General anesthesia was applied to 31 patients, whereas 27 operations were performed under spinal anesthesia. Except gender, the two study subgroups were similar in terms of demographics. Although spinal anesthesia displayed higher energy, emotional health, and general health scores these findings were not statistically significant. A positive correlation was identified between age and physical and emotional role. Operative time was associated with the estimated energy and general health. CONCLUSION: Our study could not identify a difference between spinal and general anesthesia on the postoperative quality of life. Spinal anesthesia is as effective as general anesthesia and remains an attractive anesthetic alternative for TAPP inguinal hernia repair. Given several study limitations, further high-quality trials are required.

Hemodynamic effects of anesthesia type in patients undergoing laparoscopic transabdominal preperitoneal inguinal hernia repair under spinal vs general anesthesia.

PURPOSE: General anesthesia has been used as a standard type of anesthesia for laparoscopic inguinal hernia repair by the transabdominal preperitoneal (TAPP) approach, regional anesthesia being occasionally used in high-risk patients. We had previously designed a controlled randomized trial, comparing spinal with general anesthesia in non-high-risk patients undergoing TAPP inguinal hernia repair. Our results suggested that spinal anesthesia offers some advantages in postoperative pain and additional opioid consumption during the early postoperative period. In the context of this trial, hemodynamic effects of each type of anesthesia are presented. METHODS: Seventy patients, undergoing elective TAPP inguinal hernia repair were randomized to either general or spinal anesthesia. Data regarding patients' hemodynamic status during the procedure under general or spinal anesthesia were collected, measuring systolic blood pressure (SBP), diastolic blood pressure (SBP), mean arterial pressure (MAP) and heart rate (HR). RESULTS: There was no significant effect of anesthesia type on systolic, diastolic and mean arterial pressure values after induction of anesthesia and induction of pneumoperitoneum, respectively. There was a significant effect on heart rate values after induction of anesthesia and induction of pneumoperitoneum, respectively. CONCLUSIONS: Spinal anesthesia is as effective as general anesthesia concerning hemodynamic stability and seems to provide a better result in maintaining hemodynamic stability with fewer fluctuations in blood pressure and mild alterations in heart rate values during TAPP inguinal hernia repair.

Patients' and carers' views and expectations about intensive management for moderate rheumatoid arthritis: a qualitative study.

Intensive management for rheumatoid arthritis (RA) involves frequent hospital visits and adjusted doses or combinations of medication. Research is currently underway to test whether or not intensive management strategies are valuable in moderately active disease, however, patient views on intensive management in this disease group are unknown. The objectives of this study were to explore the views and expectations of patients with moderately active RA and of carers of patients with moderately active RA. We conducted focus groups and one-to-one interviews in 2014 with 14 participants (9 patients, 5 carers) from 4 rheumatology clinics across 3 London Hospital NHS Trusts. Non-English-speaking patients were included with the assistance of a professional translator. Focus groups and interviews were audio recorded and transcribed and transcripts analysed using a framework analysis approach. Four main themes were identified: 'Hopes and Expectations of Intensive Management', 'Acceptability of Intensive Management', 'Patient Education' and 'The Importance of Continuity of Care'. Our main findings were that attendance at frequent clinic appointments was largely acceptable to patients and carers. Views on taking higher doses of medication depended on how stable patients were on their current treatment regime. Continuity of care from the rheumatologist and the provision of written/verbal information about intensive management were important to patients and carers.

Antiphospholipid (Hughes) syndrome: description of population and health-related quality of life (HRQoL) using the SF-36.

OBJECTIVE: Antiphospholipid (Hughes) syndrome (APS) affects mainly women 15 to 50 years of age and is responsible for approximately 20% of strokes in people <40 years. Little is known about the psychological burden of this long-term condition. We investigated HRQoL in APS. METHODS: We conducted a cross-sectional survey involving 270 members of the Hughes Syndrome Foundation worldwide. Data included HRQoL (SF-36), demographics, and APS-related self-reported major issues. Response rate was 60%. RESULTS: T-tests indicated significantly worse mean scores for seven of the eight domains of the SF-36 in secondary antiphospholipid syndrome (SAPS) compared to primary antiphospholipid syndrome (PAPS), e.g. bodily pain t(263) = 6.10 p < 0.001 except for mental health t(267) = 1.95 p = 0.053. PAPS appeared to be associated with poorer HRQoL in most mental health domains but overall better physical domains compared to systemic lupus erythematosus (SLE) alone. SAPS appeared to have a more adverse impact on HRQoL compared to PAPS and SLE. Major issues identified: pain and fatigue, lack of health care professional/public awareness, and medication unpredictability. CONCLUSION: HRQoL in PAPS appears to be generally better than SLE and SAPS in physical domains, but poorer in mental domains. APS patients might need more social support in terms of information and awareness of the condition to improve their coping strategies.

Long-term results after laparoscopic transabdominal preperitoneal (TAPP) inguinal hernia repair under spinal anesthesia.

BACKGROUND: Laparoscopic transabdominal preperitoneal (TAPP) repair is indicated for recurrent and bilateral inguinal hernias and traditionally is performed under general anesthesia. However, the feasibility of performing TAPP under spinal anesthesia has been recently reported by our team. AIM: To assess the long-term results of TAPP repair under spinal anesthesia for primary inguinal hernia. MATERIALS AND METHODS: Between January 2006 and October 2009, 94 consecutive patients with primary unilateral inguinal hernia were submitted to laparoscopic transabdominal preperitoneal repair under spinal anesthesia. We looked at the immediate postoperative outcome as well as the long-term outcome, mainly recurrences and incidence of chronic pain. RESULTS: One patient experienced a scrotal hematoma, one patient a trocar site infection, two patients were diagnosed with an operation-related orchitis, while 31 patients (33 %) developed symptoms of urinary retention. At a median follow-up of 35 months (range 14-59), four patients (4.3 %) were diagnosed with a recurrence, while 89 % of patients reported satisfied from the procedure in the long-term. Chronic pain was not encountered in any of the patients studied. Four patients (4.3 %) reported an intermitted foreign body sensation and/or rigidity and two patients (2.1 %) numbness in the operated inguinal area. CONCLUSION: Laparoscopic TAPP hernia repair under spinal anesthesia is associated with satisfactory short- and long-term results. Use of regional anesthesia instead of the traditional general anesthesia does not seem to adversely affect the quality of repair, and moreover, it offers the patient an attractive anesthetic alternative.

Laparoscopic cholecystectomy under spinal anesthesia: a pilot study.

BACKGROUND: Regional anesthesia has not been used as the sole anesthetic procedure other than in the scenario of a patient at high risk to undergo laparoscopic cholecystectomy with CO2 pneumoperitoneum under general anesthesia. METHODS: Fifteen ASA grade I or II patients underwent laparoscopic cholecystectomy with low-pressure CO2 pneumoperitoneum under spinal anesthesia. Intraoperative parameters, postoperative pain and recovery in general, as well as patient satisfaction at follow-up were prospectively recorded in a pilot study to assess the feasibility and safety of the procedure. RESULTS: All operations were completed laparoscopically and conversion from spinal to general anesthesia was not required in any of the cases. Median pain score 4 h postoperatively was 1.5 (range, 0-5), at 8 h it was 1 (range, 0-6), and at 24 h it was 1 (range, 0-4). All patients were discharged after 24 h. Follow-up 2 weeks postoperatively showed all but one patient to be satisfied and strongly recommending the anesthetic procedure. CONCLUSION: Laparoscopic cholecystectomy with low-pressure CO2 pneumoperitoneum can be successfully and safely performed under spinal anesthesia. Furthermore, it seems that spinal anesthesia is associated with minimal postoperative pain and at least an equally good recovery as with general anesthesia.

Drainage tube endoscopy: a contribution to the management of severe acute pancreatitis?

Peritoneal lavage is one of the interventional approaches that have gained some attention in the early, toxaemic phase of acute pancreatitis. Additionally some kind of drainage is necessary for suppurative collections that characterize the late phase of the disease. In both the above situations tube plugging is a common problem and it is usually associated with a relapse of the patient's septic state and newly formed collection(s) on abdominal CT. Two cases are presented, in early and in late phases respectively, in which drainage tube adoscopy (DTE) re-established tube patency and ensured drainage. DTE may represent an alternative to surgery or to CT-guided paracentesis and evacuation of newly formed intra-abdominal collections secondary to tube obstruction.