Center for Perioperative Mental Health

摘要/项目摘要-总体 围手术期心理健康中心将通过以下方式解决围手术期医疗保健的明显不足： 创建一个翻译平台，以改善接受手术的老年人的心理保健， 其他侵入性手术。世界卫生组织将健康定义为一种完整的身体状态， 精神和社会福利。虽然围手术期医学已经发展出一个强烈的重点， 优化围手术期身体健康和预防重大医疗并发症，整合心理 医疗保健纳入围手术期护理一直敷衍了事。有证据表明，抑郁症 和焦虑是常见的围手术期问题，在围手术期环境中没有得到充分的管理; 患有抑郁和焦虑的手术患者在生理、心理和社交方面都有明显的下降， 成果。这些负面后果表现为长期恢复和康复受损， 再入院，持续的抑郁和焦虑，最终功能恢复和质量差， 生活因此，该中心为围手术期心理健康提供了及时的干预， 改善在此期间特别脆弱的老年人的围手术期健康结果。这 护理和结果的转变将通过整合基于证据的心理 医疗保健纳入围手术期范例。我们提出了一种结合行为和药理学的方法， 针对三个关键优先领域的一揽子干预措施。首先，我们将提供行为激活， 认知行为疗法的组成部分和侧重于强化活动的独立治疗。第二、 我们将优化抑郁症和焦虑症的药物治疗。第三，我们将取消 对大脑健康有害的药物。为了克服有效和可实施的护理方面的障碍， 我们将：（1）根据不同患者的不同需求，调整、优化和个性化治疗计划。 手术患者;（2）测试治疗的有效性;以及（3）加速其在现实世界中的实施。 该中心的结构是为了最大限度地提高成功的可能性。其中包括一位经验丰富的行政人员， 领导核心;一个复杂的，多学科的方法基础设施;一个多样化的临床团队 研究人员和执行科学家;具有广泛代表性的利益攸关方组成的咨询委员会， 国际知名专家。在不同的手术亚群中进行的三项实用试验将确定 最好在不同的手术环境中实施心理保健包。我们对中心的愿景 围手术期心理健康是一个跨学科的平台，以迅速推进科学和实践， 围手术期心理和认知保健。该中心有潜力为大量的公共卫生 通过改革围手术期护理方法，基于确凿的证据和临床翻译，

Abstract/Project Summary – OVERALL The Center for Perioperative Mental Health will address a glaring deficiency in perioperative healthcare by creating a translational platform for improving the mental healthcare of older adults undergoing surgery and other invasive procedures. The World Health Organization defines health as a state of complete physical, mental, and social well-being. Although perioperative medicine has developed a strong emphasis on optimizing perioperative physical health and preventing major medical complications, the integration of mental healthcare into perioperative care has been perfunctory. This is highlighted by evidence that depression and anxiety are common perioperative problems that are inadequately managed in the perioperative setting; and surgical patients with depression and anxiety have substantially worse physical, mental and social outcomes. These negative consequences manifest as impaired long-term recovery and rehabilitation, with hospital readmissions, persistent depression and anxiety, and ultimately poor functional recovery and quality of life. Therefore, this Center for Perioperative Mental Health provides a timely intervention that will yield improved perioperative health outcomes for older adults who are especially vulnerable in this period. This transformation in care and outcomes will be actualized through the integration of evidence-based mental healthcare into the perioperative paradigm. We propose a combined behavioral and pharmacological intervention bundle targeting three key priority areas. First, we will provide behavioral activation, a flexible component of cognitive behavioral therapy and standalone treatment focusing on reinforcing activities. Second, we will optimize the pharmacological treatment of depression and anxiety. Third, we will deprescribe medications that are harmful for brain health. In order to overcome barriers to effective, implementable care, we will: (1) adapt, optimize and personalize treatment plans based on the heterogenous needs of different surgical patients; (2) test effectiveness of the treatments; and (3) speed their implementation in the real-world. The Center is structured to maximize the likelihood of success. This includes an experienced, administrative leadership core; a sophisticated, multi-disciplinary methodological infrastructure; a diverse team of clinical researchers and implementation scientists; and advisory boards with broadly representative stakeholders and internationally renowned experts. Three pragmatic trials in distinct surgical subpopulations will establish how best to implement the mental healthcare bundle in diverse surgical settings. Our vision for the Center for Perioperative Mental Health is a transdisciplinary platform to rapidly advance the science and practice of perioperative mental and cognitive healthcare. This Center has the potential for substantial public health impact by revolutionizing the approach to perioperative care, based on firm evidence and clinical translation.