Center for Perioperative Mental Health

围手术期心理健康中心

• 批准号: 10415136
• 负责人: Michael Simon Avidan
• 金额: $ 154.32万
• 依托单位: WASHINGTON UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-06-01 至 2025-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10415136
• 关键词: Address; Antidepressive Agents; Anxiety; Area; Behavior Therapy; Behavioral; Benzodiazepines; Cardiac Surgery procedures; Caring; Clinical; Cognitive; Cognitive Therapy; Collaborations; Communication; Complex; Delirium; Dose; Effectiveness; Elderly; Electronic Health Record; Emotional; Glare; Health; Health Personnel; Healthcare; Heterogeneity; Hospitalization; Hospitals; Hybrids; Impairment; Individual; Informatics; Infrastructure; Intensive Care; International; Intervention; Leadership; Length of Stay; Medicine; Mental Depression; Mental Health; Mental Health Services; Mentors; Methodology; Methods; Modeling; Needs Assessment; Operative Surgical Procedures; Orthopedic Surgery; Outcome; Patients; Perioperative; Perioperative Care; Persons; Pharmaceutical Preparations; Pharmacological Treatment; Phase; Population; Postoperative Period; Procedures; Provider; Psyche structure; Public Health; Quality of life; Randomized; Readiness; Recovery; Recovery of Function; Rehabilitation therapy; Research; Research Design; Research Personnel; Resources; Risk; Science; Scientist; Social Well-Being; Social outcome; Speed; Statistical Data Interpretation; Structure; Surgical Oncology; Telephone; Testing; Time; Training; Treatment Effectiveness; Universities; Vision; Washington; World Health Organization; base; behavioral pharmacology; brain health; care outcomes; clinical translation; depressive symptoms; effectiveness implementation trial; effectiveness testing; evidence base; experience; falls; flexibility; follower of religion Jewish; hospital readmission; implementation evaluation; implementation outcomes; implementation science; implementation strategy; improved; individual patient; innovation; interest; medical complication; multidisciplinary; operation; opioid misuse; personalized medicine; physical conditioning; postoperative recovery; pragmatic trial; preference; prevent; research data dissemination; resilience; success; treatment as usual; treatment planning

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.

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保健方面的一个明显缺陷 为改善正在接受手术和治疗的老年人的心理健康创造一个翻译平台 其他侵入性手术。世界卫生组织将健康定义为一种完全的身体状态， 精神和社会福利。尽管围手术期医学已经发展出对 优化围手术期身体健康，预防重大内科并发症，心智融合 将医疗保健纳入围手术期护理一直是敷衍了事。这一点突出表现在有证据表明，抑郁症 焦虑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处理； 患有抑郁症和焦虑症的外科患者在生理、心理和社交方面都有明显的恶化。 结果。这些负面后果表现为损害了长期恢复和康复， 再次住院，持续的抑郁和焦虑，最终功能恢复和质量较差 生活。因此，这个围术期心理健康中心提供了及时的干预，将产生 改善这一时期特别脆弱的老年人的围手术期健康结果。这 将通过整合循证心理来实现护理和结果的转变 将医疗保健纳入围手术期范式。我们建议将行为学和药理学相结合 针对三个关键优先领域的干预捆绑。首先，我们将提供行为激活，一个灵活的 认知行为疗法和注重强化活动的独立治疗的组成部分。第二, 优化抑郁症、焦虑症药物治疗。第三，我们将取消处方 对大脑健康有害的药物。为了克服有效的、可实施的护理的障碍， 我们将：(1)根据不同患者的异质需求，调整、优化和个性化治疗方案 (2)测试治疗的有效性；(3)加快它们在现实世界中的实施。 该中心的结构旨在最大限度地提高成功的可能性。这包括一位经验丰富的行政人员 领导核心；复杂的、多学科的方法基础设施；多样化的临床团队 研究人员和实施科学家；以及具有广泛代表性的利益攸关方和 国际知名专家。在不同的外科人群中进行的三项实用试验将确定如何 最好在不同的外科环境中实施心理保健捆绑。我们对中心的愿景 围术期心理健康是快速推进心理健康科学与实践的跨学科平台 围手术期心理和认知保健。该中心具有相当大的公共卫生潜力 基于确凿证据和临床翻译的围术期护理方法的革命性影响。