Center for Perioperative Mental Health

围手术期心理健康中心

• 批准号: 10206497
• 负责人: Michael Simon Avidan
• 金额: $ 157.5万
• 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/10206497
• 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; 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 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解决周期性医疗保健的明显缺陷 创建一个转化平台，以改善接受手术和 其他侵入性程序。世界卫生组织将健康定义为完全身体的状态 精神和社会福祉。尽管周期性医学已经非常重视 优化定期身体健康并防止重大医学并发症，精神融合 定期护理的医疗保健是敷衍的。这是有证据表明抑郁症的证据 动画是在周期性环境中经常管理的常见周期性问题。 抑郁症和焦虑的手术患者的身体，精神和社交状况更加严重 结果。这些负面后果表现为长期恢复和康复的受损， 医院再入院，持续的抑郁和焦虑，最终功能恢复和质量不佳 生活。因此，这个围手术期心理健康中心提供了及时的干预措施，将产生 在此期间特别容易受到伤害的老年人的周期性健康结果改善。这 护理和成果的转变将通过基于证据的心理整合来实现 医疗保健进入周期性范式。我们提出了一个联合行为和药物 干预束针对三个关键优先区域。首先，我们将提供行为激活，灵活 认知行为疗法和独立治疗的组成部分，重点是增强活动。第二， 我们将优化抑郁和动画的药物治疗。第三，我们将描述 对大脑健康有害的药物。为了克服有效，可实施护理的障碍， 我们将：（1）根据不同的异质需求适应，优化和个性化治疗计划 手术患者； （2）治疗的测试有效性； （3）加快其在现实世界中的实现。 该中心的结构是最大化成功的可能性。这包括经验，管理 领导力核心；一个复杂的多学科方法论基础设施；一个临床的潜水队 研究人员和实施科学家；以及与广泛代表的利益相关者和 国际知名的专家。在不同的手术亚群中进行的三项务实试验将确定如何 最好在潜水员手术环境中实施心理保健捆绑。我们对中心的愿景 围手术期心理健康是一个跨学科平台，旨在快速发展科学和实践 围手术期的心理和认知医疗保健。该中心有可能实现大量公共卫生 基于牢固的证据和临床翻译，通过彻底改变定期护理的方法来影响。