In addition to the general care provided by health professionals, the study group received discharge training created according to the Nursing Interventions Classification.

The control group continued to receive the routine care

In addition to the routine care they received, the patients in the intervention groups were given discharge training developed in the pre-discharge period. Discharge training consisted of a verbal and written information booklet containing instructions for the patient and the patient's caregiver on pain management, nutrition management, incision site care, strengthening self-care, returning to daily life activities, and colostomy care. Discharge training was given in the service after evaluating the surgical recovery status of the patient before discharge. The average duration of each training was 30-45 minutes. The patients were evaluated in terms of surgical recovery by calling by phone 2 weeks after discharge, 4 weeks and 8 weeks later. The developed education booklet was given to the patient and it was ensured that he could benefit from the information at home.

Intervention group

Ezgi Arslan, PhD Student

A randomized control trial was made to examine the effect of discharge training developed using Nursing Interventions Classification on surgical recovery in patient who underwent oncological surgery.

The concept of surgical recovery is defined as "starting activities aimed at maintaining daily life, health and well-being after surgery" and delay in surgical recovery "increasing the number of days after surgery required to start activities aimed at maintaining daily life, health and well-being after surgery". Problems such as fatigue, pain, incisional surgical site infection, loss of appetite, which are common in patients in the postoperative period, are symptoms associated with delayed surgical recovery. In addition to these symptoms, the presence of conditions such as delayed return to home / work activities need for self-care, nausea, anorexia, pain, and difficulty in moving indicate that surgical recovery is interrupted. It has been reported that delay in surgical recovery is common after surgeries such as gastrostomy, colectomy, and exploratory laparotomy.

Patients who have undergone gastric or colorectal cancer surgery should receive discharge training before returning to social life and business life. Nurses should determine the problems they may experience at home in patients who have undergone surgeries such as gastrostomy, colectomy, and exploratory laparotomy, where delay in surgical recovery is frequently reported, plan and apply discharge training for these problems, and monitor patients in terms of surgical recovery processes at home. It has been reported that this way, the surgical recovery process can be supported and delays in surgical recovery can be prevented.

This study was conducted to determine the effect of a discharge training developed using the Nursing Interventions Classification on surgical recovery in patients undergoing oncologic surgery.

It was tested the hypotheses that there was no difference between the post-intervention intervention and control groups in terms of the surgical recovery score averages in patients who had undergone oncologic surgery were tested.

Following recruitment, patient who underwent oncological surgery were divided into a study and a control group by randomization (1:1 randomization)

The Effect of Discharge Training on Surgical Recovery in Oncology Patients

The Effect of Discharge Training on Surgical Recovery in Oncology Patients: A Randomized Control Trial

The data sets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

assessed using the Patient Evaluation Form, nine defining features of the diagnosis of "delayed surgical recovery" defined in NANDA-I (delaying starting activities at home / work, understanding that more time is required for recovery/ recovery, need for assistance in self-care practices, evidence indicating impaired surgical site presence (discharge, swelling, redness, pain, presence of one of the bleeding in the area mild; the presence of all will be marked as severe distress), loss of appetite with nausea, loss of appetite without nausea, difficulty in moving around, pain or discomfort, fatigue) It contains questions.

The patient evaluation form was created using the Nursing Outcomes Classification of the five-point Likert-type scale measuring the severity of descriptive features. The expression "severely distressed" was "1 point"; The expression "significantly distressed" was evaluated as "2 points", "moderately distressed" as "3 points", "mildly distressed" as "4 points", and "no

assessed using the Patient Evaluation Form. The form is composed of nine items. The form is The expression "severely distressed" was "1 point"; The expression "significantly distressed" was evaluated as "2 points", "moderately distressed" as "3 points", "mildly distressed" as "4 points", and "no distress" as "5 points". The patient can get a minimum of nine and a maximum of 45 points. As the score for each evaluation question increased, the improvement was evaluated as positive. It was applied by telephone in the second week after discharge.

assessed using the Patient Evaluation Form. The form is composed of nine items. The form is The expression "severely distressed" was "1 point"; The expression "significantly distressed" was evaluated as "2 points", "moderately distressed" as "3 points", "mildly distressed" as "4 points", and "no distress" as "5 points". The patient can get a minimum of nine and a maximum of 45 points. As the score for each evaluation question increased, the improvement was evaluated as positive. It was applied by telephone in the fourth week after discharge.

assessed using the Patient Evaluation Form. The form is composed of nine items. The form is The expression "severely distressed" was "1 point"; The expression "significantly distressed" was evaluated as "2 points", "moderately distressed" as "3 points", "mildly distressed" as "4 points", and "no distress" as "5 points". The patient can get a minimum of nine and a maximum of 45 points. As the score for each evaluation question increased, the improvement was evaluated as positive. It was applied by telephone in the eighth week after discharge.

Aydin Adnan Menderes University

Research Assistant

Symptoms and General Pathology

All Conditions

Neoplasms

Respiratory Tract (Lung and Bronchial) Diseases

Postoperative Complications

Pain, Postoperative

Nausea

Lung Neoplasms

Pain

Vomiting

Postoperative Nausea and Vomiting

Signs and Symptoms, Digestive

Central Nervous System Depressants

All Drugs and Chemicals

Anesthetics

The participants of this arm will receive the convencional pre operative, anesthesia and postoperative care for lung resections for treatment of lung neoplasms

The participants of this arm will receive the PROSM protocol pre operative, anesthesia and postoperative care for lung resections for treatment of lung neoplasms

The PROSM guidelines is described previously in study description

PROSM guidelines for preoperative, anesthesia and postoperative care for lung resections

Igor Renato LB de Abreu, M.D.

Fernando C Abrão, M.D.

Igor Renato LB Abreu, MD

Introduction:

Aiming at reducing costs and optimizing the use of these financial resources, several postoperative recovery protocols have emerged that aim to reduce the length of hospital stay by accelerating surgical recovery.1,2 In view of the current Brazilian political and economic scenario allied to the existing scientific knowledge on the subject , the investigators developed a protocol that aims to meet this need using resources already available and offered in brazilian public health system. The investigators called this protocol as Protocol of Operative Recovery Santa Marcelina (PROSM) that had as inspiration the protocols of accelerated postoperative recovery already used in several European health services.

Goals:

1. To evaluate the impact of PROSM on the length of hospitalization in days and postoperative pain (visual analog pain scale - VAS) in patients submitted to surgical procedures performed by the thoracic surgery team of the Hospital Santa Marcelina de Itaquera.
2. Evaluate the impacts of PROSM in reducing the costs (US dollars) of surgical treatment and hospitalization of these patients.

Materials and methods:

A group of 200 patients with elective pulmonary resections (segmentectomies, lobectomies or pneumonectomies) to treat neoplastic lung diseases will be selected by the investigators.

The participants will be randomized into two groups (rate of randomization 1/1).

The first group will be submitted to the standard surgical treatment that is currently used in Santa Marcelina - Itaquera hospital. The second group will be submitted to treatment with the adoption of the PROSM guidelines, which will be detailed later.

Investigators will evaluate in the two groups: surgical time in minutes, intraoperative complications: intraoperative bleeding in mililiters, need for transfusion of blood products, intraoperative clinical complications. Investigators will also evaluate the need for postoperative recovery in Intensive Care Unit (ICU), medications used to maintain the anesthetic plane during the procedure (amount of drugs in milligrams), medications used for postoperative analgesia, length of hospital stay in days, postoperative clinical complications, need for surgical re-boarding, immediate postoperative pain (VAS), postoperative pain at the time of discharge and the first outpatient return (VAS), the need for opioid analgesics at home after discharge.

After the data collection, the investigators will analyze them and make a comparative study of the costs of surgical treatment and hospitalization between the two groups. This data will be obtained from the billing department of the Hospital Santa Marcelina de Itaquera.

Introduction:

Patients submitted to surgical procedures for the treatment of thoracic diseases, whether benign or neoplastic, are exposed to potential complications.

The main complications related to these procedures are primarily lung infections, followed by thrombotic events, cardiovascular events, and complications due to previous chronic diseases.

Faced with the occurrence of complications, these patients require a longer hospitalization period, using high cost medications, generating additional unexpected costs.

Aiming at reducing costs and optimizing the use of these financial resources, several postoperative recovery protocols have emerged that aim to reduce the length of hospital stay by accelerating surgical recovery.1,2 In view of the current Brazilian political and economic scenario allied to the existing scientific knowledge on the subject , the investigators developed a protocol that aims to meet this need using resources already available and offered in brazilian public health system. The investigators called this protocol as Protocol of Operative Recovery Santa Marcelina (PROSM) that had as inspiration the protocols of accelerated postoperative recovery already used in several European health services.

Goals:

1. To evaluate the impact of PROSM on the length of hospitalization in days and postoperative pain (visual analog pain scale - VAS) in patients submitted to surgical procedures performed by the thoracic surgery team of the Hospital Santa Marcelina de Itaquera.
2. Evaluate the impacts of PROSM in reducing the costs (US dollars) of surgical treatment and hospitalization of these patients.

Materials and methods:

A group of 200 patients with elective pulmonary resections (segmentectomies, lobectomies or pneumonectomies) to treat neoplastic lung diseases will be selected by the investigators.

Patients under the age of eighteen years old, unable to read, understand and sign informed consent, patients with compromised performance status (ECOG greater than 2), patients with a body mass below 60 kilograms or greater than 120 kilograms , patients with allergy to latex, patients with a history of allergy to any of the drugs used in anesthesia for PROSM, patients with renal dysfunction, liver dysfunction and severe cardiac dysfunction (cardiac failure), will be excluded from this study.

The participants will be randomized into two groups (rate of randomization 1/1). The first group will be submitted to the standard surgical treatment that is currently used in Santa Marcelina - Itaquera hospital. The second group will be submitted to treatment with the adoption of the PROSM guidelines, which will be detailed later.

Investigators will evaluate in the two groups: surgical time in minutes, intraoperative complications: intraoperative bleeding in mililiters, need for transfusion of blood products, intraoperative clinical complications. Investigators will also evaluate the need for postoperative recovery in Intensive Care Unit (ICU), medications used to maintain the anesthetic plane during the procedure (amount of drugs in milligrams), medications used for postoperative analgesia, length of hospital stay in days, postoperative clinical complications, need for surgical re-boarding, immediate postoperative pain (VAS), postoperative pain at the time of discharge and the first outpatient return (VAS), the need for opioid analgesics at home after discharge. The follow-up time of these patients for the purpose of collecting data for this study will be started with their agreement to participate in the project and with the signing of the free and informed consent term and will extend until the third postoperative return. After this period, the participants will be followed for assistance purposes only.

After the data collection, this will be analyzed and a comparative study of the costs of surgical treatment and hospitalization between the two groups will be made. This data will be obtained from the billing department of the Santa Marcelina - Itaquera hospital.

Continuous variables will be expressed as medians with deviations. Categorical variables will be represented by absolute numbers and percentages. The Gaussian distribution of the variables will be tested using Kolmogorov - Smirnov test. The comparison between medians will be evaluated through the use of Student's T test. The comparison between categorical variables will be carried out using Chi-square test. Possible risk factors that contribute to an increase in the length of hospital stay and an increase in postoperative pain will be traced through the use of logistic regressions.

The analysis of the data will be carried out using the software Statistical Package for the Social Sciences (SPSS) 17.0 software (SPSS, Chicago, IL, USA)

PROSM Guidelines Description:

Selected patients who agree to participate in the present project and whose randomization assign them to the intervention PROSM group will be submitted to the following guidelines.

Preoperative care: In addition to conventional preoperative care including cessation of smoking and use of medications for comorbidities treatment, guidelines for preoperative fasting, verification of preoperative exams and cardiovascular and pre-anesthetic evaluations, the patient will receive guidelines for home exercises to perform daily walks with thirty minutes duration until the day of surgery. This measure aims to create in the patient the habit of moving daily. This will facilitate adherence to the proposed exercises for postoperative recovery.

On the day of surgery, immediately before the patient is taken to the operating room, we will administer 8 drops of chlorpromazine solution and 750 milligrams of paracetamol or 500 milligrams of dipyrone. The goal is to generate preemptive analgesia. Patients who admitted to the surgical procedure exhibit evidence of abandonment of the preoperative guidelines will be excluded from the study.

Anesthesia: The participant will be adequately monitored with pulse oximetry, cardioscopy, capnography, noninvasive blood pressure, temperature monitoring, anesthetic depth monitoring through the BIS method (bispectral index), delayed bladder catheter. The necessity or not of central venous access and invasive blood pressure will be evaluated according to the cardiovascular risks and the size of the surgery. For pulmonary resection operations we will use selective orotracheal intubation as already agreed in the institution.

Anesthetic induction will be performed using short duration opioid (remifentanil), hypnotic (propofol) and neuromuscular blocker with dose adjusted according to the patient's body mass.3 Intraoperative analgesia will be obtained through paravertebral and incisional intercostal block through the infiltration of a drug solution containing 500mililiters of saline, 1 vial of 5milligrams / 20milliliters bupivacaine, 20milliliters of lidocaine 2% without vasoconstrictor, 10milligrams of dexamethasone , 500milligrams of hydrocortisone, 75milligrams of clonidine, 5milligrams of ketamine and 40milliliters of sodium bicarbonate 8.4% solution). Investigators will use only the volume of solution sufficient to generate the intercostal blocks of the spaces pertaining to the incision and the orifice of the pleural drain and completely infiltrate the surgical wound. The surplus drug solution will be discarded.4 The participants will not be submitted to epidural anesthesia, only to the block.

Intercostal block and infiltration of the surgical wound will be performed by the surgical team while the other anesthetic procedures will be performed and accompanied by the anesthesiologist. At any time during the procedure, the anesthesiologist may administer additional anesthetic drugs or any other type of drug deemed necessary to ensure adequate pain control and hemodynamic stability of the patient. Throughout the procedure there should be dialogue and exchange of information between the surgical and anesthetic teams.

Anesthetic recovery: Post anesthetic recovery will commence immediately after the surgical dressing. The participants will be placed in horizontal dorsal decubitus, the anesthetic drugs will be switched off, the patient will receive intravenous antiemetic (ondansetron) and intravenous non-steroidal anti-inflammatory drug (ketoprofen) before extubation to avoid nausea and decrease postoperative pain. The patient will be extubated as soon as he is recovering his consciousness and is able to maintain an effective spontaneous breath.

Immediately after the extubation, the surgeon will elevate the decubitus of the surgical table to 45 degrees maintaining the constant observation of the blood pressure, heart rate and pulse oximetry. It will remain elevated until the patient is well awake. If the patient is unable to maintain a sufficient level of consciousness to understand and respond to verbal commands within 50 minutes of extubation or if during awakening the patient develops postural hypotension surgical team will abort the protocol and resume recovery by conventional measures.5 These cases will be counted as failure to execute the method.

When the patient is conscious and able to understand sentences and respond to verbal commands, investigators will begin the postoperative exercise program. Initially participant will do breathing exercises with inspirations and forced exhalations followed by elevation and lowering of the upper limbs.

While the participant is in the operating room, sequences of 10 exercises with a 1-minute interval between sequences will be performed.5 From the moment the anesthesiologist authorizes, the patient will be referred for anesthetic recovery room Upon reaching anesthetic recovery room, the patient will receive water and diet. After feeding, will be placed in an armchair, maintaining monitoring where will continue to do breathing exercises, lifting and lowering exercises of the upper limbs and extension and flexion of lower limbs. At this moment the participant will be accompanied by a doctor of the surgical team and a physiotherapist who will guide him in relation to the movements. A family escort will be allowed to remain with the patient helping to do the exercises. This phase of recovery will last 2 hours.5, 6 After this period of time, the physician representing the surgical team will put the patient on stand and watch the patient for 4 minutes in order to evaluate possible postural hypotension and assess the patient's ability to support his or her own weight. If the patient does not tolerate standing, participant will be placed back in the armchair and will continue with the exercises. Otherwise, the physician and physiotherapist will walk with the patient into the anesthetic recovery room for a period of 30 minutes with rest breaks as needed.

Referral to the hospitalization unit: After anesthesia recovery, the participants will be referred to the hospitalization units. In the hospitalization units the patient will do a 15 minute walk in the hallway every 60 minutes interval. During the intervals the patient will be resting in an armchair doing the movements previously described.

Those patients at risk of postoperative cardiac arrhythmias who received intraoperative blood products with a risk for hemorrhagic events using some type of vasoactive drug requiring ventilatory support will be referred to the ICU where they will remain for at least 24 hours , maintaining the same lines of proposed postoperative exercises. Indication or not of ICU postoperatively should be a consensus between surgical team and anesthetic team.7

Postoperative Prescription: The postoperative prescription should contain a general voluntary diet, medications that the patient already use, prophylactic antibiotics in the first 24 hours of the postoperative period, dipyrone or paracetamol of schedule, ketoprofen of schedule or toragesic, methadon 5milligrams per mouth if pain, antiemetics (ondansetron) schedule, laxative once a day, chlorpromazine solution drops (from 8 to 10 drops) at nigth. Investigators should not prescribe anticoagulants or antiplatelet agents until the patient has 7 days postoperative. There is no need for prophylactic enoxaheparin because the patient will be in continuous movement. Daily radiographs will be performed while the patient has a thoracic drainage. Laboratory tests will be requested only if the patient shows some type of abnormality on the physical examination that raises some suspicion of organic dysfunction or if there is any indication for it based on the preoperative cardiovascular and anesthetic evaluations.

Discharge: When the patient is in conditions for hospital discharge, this will be done through some guidelines:

1. Return to the outpatient thoracic surgery in 7 days to continue postoperative follow-up.
2. Prescription of analgesics for home use.
3. Guidance on possible postoperative complications, making it very clear in which circumstances the patient should return to the emergency room (fever, dyspnea, bleeding or chest pain refractory to the use of medication).

It's impossible to mask the participants, care providers and investigators, because of the apparent differences in both techniques. For this reason the data analysis will be masked to avoid influences by the other participants during the analysis.

Protocol for Accelerated Recovery in Patients Undergoing Thoracic Surgical Procedures (PROSM). Study Randomized Comparative Between the Adoption of the Proposed Guidelines and the Traditional Method Currently Used in the Institution

Protocol for Accelerated Recovery in Patients Undergoing Thoracic Surgical Procedures Adapted to the Conditions of Santa Marcelina - Itaquera Hospital - São Paulo - Brazil (PROSM). Study Randomized Comparative Between the Adoption of the Proposed Guidelines and the Traditional Method Currently Used in the Institution

We are planning to publish partial data analysis during the study period

To evaluate the impact of PROSM on the length of hospitalization in patients submitted to surgical procedures by thoracic surgery team of the Santa Marcelina - Itaquera hospital

To evaluate the impact of PROSM on postoperative pain in patients submitted to surgical procedures by thoracic surgery team of the Santa Marcelina - Itaquera hospital

Evaluate the impacts of PROSM in reducing the costs of surgical treatment and hospitalization of these patients.

Igor Renato Louro Bruno de Abreu

Assistant physician of the thoracic surgery team of the Hospital Santa Marcelina de Itaquera

Digestive System Diseases

Colorectal Neoplasms

Intestinal Neoplasms

Gastrointestinal Neoplasms

Digestive System Neoplasms

Gastrointestinal Diseases

Colonic Diseases

Intestinal Diseases

Rectal Diseases

The prehabilitation program will begin several weeks preop and continue in the postoperative period

The prehabilitation program will begin after the surgery.

multimodal prehabilitation program based on exercise, supplemental nutrition and psychological support starting 3-5 weeks before surgery and continuing postoperative for up to 8 weeks

multimodal prehabilitation

multimodal prehabilitation program based on exercise, supplemental nutrition and psychological support beginning postoperative and continuing for up to 8 weeks

Despite advances in surgical care, the incidence of postoperative complications and prolonged recovery following colorectal surgery remains high. Efforts to improve the recovery process have primarily focused on the intraoperative (eg, minimally invasive surgery, afferent neural blockade) and post-operative periods (eg, "fast track" early nutrition and mobilization. The pre-operative period may in fact be a better time to intervene in the factors that contribute to recovery. The process of enhancing functional capacity of the individual in anticipation of an upcoming stressor has been termed "prehabilitation". Based on the notion that preoperative exercise would have an impact on recovery of functional capacity after colorectal surgery, our group recently conducted a randomized controlled trial. Subgroup analysis identified that patients whose functional exercise capacity improved preoperatively, regardless of exercise technique, recovered well in the postoperative period. However, one-third of patients deteriorated preoperatively despite the exercise regimen, and these patients were also at greater risk for prolonged recovery after surgery. These results suggested that exercise alone is not sufficient to attenuate the stress response in all patients. In the present trial, the impact of a multimodal prehabilitation intervention composed of exercise, nutritional supplement and psychological well-being begun in the preoperative period will be compared to one begun in the postoperative period.

Multimodal Prehabilitation for Colorectal Surgery

Multimodal Prehabilitation to Enhance Functional Recovery After Colorectal Surgery: a Randomized Controlled Trial

6 MWT is a patient-relevant measure of functional walking capacity, reflective of the activities of daily living. Subjects are instructed to walk back and forth, in a 20 m stretch of hallway, for six minutes, at a pace that would make them tired by the end of the walk. The distance in meters is recorded. Reference equations are available for calculating percent of age- and gender-specific norms.

The SF-36 is the most widely used HRQL measure and has been validated for surgical population; Canadian norms are also available. It incorporates behavioural functioning, subjective well-being and perceptions of health by assessing, on a 0 to 100 scale, eight health concepts.

Physical activity level will be measured through the Community Health Activities Model Program for Seniors (CHAMPS) questionnaire. CHAMPS is a self-reported measure of physical activity, comprising 41 activities evaluated according to the total number of hours done during an average week. Each physical activity is assigned a MET (metabolic equivalent) value yielding average weekly caloric expenditure for the listed physical activities

Depression and anxiety will be assessed by The Hospital Anxiety and Depression Scale (HADS), a 14-question measure with seven items each for depression and anxiety. HADS generates separate scores for anxiety and depression as well as a combined score of psychological distress.

Nutritional status will be assessed at baseline by measuring body mass index (BMI), body weight loss over the preceding three months (\> 10% ), and/or serum albumin \< 35 g -1 will define poor nutritional status.

Study title	NCT ID	Conditions	Interventions	Eligibility	Organization
The Effect of Discharge Training on Surgical Recovery in Oncology Patients	NCT04862104	Surgery--Compli... Nursing Caries	Intervention gr...	18 Years - 75 Years	Aydin Adnan Menderes University
Protocol for Accelerated Recovery in Patients Undergoing Thoracic Surgical Procedures (PROSM). Study Randomized Comparative Between the Adoption of the Proposed Guidelines and the Traditional Method Currently Used in the Institution	NCT03271749	Postoperative P... Postoperative C... Postoperative N... Lung Cancer	PROSM guideline...	18 Years -	Hospital Santa Marcelina
Protocol for Accelerated Recovery in Patients Undergoing Thoracic Surgical Procedures (PROSM). Study Randomized Comparative Between the Adoption of the Proposed Guidelines and the Traditional Method Currently Used in the Institution	NCT03271749	Postoperative P... Postoperative C... Postoperative N... Lung Cancer	PROSM guideline...	18 Years -	Hospital Santa Marcelina
Multimodal Prehabilitation for Colorectal Surgery	NCT01356264	Colorectal Canc... Colorectal Canc...	multimodal preh... multimodal preh...	18 Years - 100 Years	McGill University Health Centre/Research Institute of the McGill University Health Centre
The Effect of Discharge Training on Surgical Recovery in Oncology Patients	NCT04862104	Surgery--Compli... Nursing Caries	Intervention gr...	18 Years - 75 Years	Aydin Adnan Menderes University
The Effect of Discharge Training on Surgical Recovery in Oncology Patients	NCT04862104	Surgery--Compli... Nursing Caries	Intervention gr...	18 Years - 75 Years	Aydin Adnan Menderes University
Multimodal Prehabilitation for Colorectal Surgery	NCT01356264	Colorectal Canc... Colorectal Canc...	multimodal preh... multimodal preh...	18 Years - 100 Years	McGill University Health Centre/Research Institute of the McGill University Health Centre

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