Examining the Association Between Anxiety Severity and Required Sedative Medication Dosage in Children Undergoing Upper Gastrointestinal Endoscopy

Upper gastrointestinal endoscopy plays a major role in diagnosis and management of upper gastrointestinal disorders. Lack of patient's knowledge regarding endoscopy procedure is the main reason for increasing anxiety. This study aimed to: Assess knowledge and anxiety levels of patients undergoing upper gastrointestinal endoscopy. The study was carried out: In the gastrointestinal endoscopy units, Tanta University Hospital: A convenience sample of adult patients with GI disorders admitted to GI endoscopy units at Tanta University Hospital and scheduled for GI endoscopy were recruit to the study. The research questions include, - What are the levels of knowledge of patients undergoing upper GI endoscopy at Tanta University Hospital? - What are relations between levels of state and trait anxiety and different variables? Tools of the study: Two tools were used, Tool (I) Structured interview questionnaire: This tool was developed and used by the researcher for collection of baseline data and is consisted of three parts: Socio demographic data, patient's clinical information and patient's knowledge regarding upper gastrointestinal endoscopy. Tool (II) The State Trait Anxiety Inventory Scale: The original scale was developed by Spielberger in to evaluate respectively, state and trait anxiety. Results: It was observed that Less than half ( . ) of studied patients had poor knowledge score, while ( ) had severe state anxiety and more than half ( ) had severe trait anxiety. there was a high negative significant correlation (r= - , - respectively) between knowledge and The State Trait Anxiety Inventory Scale. Conclusion: Providing information to the patient before upper gastrointestinal endoscopy, decrease their level of anxiety and improve tolerance level during endoscopy procedure. Recommendations: It was recommended that provision of institutional written policies and guidelines regarding increasing knowledge and declining anxiety for patients undergoing upper gastrointestinal endoscopy.

Hydroxyurea Pharmacokinetics for Predicting Maximum Tolerated Dose in Children with Sickle Cell Anemia

Background: upper gastrointestinal endoscopy is the most preferable diagnostic examination for patients, Anxiety is one of the common problems and issues in the patients selected for surgery or invasive diagnostic and therapeutic methods. This study was aimed to investigate the effectiveness of behavioral intervention on Patient's anxiety and distress levels among upper gastroscopy patients in Benha University Hospital. Study design: This study experimental design (Pretest-Posttest study control group). Setting: The study was carried out in the endoscopy department at Benha University hospital in Benha city, Egypt. Subject: One hundred twenty patients alert mentally and willingness to participate in the study who were subjected for upper gastroscopy. The selected subjects were assigned to study and control groups (n= 60) in each group. Three tools for data collection: The 1st. tool consists of two parts: Part I: It was concerned with the socio-demographic characteristic of the studied subjects. Part II: clinical variables. 2nd. Tool: The State-Trait Anxiety Inventory Scale (STAIYI) to measures the state and trait anxiety level. 3rd. Tool: Endoscopy Concerns Scale to measure patient’s distress pre-procedure regarding a scope procedure. Results: The main findings of the study were: A majority of the control group had a severe distress and severe anxiety as compared with the study group post behavioral intervention had mild distress and mild level of anxiety. Therefore there was a positive association between total anxiety and total distress score within both the control and the study group post-intervention. Conclusion: The present study concluded that reduction of anxiety and distress level in the study group than the control group after behavioral intervention for upper gastrointestinal endoscopy patients. Recommendations: The nurses should be implement the behavioral intervention to reduce the anxiety and distress toward upper gastroscopy and enhance patient cooperate during the procedure.

IntroductionThis study aimed to examine the impact of social-psychological factors on anxiety before gastrointestinal endoscopy and its effect on patients’ quality of life (QoL).MethodsPatients scheduled for gastrointestinal endoscopy were recruited for the study. Demographic characteristics, social factors, lifestyle information and endoscopy-related data were obtained through self-reports and the hospital information system. The 7-item Generalized Anxiety Disorder Questionnaire (GAD-7) was used to assess anxiety, while depression and somatization were evaluated using the Patient Health Questionnaire-9 (PHQ-9) and PHQ-15, respectively. Sleep quality was measured with the Pittsburgh Sleep Quality Index (PSQI), social support was assessed using the Social Support Rating Scale (SSRS), and QoL was evaluated through the 12-item Short Form Survey (SF-12).ResultsThe prevalence of anxiety before gastrointestinal endoscopy was 34.44%. Gender, age, sleep quality, social support, depression, and somatization were associated with anxiety (all P<0.05). Independent predictors of anxiety were gender, age, PSQI, SSRS, PHQ-9 and PHQ-15 scores (all P<0.05). Furthermore, PSQI, PHQ-9, and PHQ-15 scores were positively correlated with the severity of anxiety (all P<0.05). Patients with anxiety exhibited lower scores in domains of the SF-12, including general health (GH), physical functioning (PF), role-physical (RP), bodily pain (BP), role-emotional (RE), mental health (MH), vitality (VT), and social functioning (SF). Both physical component summary (PCS) and mental component summary (MCS) scores were reduced. Notably, GH, RP, RE, MH, VT, SF, and MCS scores were negatively correlated with varying levels of anxiety (all P<0.05).ConclusionSocial-psychological factors play a role in anxiety before gastrointestinal endoscopy; anxiety can negatively affect patients’ QoL.

Wrong dose calculation medication errors are widespread in pediatric patients mainly due to weight-based dosing. PediPain app is a clinical decision support tool that provides weight- and age- based dosages for various analgesics. We hypothesized that the use of a clinical decision support tool, the PediPain app versus pocket calculators for calculating pain medication dosages in children reduces the incidence of wrong dosage calculations and shortens the time taken for calculations. The study was a randomised controlled trial comparing the PediPain app vs. pocket calculator for performing eight weight-based calculations for opioids and other analgesics. Participants were healthcare providers routinely administering opioids and other analgesics in their practice. The primary outcome was the incidence of wrong dose calculations. Secondary outcomes were the incidence of wrong dose calculations in simple versus complex calculations; time taken to complete calculations; the occurrence of tenfold; hundredfold errors; and wrong-key presses. A total of 140 residents, fellows and nurses were recruited between June 2018 and November 2019; 70 participants were randomized to control group (pocket calculator) and 70 to the intervention group (PediPain App). After randomization two participants assigned to PediPain group completed the simulation in the control group by mistake. Analysis was by intention-to-treat (PediPain app = 68 participants, pocket calculator = 72 participants). The overall incidence of wrong dose calculation was 178/576 (30.9%) for the control and 23/544 (4.23%) for PediPain App, P < 0·001. The risk difference was - 32.8% [-38.7%, -26.9%] for complex and - 20.5% [-26.3%, -14.8%] for simple calculations. Calculations took longer within control group (median of 69 Sects.[50, 96]) compared to PediPain app group, (median 48 Sects.[38, 63]), P < 0.001. There were no differences in other secondary outcomes. A weight-based clinical decision support tool, the PediPain app reduced the incidence of wrong doses calculation. Clinical decision support tools calculating medications may be valuable instruments for reducing medication errors, especially in the pediatric population.

Topical anesthesia: To use or not to use—that is the question

Depression level, not pain severity, is associated with smoked medical marijuana dosage among chronic pain patients

We investigated whether the severity of anxiety among children undergoing endoscopy could affect sedation. We prospectively recruited patients under 18years of age who were scheduled to undergo esophagogastroduodenoscopy (EGD). Baseline anxiety was evaluated using the Spence Children's Anxiety Scale (SCAS). Our analysis considered the type and dose of sedative drugs, degree of sedation, and complications associated with sedation according to the scale score. The mean total SCAS T-scores and each subscale score were significantly higher in the 6-12-year age group. The mean T-score among patients who exhibited irritability during EGD was higher than that among other patients, with significant differences in the Total, Obsessive Disorder, Panic Agoraphobia and General Anxiety subscales. The midazolam doses of children exhibiting irritability were more likely to need higher (p = 0.006). Other sedation-related complications were not associated with the T-scores in each subscale. Total sleep time was not associated with any T-score subscales. Anxiety levels were significantly higher among 6-12-year-olds and children exhibiting irritability. Anxiety was often associated with irritability, difficulties achieving adequate sedation during EGD, and additional sedative drug administration. We recommend higher doses or more potent drugs to facilitate endoscopy for children with high anxiety levels.

Comparing high-flow nasal oxygenation or standard oxygenation for gastrointestinal endoscopy with sedation. Comment on Br J Anaesth 2021; 127: 133-42

Pain and anxiety are almost universal feature of ICU patients. Clinically significant pain and anxiety have been reported in up to 70 % of ICU patients. Anxiety is often caused or exacerbated by uncontrolled pain. Severe anxiety is not limited to mechanically ventilated patients; indeed Treggiari-Venzi and colleagues demonstrated that up to 30 % of non-intubated SICU patients had severe anxiety [1]. Anxiety has numerous adverse effects, consequently, the control of anxiety is an integral component of the management of the ICU patient. Traditionally, the liberal use of sedatives was recommended in order to treat anxiety, with ventilated patients being heavily sedated with continuous infusions of sedative agents. The traditional approach to sedation in the ICU was one of deep sedation in which the patient was “snowed”. We now know that is approach to harmful and associated with numerous complications. Furthermore, ICU patients can be effectively managed with minimal or no sedation. Indeed, Strom et al. performed a RCT in which 140 mechanically ventilated patients were randomized to standard sedation or no sedation [2]. In this study patients were randomized to receive no sedation or sedation with propofol for 48 h. After 48 h the sedative was change to an infusion of midazolam. Both groups were treated with bolus doses of morphine (2·5 or 5 mg) as required for pain control. In cases in which delirium was suspected, intravenous haloperidol was given as bolus doses. Patients who received no sedation had greater ventilator and ICU free days with no apparent adverse events. This study dispels the common myth that all patients who require mechanical ventilation should receive sedative medications [3].

For the Kids: Managing Medical Equipment in Children's Hospitals

The reason for the high frequency of depression and anxiety in Parkinson's disease is poorly understood. Degeneration of neurotransmitter systems other than dopamine might play a specific role in the occurrence of these affective disorders. We used [11C]RTI-32 PET, an in vivo marker of both dopamine and noradrenaline transporter binding, to localize differences between depressed and non-depressed patients. We studied eight and 12 Parkinson's disease patients with and without a history of depression matched for age, disease duration and doses of antiparkinsonian medication. The depressed Parkinson's disease cohort had lower [11C]RTI-32 binding than non-depressed Parkinson's disease cases in the locus coeruleus and in several regions of the limbic system including the anterior cingulate cortex, the thalamus, the amygdala and the ventral striatum. Exploratory analyses revealed that the severity of anxiety in the Parkinson's disease patients was inversely correlated with the [11C]RTI-32 binding in most of these regions and apathy was inversely correlated with [11C]RTI-32 binding in the ventral striatum. These results suggest that depression and anxiety in Parkinson's disease might be associated with a specific loss of dopamine and noradrenaline innervation in the limbic system.

Outcomes research in endoscopy: current status and future directions

3398 Effect of an educational intervention program on gastrointestinal endoscopic overuse in primary care physicians.

Adverse events of upper GI endoscopy