Decrease Patient Anxiety Research Articles

Virtual Follow-Up after Cataract Surgery: A Systematic Review.

To examine the association between virtual postoperative follow-up care and patient outcomes after cataract surgery. Cataract surgery is a safe and commonly performed surgery. Follow-up visits are used to monitor for complications. It is uncertain whether virtual follow-up provides a safe alternative to in-person review. Medline, Embase and CINAHL were searched from inception to October 2023 for relevant articles containing original data. Studies that: 1) included patients that were seen in a virtual follow-up (i.e., telephone or video call) for postoperative appointments after cataract surgery, and 2) reported patient outcomes were included. Risk of bias was assessed using the Newcastle-Ottawa and ROB2 assessment tools. Descriptive statistics were used to summarize findings. The review was registered in PROSPERO (registration number, CRD42023477207) and PRISMA guidelines were followed. The search yielded 1710 records with seven studies included in this review. The seven studies reported on 2113 cataract surgeries in 1994 patients. The studies ranged between 2004 and 2020. Most of the studies (5/7) included only patients with uncomplicated cataract surgery. Virtual follow-ups were all conducted by telephone. The follow-up calls were made at varying timepoints including postoperative day 1 (n= 3), day 7 (n=2) and day 14 (n=1). Two observational studies directly compared patients who had a telephone follow-up to a control group who had an in-person follow-up. There were no significant differences in complication rates (p=0.22) or visual acuity (p=0.28) between these follow-up groups. None of the studies reported serious adverse outcomes from replacing in-person follow-up with telephone follow-up. One study used virtual follow-up in conjunction with in-person visits for elderly patients and found that additional telephone follow-up was associated with decreased surgical recovery time and decreased patient anxiety. Three studies reported on patient perceptions about telephone follow-up. A common theme was that patients preferred telephone reviews and found them to be more convenient than in-person follow-up. For patients with uncomplicated cataract surgery, virtual follow-ups seem to be a safe alternative to in-person visits and were preferred by patients. These conclusions are preliminary given the limited literature base, and further study is needed.

A Parallel-Group, Randomized Trial Examining Impact of Colposcopy Results Delivery by a Nurse Liaison on Patient-Reported Outcomes and Adherence

ObjectivesCervical cancer is on the rise in Canada. Addressing patient anxiety and improving patient understanding of colposcopy and results may improve adherence. This randomized controlled trial examined the impact of colposcopy results delivery by a Nurse Liaison versus the referring primary care provider (PCP) on patient anxiety, and secondary outcomes including patient satisfaction, knowledge of diagnosis, and 9-month adherence to follow-up. MethodsPatients ≥18 years old presenting for initial appointment at the study colposcopy clinic were randomized 1:1 to an intervention group (Nurse Liaison) versus a control group (PCP). After receiving colposcopy results, participants completed online measures of anxiety (State-Trait Anxiety Inventory), health care satisfaction scales (Patient Satisfaction Questionnaire-18, Health Anxiety Inventory, Visit-Specific Satisfaction Questionnaire-9), self-reported colposcopy diagnosis, and demographics. Chart review at 9 months assessed adherence to recommended colposcopy follow-up. Groups were compared on continuous and categorical variables, controlling for diagnosis severity and trait anxiety. ResultsThe intervention group had significantly lower state anxiety with State-Trait Anxiety Inventory-state mean scores of 37.3 versus 40.7 in controls (P = 0.03). Intervention group participants were more likely to correctly report their diagnosis (84% vs. 66.3%, P = 0.003). Questionnaire responders were more likely to be in the intervention group and had a higher proportion of cervical intraepithelial neoplasia 2+ pathology. There were no differences in demographics, patient satisfaction, or adherence to follow-up between groups. ConclusionsDirect delivery of colposcopy results by a trained Nurse Liaison was associated with decreased patient anxiety around colposcopy results, and increased patient knowledge regarding diagnosis. This model may be considered to improve patient-centred care.

Interventions to improve nurse-family communication in the emergency department: A scoping review.

To determine and describe what interventions exist to improve nurse-family communication during the waiting period of an emergency department visit. Communication between nurses and families is an area needing improvement. Good communication can improve patient outcomes, satisfaction with care and decrease patient and family anxiety. Scoping Review. A scoping review was conducted following the Joanna Briggs Institution methodology: (1) identify the research question, (2) define the inclusion criteria, (3) use a search strategy to identify relevant studies using a three-step approach, (4) select studies using a team approach, (5) data extraction, (6) data analysis, and (7) presentation of results. Medline, CINAHL, EMBASE, PsychInfo and grey literature were searched on 3 August 2022. The search yielded 1771 articles from the databases, of which 20 were included. An additional seven articles were included from the grey literature. Paediatric and adult interventions were found targeting staff and family of which the general recommendations were summarised into communication models. Future research should focus on evaluating the effectiveness of interventions using a standardised scale, understanding the specific needs of families, and exploring the communication models developed in this review. Communication models for triage nurses and all emergency department nurses were developed. These may guide nurses to improve their communication which will contribute to improving family satisfaction. PRISMA-ScR. Protocol has been registered with the Open Science Framework, registration number 10.17605/OSF.IO/ETSYB. No patient or public contribution.

Coloring complex shapes decreases patient anxiety in three care environments: a pilot study with color analysis.

This study was conducted to determine the effectiveness of coloring activity of circular symmetrical shape with complex patterns, so-called mandala, on anxiety associated with chronic illness in three different ambulatory medical situations (general consultation, psychiatric day hospital, and hemodialysis session). Thirty patients were included in three groups and came from three different ambulatory medical situations: a hemodialysis group (n = 10), a psychiatric day hospital group (n = 10), and a nephrology consultation group (n = 10). We asked the patients to fill STAI-S and STAI-T questionnaires before to color complex circular shape with complex patterns, then to fill the STAI-S questionnaire again and a questionnaire on the experience of the activity. The results show that the STAI-S score was significantly lower after coloring for the hemodialysis (p = 0.02) and psychiatric groups (p = 0.005) but not for the general consultation group (p = 0.26). STAI-T scores did not differ between groups. The distribution of colors in the mandala was different in the three groups of patients. A positive subjective experience of the activity was found in all groups. These results show the effectiveness of a coloring activity of a circular shape with complex patterns on anxiety associated with chronic illness in care environment. The different distribution of the colors of the mandala in the three groups raises the question of the influence of the context on the mood of the patients and the deeper meaning of the choice of colors and their placement in the mandala. Our study reinforces the multiple applications of art activities in different medical disciplines and encourages their development within healthcare settings.

Impact of the practice of touch-massage® by a nurse on the anxiety of patients with hematological disorders hospitalized in a sterile environment, a randomized, controlled study

ContextIn addition to curative care, supportive care is beneficial in managing the anxiety symptoms common in patients in sterile hematology unit. We hypothesize that personal massage can help the patient, particularly in this isolated setting where physical contact is extremely limited. The main objective of this study was to show that anxiety could be reduced after a touch-massage® performed by a nurse trained in this therapy.MethodsA single-center, randomized, unblinded controlled study in the sterile hematology unit of a French university hospital, validated by an ethics committee. The patients, aged between 18 and 65 years old, and suffering from a serious and progressive hematological pathology, were hospitalized in sterile hematology unit for a minimum of three weeks, patients were randomized into either a group receiving 15-minute touch-massage® sessions or a control group receiving an equivalent amount of quiet time once a week for three weeks. In the treated group, anxiety was assessed before and after each touch-massage® session, using the State-Trait Anxiety Inventory questionnaire with subscale state (STAI-State). In the control group, anxiety was assessed before and after a 15-minute quiet period. For each patient, the difference in the STAI-State score before and after each session (or period) was calculated, the primary endpoint was based on the average of these three differences. Each patient completed the Rosenberg Self-Esteem Questionnaire before the first session and after the last session.ResultsSixty-two patients were randomized. Touch-massage® significantly decreased patient anxiety: a mean decrease in STAI-State scale score of 10.6 [7.65–13.54] was obtained for the massage group (p ≤ 0.001) compared with the control group. The improvement in self-esteem score was not significant.ConclusionThis study provides convincing evidence for integrating touch-massage® in the treatment of patients in sterile hematology unit.Trial registrationNCT02343965.

Family Medicine Residents' Knowledge and Attitudes About End-of-Life Care in Taif City, Saudi Arabia.

Background End-of-life care is essential for individuals with advanced illness and their families, providing comfort, symptom control, and dignity in the final year of life. Additionally, physician competence requires the ability to communicate, make decisions, and create relationships in end-of-life care. This study assesses family physicians' knowledge and attitude regarding end-of-life care in Taif, Saudi Arabia. Methods Thisdescriptive cross-sectional study conducted between October and November 2021 assessed the knowledge and attitudes of 163 family physicians in Taif City, Saudi Arabia, regarding end-of-life care. Using a convenient sampling technique, an adapted and validated questionnaire was administered electronically, collecting sociodemographic information and assessing participants' knowledge and attitudes. Data were analyzed using descriptive statistics in Statistical Product and Service Solutions (SPSS, version 28) (IBM SPSS Statistics for Windows, Armonk, NY). Results Findings included that 41.1% of residents believed the patient and family should be informed about diagnoses and prognoses in advanced diseases. At the same time, attitudes varied, with 45.4% agreeing that discussing such information could lead to patient depression and 42.9% believing it held no privilege for patients. Additionally, 57.7% recognized that grief reactions would occur, but patients would eventually adjust, and 44.8% agreed that discussing diagnoses would decrease patient anxiety. However, limited awareness of advance directives was evident, with 12.3% reporting being well aware and 45.4% having never heard of them. There was uncertainty and hesitancy regarding Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) decisions, with 39.9% being well aware and 46% having heard of it without a strong understanding. Conclusion The findings revealed a mixed landscape, with physicians demonstrating awareness of the importance of transparent communication but needing more knowledge in areas such as advance directives and complex decision-making. The study highlighted the need for targeted education to address these gaps and promote a more informed and consistent approach to end-of-life care.

Evaluating the impact of therapy dogs on patients with cancer.

278 Background: Chemotherapy/Immunotherapy infusion visits are unique experiences for cancer patients that can often increase stress and anxiety. Multiple papers have shown that therapy dogs can decrease anxiety, improve mental health, and increase relaxation. It has not been established that therapy dog visits during infusions can improve stress and anxiety similar to other clinical experiences. Our purpose was to explore if during this stressful experience therapy dogs would have the same impact as previously researched situations. Methods: At Virginia G. Paper Cancer Care Network North Scottsdale (HonorHealth) we drafted a survey. This anonymous and voluntary survey abstracted patient data that included: age, gender, dog ownership, and pet affinity. Patients were asked prior to a therapy dog visit to grade their anxiety and relaxation level and answered identical questions post-visit. Questions were drafted with Yes/No and scale of 1-10. Surveys were collected over an eight-week period from January 1, 2023 through February 28, 2023. Patients were surveyed in an outpatient infusion center. Results: 61 surveys were collected and analyzed. Statistical analysis was performed with a t-test for numeric and a binomial regression was fit to the data. 100% of patients surveyed liked animals & felt that therapy dogs helped with anxiety and relaxation. Anxiety levels significantly decreased by 31.1% (p <0.00001) after a therapy dog visit and relaxation levels increased by 25.8% (p = 0.0001). Age surveyed ranged from 40-85 with an average age of 63, with more females than males being surveyed. Conclusions: Patients at a small community hematology/oncology center can benefit from additional supportive services. In our prospective survey project, having a visiting therapy dog significantly decreased patient anxiety and improved relaxation during chemotherapy/immunotherapy infusion visits.

A Pilot Study of an Interactive Virtual Tour Tool for Patient Education Prior to Undergoing High-Dose Rate Brachytherapy for Prostate Cancer.

High-dose rate (HDR) brachytherapy for treatment of prostate cancer is an invasive procedure that can be associated with patient anxiety. Patient education regarding the procedure can allow for better informed decision-making while also decreasing anxiety. We sought to develop and assess the utility of an interactive virtual tour tool that portrays a 360-degree view of the HDR brachytherapy patient experience, with the goals of providing patient education, decreasing patient anxiety, and assisting in wayfinding on the procedure day. Using a 360-degree camera, we captured multiple photographs that depicted the various hospital locations that a patient would navigate through on the day of their HDR brachytherapy procedure, including the medical center lobby, pre-operative/post-operative units, and the brachytherapy suite. We then compiled these 360-degree photographs using virtual tour software, to allow users to navigate throughout the locations. We added informational text, spoken audio, and videos associated with key staff, objects, and the brachytherapy procedure that allow the users to interact with and learn about these various components within the virtual tour. This tool was accessible via a website link on a computer, tablet, or smartphone and was provided at the time of consult to patients who were planning to undergo HDR brachytherapy for prostate cancer. A questionnaire assessing the tool's ease of use, educational value, wayfinding utility, and ability to improve anxiety and treatment decision-making was conducted prior to and after their procedure. Preliminary feedback from healthy volunteers is highly positive, with users finding that the tool is easily accessible, user-friendly, improves understanding of HDR brachytherapy, simulates the treatment experience accurately, helps with wayfinding, and has the potential to decrease patient anxiety and increase comfort with the treatment decision. Data from the patient questionnaires are being collected and will be analyzed. A 360-degree virtual tour tool allows for an easily accessible, immersive, and interactive method of patient education on an invasive, anxiety-associated procedure. This has the potential to decrease patient anxiety and improve comfort regarding treatment decision-making. This tool may be applied toward other relatively involved radiotherapy modalities, including gynecologic HDR brachytherapy, respiratory-gated treatments, and CyberKnife stereotactic radiosurgery.

Expanding the functions of dental assistants in Bulgaria and perceptions about their role in the Bulgarian healhcare workforce

The study queries a sample of dentists and dental assistants in Bulgaria about their understanding and perceptions of Expanded Function Dental Auxiliaries (EFDA). The study considers whether expanding the skillset of dental assistants to function in specific scenarios without personal supervision by the dentist may be a viable strategy to address various oral health inequities in the country. An anonymous survey was conducted among 103 practicing dentists and 100 dental assistants throughout the country. The questionnaire consisted of 20 questions that probed respondents' understanding about the duties performed by EFDAs and their potential to increase productivity and efficiency of the dental workforce. Sociological (poll) and statistical (alternative analysis) methods were used in the survey. The majority of respondents were female. Most worked in the larger cities. One worked in a village. Most were ethnic Bulgarians and none were Roma, reflecting the racial imbalance in the national workforce. Two-thirds (67%) believed that dental assistants with appropriate training are capable of doing expanded dental procedures without personal supervision by a dentist. The majority (83.7%) believed that EFDAs could improve efficiency of a dental practice, while 58.1% indicated that with appropriate training, they could perform expanded duties as well as the dentist. However, only one third believed that EFDAs could increase practice output (38.9%); enhance the quality of the dentist's work (37.4%); or decrease patient anxiety (31.5%). Though most respondents (78.3%) believed that a patient would not be receptive to an EFDA placing a restoration without personal supervision by the dentist, two thirds of respondents (66.5%) would like to see dental assistants trained to perform expanded duties otherwise reserved for dentists. Most respondents felt that EFDAs could help to build a well-functioning dental team. Most respondents believed that EFDAs can benefit the efficiency of a practice, suggesting that Bulgarian dental professionals would respond favorably to enhancing the skillset of assistants with expanded functions. The study suggests they are skeptical about "general" versus "personal" supervision. EFDAs may potentially provide improved access by underserved communities, while building a more inclusive oral healthcare workforce reflective of the population.

Postoperative Telenursing During the COVID-19 Pandemic: Improving Patient Outcomes

PurposeThis study was conducted to determine if postoperative nurse-driven telehealth visits for patients undergoing septorhinoplasty decreased patient anxiety while improving comfort and satisfaction levels. DesignThe present study was an intervention-control study completed with a total of 320 participants (n = 160, intervention group; n = 160, control group). The intervention postseptorhinoplasty training using the telenursing method was conducted at three time points in this study; preoperatively-postoperatively, on days 3, and 10. MethodsData were collected from a group of patients undergoing septorhinoplasty in the Ear, Nose, and Throat department of a University Hospital in Turkey between October 2021 and February 2022. The data collected in the study were evaluated with the SPSS 23.00 program and were analyzed with the independent sample t test for two independent groups and the F test (ANOVA) for more than two groups. Correlation analysis was performed to examine the relationship between scales, and P < .05 was considered statistically significant. FindingsIn the postoperative period, the mean anxiety inventory score of the experimental group was found to be significantly lower than that of the control group (P < .01). Telenursing increased the satisfaction and comfort of the patients and shortened the discharge time. There was a negative and statistically significant relationship between satisfaction and State Anxiety Inventory and Trait Anxiety Inventory (r = -0.715, r = -0.739, P < .01). ConclusionsThis study confirms the importance of postoperative telenursing for septorhinoplasty patients in promoting continuity of care, reducing anxiety and discharge time, improving comfort and satisfaction levels during the Covid-19 pandemic. Remote care was well received during the study and should be used more frequently. There is a need for further research regarding telehealth; and the international incentives and regulations which will be needed to make telenursing a standard of care should be pursued.

Effects of aromatherapy and music therapy on patients' anxiety during MRI examinations: a randomized controlled trial.

Many patients experience anxiety during MRI examinations. However, little attention has been focused on decreasing patient anxiety and minimizing on-site cancellations. Here, we aimed to investigate the effects of aromatherapy and music therapy on alleviating anxiety during MRI examinations. This single-center, double-blinded, randomized control trial was conducted between November 1, 2021, and January 10, 2022. Patients undergoing MRI examinations were assigned randomly into either the aromatherapy group (AG), music therapy group (MG), aromatherapy plus music therapy group (AMTG), or routine care group (RG) at a ratio of 1:1:1:1. Aromatherapy was conducted through inhalation of lavender oil. Music therapy was performed using Pachelbel's Canon in D major. The primary outcome was the change in anxiety before and after the MRI scan, assessed using both the State-Trait Anxiety Inventory form 1 (STAI-1) and Self-Rating Anxiety Scale (SAS). The second outcome was the participant's comfort, measured using Kolcaba's General Comfort Questionnaire (GCQ). A total of 200 participants (mean age: 48.3 ± 14.9 years; 126 [63.0%] females) were enrolled, with 50 per group. The mean anxiety scores of the AMTG showed greater reduction compared with the AG, MG, and RG (ΔSTAI-1: 6.5 vs 2.6 vs 2.7 vs 1.9, p < 0.001; ΔSAS: 4.0 vs 1.4 vs 1.7 vs 0.6, p < 0.001). The mean GCQ score of the AMTG was higher compared with the AG, MG, and RG (98.0 vs 92.6 vs 91.2 vs 89.2, respectively, p < 0.001). Aromatherapy combined with music therapy is effective for reducing patients' anxiety and improving their comfort level during MRI scans. • In this randomized control trial of 200 participants undergoing MRI scans, aromatherapy plus music therapy is effective in reducing STAI-1 and SAS, as well as improving GCQ scores. • Although there was a significant difference between the aromatherapy plus music therapy and the single-intervention modalities, no significant differences were observed between the aromatherapy and music therapy themselves for state anxiety and comfort score. • Aromatherapy plus music therapy is a safe, non-invasive, nonpharmacological, and inexpensive patient-centered intervention for reducing anxiety and improving comfort in adults undergoing MRI examinations.

Clinical utility of routine postoperative serial hemoglobin measurements in patients undergoing radical cystectomy for urothelial carcinoma.

Routine measurements of serum hemoglobin (sHgb) are common after abdominal surgery; however, prolonged measurements may be associated with patient anxiety, increased costs, and longer hospitalization without clinical benefit. The objective of this study was to determine the utility of routine sHgb measurements after radical cystectomy (RC) and factors associated with transfusion of packed red blood cell (pRB C) beyond postoperative day (POD ) 2. We retrospectively reviewed patients who underwent RC between 2009 and 2019 at a single academic tertiary care center. The number of sHgb measurements for each patient was examined and pRB C transfusion rates were calculated. Multivariable logistic regression was used to determine factors associated with transfusion beyond POD 2. The median number of sHgb measurements per patient during admission was nine (interquartile range [IQR] 7, 25). Overall, 69/240 (28.7%) patients received a postoperative transfusion, including 46/240 (19.2%) patients receiving a transfusion beyond POD 2. Among patients with a sHgb ≥100 g/L on POD 2, 7/85 (8.2%) went on to receive a transfusion beyond this day compared with 39/155 (25.2%) patients with sHgb <100 g/L. On multivariable analysis, risk factors associated with pRB C transfusion beyond POD 2 included older age, lower sHgb on POD 2, and longer length of stay in hospital. Transfusion of pRB Cs beyond POD 2 was found to be common; however, patients with sHgb ≥100 g/L on POD 2 were at low risk of requiring subsequent transfusion. Discontinuing further routine sHgb checks in these patients may serve to decrease patient anxiety, healthcare costs, and delays in hospital discharge.

Learning In 360 Degrees: The Use of Virtual Reality for Radiation Therapy Patient Education

Purpose: External beam radiation therapy (EBRT) is not well understood by the cancer patient population and this lack of understanding can increase anxiety around the procedure. Conventional written or verbal education may not provide patients with a clear picture of the complex technical aspects of EBRT treatment. Commercially available technologies such as Virtual Reality (VR) can immerse an individual in a 360degree virtual world and are increasingly being used to manage anxiety through exposure and education in various medical settings. The purpose of this study was to determine if the integration of a VR video depicting EBRT from the patient's point of view into conventional patient education decreases patient anxiety prior to treatment. Methods: The study population included patients having EBRT to the pelvis in a supine position. Participants were assigned to one of 3 study arms: Control, Early Intervention or Intervention. All participants completed the National Comprehensive Cancer Network's Distress Thermometer (DT) as a pre-intervention assessment of anxiety and received standard patient education. Participants in the Early Intervention and Intervention arms also watched the VR video. Early Intervention participants viewed the VR video 2 weeks prior to treatment at their CT planning appointment while Intervention participants viewed the VR video just prior to treatment on the day of their first treatment fraction appointment. All participants completed a post-intervention DT and a modified Cancer Treatment Survey (CaTS) on the first day of treatment after all education was completed. Descriptive statistics were calculated for all variables of interest. The primary endpoint of pre-post anxiety between groups was assessed using general linear mixed model for repeated measures. Results: 82 patients were approached to participate in this investigation, 61 consented and 4 withdrew. 19 participants were assigned to each of the 3 arms. Mean pre-intervention anxiety levels on the DT scale (0-10) were generally low and not significantly different between the three arms (Control X=2.4, SD=2.3; Early Intervention X=2.6, SD=2.0; Intervention X=2.1, SD=2.3). The difference between pre and post-intervention anxiety was not significant in the Control (p=0.92, SE=0.10) or the Early Intervention arms (p=0.69, SE=0.04). However, the difference between pre and post-intervention anxiety was statistically significant in the Intervention arm (p<0.01, SE=0.07) with post-intervention anxiety being lower (X=1.3, SD=1.4). Responses to Likert scale questions on the CaTS showed similar levels of satisfaction with education received in all arms. Conclusion: Participants in the Intervention arm reported significantly less anxiety on the first day of treatment following the VR video. This suggests VR is a valuable tool for reducing radiation treatment-related anxiety. However, timing is an important factor as the anxiety reducing effect was no longer observed when the VR video was viewed two weeks before the first radiation treatment.

The Longitudinal Effect of a Prechemotherapy Educational Video on the Treatment-Related Anxiety of Women With Breast Cancer.

Patients recently diagnosed with breast cancer have a multitude of emotions. Although each patient goes through emotional phases differently, these feelings often manifest as anxiety or fear. The objective is to decrease patient anxiety using a prechemotherapy educational video for newly diagnosed patients with breast cancer. A quantitative comparative design, using repeated measures, was conducted with 27 patients with breast cancer who received chemotherapy treatment. An educational video was developed and provided as a part of the prechemotherapy education. Anxiety was measured using the Patient-Reported Outcomes Measurement Information System instrument before and two weeks after initiation, at the end of treatment, and three months after chemotherapy administration. Anxiety decreased over time, from before chemotherapy started to three months after the chemotherapy treatment was completed.

Anxiety surrounding supracondylar humerus pin removal in children.

Purpose:The purpose of this study was to quantify the anxiety experienced by patients undergoing pin removal in clinic following closed reduction and percutaneous pinning for supracondylar humerus fractures.Methods:We prospectively enrolled 53 patients (3–8 years) treated for supracondylar humerus fracture with closed reduction and percutaneous pinning between July 2018 and February 2020. Demographic and injury data were recorded. Heart rate and the Face, Legs, Activity, Cry, and Consolability scale were measured immediately before pin removal and after pin removal, and crossover control values were obtained at the subsequent follow-up clinic visit.Results:All patients experienced anxiety immediately prior to pin removal (95% confidence interval, 94%–100%) with a median Face, Legs, Activity, Cry, and Consolability score of 7 (interquartile range, 6–8). In addition, 98% of subjects experienced an elevated heart rate (95% confidence interval, 88%–100%). Patients experienced a median 73% reduction in Face, Legs, Activity, Cry, and Consolability score and mean 21% reduction in heart rate from prior to pin removal to after pin removal (p < 0.001). All 45 patients who completed their follow-up visit had a control Face, Legs, Activity, Cry, and Consolability score of 0 and a mean control heart rate of 89.7 bpm. Twenty-five of these 45 subjects (56%) had an elevated control heart rate for their age and sex. Mean heart rate prior to pin removal was 36% higher than control heart rate. There were no sex differences detected in Face, Legs, Activity, Cry, and Consolability scores or heart rate.Conclusions:Pediatric patients experience high levels of anxiety when undergoing pin removal following closed reduction and percutaneous pinning for supracondylar humerus fractures. This is an area of clinical practice where intervention may be warranted to decrease patient anxiety.Level of evidence:II

Effects of a 2-Week Remote Learning Program on Empathy and Clinical and Communication Skills in Premedical Students: Mixed Methods Evaluation Study.

BackgroundExpressing empathy builds trust with patients, increases patient satisfaction, and is associated with better health outcomes. Research shows that expressing empathy to patients improves patient adherence to medications and decreases patient anxiety and the number of malpractice lawsuits. However, there is a dearth of research on teaching empathy to premedical students. The Clinical Science, Technology, and Medicine Summer Internship of Stanford Medicine (also called the Stanford Anesthesia Summer Institute) is a 2-week collaborative medical internship for high school and undergraduate students to inspire learners to be compassionate health care providers. The summer 2020 program was adapted to accomplish these objectives in a fully remote environment because of the COVID-19 global pandemic.ObjectiveThis study aims to measure the change in empathy and competencies of participants in clinical and communication skills before and after program participation.MethodsA total of 41 participants completed only the core track of this program, and 39 participants completed the core + research track of this program. Participants in both tracks received instructions in selected clinical skills and interacted directly with patients to improve their interviewing skills. Research track participants received additional instructions in research methodology. All participants completed web-based pre- and postsurveys containing Knowledge and Skills Assessment (KSA) questions. Participant empathy was assessed using the validated Consultation and Relational Empathy measure. A subset of participants completed optional focus groups to discuss empathy. The pre- and post-KSA and Consultation and Relational Empathy measure scores were compared using paired 2-tailed t tests and a linear regression model. Open-ended focus group answers were then analyzed thematically.ResultsParticipants in both tracks demonstrated significant improvement in empathy after the 2-week remote learning course (P=.007 in core track; P<.001 in research track). These results remained significant when controlling for gender and age. A lower pretest score was associated with a greater change in empathy. Participants in both tracks demonstrated significant improvement in KSA questions related to surgical skills (P<.001 in core track; P<.001 in research track), epinephrine pen use (P<.001 in core track; P<.001 in research track), x-ray image interpretation (P<.001 in core track; P<.001 in research track), and synthesizing information to solve problems (P<.001 in core track; P=.05 in research track). The core track participants also showed significant improvements in health communication skills (P=.001). Qualitative analysis yielded 3 themes: empathy as action, empathy as a mindset, and empathy in designing health care systems.ConclusionsSummer internships that introduce high school and undergraduate students to the field of health care through hands-on interaction and patient involvement may be an effective way to develop measurable empathy skills when combined with clinical skills training and mentorship. Notably, increases in empathy were observed in a program administered via a remote learning environment.

Optimizing Pediatric Induction Experiences Using Human-centered Design

PurposeAnesthesia inhalation induction (falling asleep for a surgery using a medical mask) is often stressful for children. When children become anxious about induction, they may resist wearing the anesthesia mask. High anxiety during induction is associated with poorer outcomes after surgery, such as increased emergence delirium, increased pain and negative behavioral changes after discharge. The purpose of this project was to design an optimal anesthesia induction experience for children, with a focus on decreasing patient anxiety during inhalation induction. DesignDesigning for the perioperative environment requires in-depth knowledge of existing processes, needs of key stakeholders, strengths/shortcomings of existing approaches, and iterative testing of design concepts. We used a human centered design model (design research) to approach this challenge. MethodsHospital staff partnered with a design team at the Live Well Collaborative. Families and staff were consulted during all phases of the design process. The iterative design research process (research, ideation, refinement) was used to develop product and process concepts for optimizing the induction experience. Requirements for an optimal induction experience were defined during the research phase through reviewing the scientific literature, process mapping and benchmarking with other products. Product and process concepts were developed during the ideation phase. Concepts were tested and refined during the refinement phase. FindingsThe research phase provided insights about the current anesthesia induction process and what interventions help engage children in medical care. Key insights included normalizing the anesthesia mask through medical play, providing patients with an increased sense of control preoperatively and during induction, and engaging multiple senses during the process. The ideation phase led to the development of several design concepts, including an app that is activated by breathing into the anesthesia mask. During the refinement phase, concepts were shared and refined with input from families and clinical staff. This phase led to the development of a novel zoo-themed gaming app. ConclusionsThe design research process facilitated the creation of a new anxiety reduction tool for the perioperative environment. The breath-controlled induction app simultaneously employs multiple evidence-based anxiety reduction techniques and is designed to seamlessly integrate into the fast-paced perioperative workflow during key stress points. Testing in the clinical setting is needed to determine the effectiveness of the app for preoperative anxiety reduction.

Radiologist-patient consultation of imaging findings after neck ultrasonography: An opportunity to practice value-based radiology

ObjectiveTo investigate how patients experience a radiologist-patient consultation of imaging findings directly after neck ultrasonography (US), and how much time this consumes. Materials and methodsThis prospective randomized study included 109 consecutive patients who underwent neck US, of whom 44 had a radiologist-patient consultation of US results directly after the examination, and 65 who had not. ResultsThe median ratings of all healthcare quality metrics (friendliness of the radiologist, explanation of the radiologist, skill of the radiologist, radiologist's concern for comfort during the examination, radiologist's concern for patient questions/worries, overall rating of the examination, and likelihood of recommending the examination) were either good/high or very good/very high, without any significant differences between both patient groups. Patients who did not discuss the US results with the radiologist, were significantly more worried during the examination (P = 0.040) and had significantly higher anxiety levels after completion of the US examination (P = 0.027) than patients who discussed the US results with the radiologist. Fifty-one out of 55 responding patients (92.7%) indicated a radiologist-patient consultation of US results to be important. The median duration of US examinations that included a radiologist-patient consultation of US results was 7.57 min (range: 5.15–12.10 min), while the median duration of US examinations without a radiologist-patient consultation of US results was 7.34 min (range: 3.45–14.32 min), without any significant difference (P = 0.637). ConclusionA radiologist-patient consultation of imaging findings after neck US decreases patient anxiety, is desired by most patients, and does not significantly prolong total examination time.

THE EFFECT OF PATIENT COOPING MECHANISM ON ANXIETY IN DEALING WITH MAJOR SURGERY IN THE SURGERY INPATIENT ROOM OF PUSKESMAS TIGA BALATA JORLANG HATARAN DISTRICT YEAR 2016

Patients with a history of hypertension when experiencing anxiety before surgery can result in insomnia of the patient and the blood pressure will increase so that the operation will be canceled. Surgery or surgery can cause anxiety. Anxiety is a normal adaptive response to stress due to surgery. Anxiety can be reduced what if the patient can see the surgery will heal. Signs of anxious surgery may not be the same for every individual. Every stress cause people to experience, for the automatic appears efforts to cope with a variety of coping mechanisms, to control coping and decrease anxiety in patients is the task of the team. Served in the room where the patients were treated. Having interactions to patients to anxiety in the face of major surgery that ascribed by Tiga Balata Health Center, Kec. Jorlang Hataran of 2016. The experience is descriptive analytic with the experience design cross sectional. Take in population in this study were an patients who ascribed. To undergo surgery used in this study is a questionnaire filled by respond. After the data was collected then for the percentage of data used by ghi-sguare a - 0.05 with the computer Which then obtained the effect of each independent variable. The result of data analysis and the result of ghi-sguare is P — 0.001 (P « 0.005), is Ha is accept and Ho is eject, is patient influence between the coping mechanisms of the anxiety in the face major operation. 05 with the computer Which then obtained the effect of each independent variable. The result of data analysis and the result of ghi-sguare is P — 0.001 (P « 0.005), is Ha is accept and Ho is eject, is patient influence between the coping mechanisms of the anxiety in the face major operation. 05 with the computer Which then obtained the effect of each independent variable. The result of data analysis and the result of ghi-sguare is P — 0.001 (P « 0.005), is Ha is accept and Ho is eject, is patient influence between the coping mechanisms of the anxiety in the face major operation.

28713 Dermoscopic changes observed in acute UV radiation

A 55-year-old male with a history of melanoma of unknown primary which was metastatic to the right parietal scalp as well as metastatic squamous cell carcinoma status post radiation therapy, presented for surveillance exam. His wife was concerned about a changing spot on his back which was also his only concern at this visit. On exam he was severely sunburned. He stated that he had been at the lake all day a few days previously and had not reapplied any sunscreen. Examination of his back revealed a dark brown, irregularly pigmented papule with a reticular network and symmetric focus of irregular dark brown-purple blotches on dermoscopy. A shave removal was performed. Pathology demonstrated a compound melanocytic nevus with background changes compatible with recent sunburn. It was found that the brown-purple blotches observed on dermoscopy correlated with keratinocyte dyskeratosis and necrosis observed on histopathology. The patient was informed of these results and will continue to follow with routine surveillance. This case is important because it highlights an underreported but previously demonstrated fact that melanocytic nevi can have acute changes secondary to ultraviolet radiation which may be concerning for melanoma. Greater awareness in this area could allow more clinicians to reasonably follow patients with similar changes in nevi in the setting of an acute sunburn thus preventing unnecessary biopsies and decreasing patient anxiety by waiting for these biopsy reports.