Interactive Distraction Research Articles

A Systematic Review of Tablet-Based Interactive Distraction as a Preoperative Anxiolytic in Pediatric Patients Undergoing Same-Day Procedures.

Evidence shows tablet-based interactive distraction (TBID) is effective as a preoperative anxiolytic in pediatric patients. TBID involves age-appropriate video games that have been preloaded onto a tablet (TAB) and subsequently given to a pediatric patient before the administration of anesthesia. The purpose of this study is to provide a comprehensive analysis of previous studies that have investigated the use of TBID to minimize preoperative anxiety. The literature criteria for this systematic review included randomized controlled trials and prospective studies that used TBID as a method to reduce preoperative anxiety in pediatric patients aged 1-12 years. Data extraction concentrated on the patient population to which the TABs were introduced, the method of TAB administration, how anxiety was evaluated, who completed the evaluations, and the results of each publication. This chosen data set is to systematically understand if TBID is effective and to identify the most practical ways to implement TBID. Collected data from the selected publications were entered into a table. For this systematic review, 27 publications from 2006 to 2023 were screened for eligibility. These studies were selected using a combination of MeSH terms and a Title-Abstract filter in PubMed, Embase, and Scopus. These data represented 475 total patients (T) and 249 patients who implemented TAB use. The other 226 patients were used as various control groups. The outcome of each study is summarized and placed into a table. This study is expected to provide an overall assessment of the effectiveness of TBID and proposed guidelines for clinicians to incorporate TAB use into preoperative protocols. The time to give the TAB to the children impacts its efficiency. This review accentuates the effectiveness of utilizing TBID to mitigate preoperative anxiety in pediatric patients based on a comprehensive analysis of multiple prior studies conducted in diverse healthcare settings, including pediatric hospitals and surgical centers. TAB use demonstrated an effective reduction in perioperative anxiety, emergence of delirium, and time to discharge, increasing parental satisfaction compared to midazolam. These results are likely replicable across a broader range of clinical settings, provided the intervention parameters, such as the timing of TAB introduction and the personalization of content to patient interests, are carefully adapted to each situation. The anxiety evaluations of patients using TBID varied based on the evaluator. Therefore, future research should analyze if perceived anxiety in patients using TABs is consistent or not among the evaluators.The impact of this TBID review has the potential to set a new benchmark for managing pediatric preoperative anxiety, with significant implications for healthcare quality and patient satisfaction.

Interactive and passive mixed reality distraction: effects on cold pressor pain in adults.

While interactive distractors are predicted to be more effective in reducing acute pain than passive distractors, the underlying mechanisms remain poorly understood. Previous work using Virtual-Reality (VR) has suggested that interactive distraction may be enhanced by increasing the person's sense of immersion. Despite the possible utility of immersive VR in reducing pain, some people report being disoriented and motion sick, and it doesn't allow for interactions with environment (e.g., following instructions from medical staff). Here, we explore the role of the immersion in the effectiveness of interactive distraction by employing an alternative technology, a Mixed-Reality (MR) headset that limits disorientation by projecting virtual objects into the real world. Healthy volunteers (18-35 years) participated in two experiments employing either a between (N = 84) or a within-subject (N = 42) design to compare Interactive and Passive distraction tasks presented via MR or a standard computer display. For both experiments, a cold-pressor task was used to elicit pain, with pain tolerance and pain perception being recorded. Analysis revealed that whilst interactive distraction was more effective in reducing pain perception and increasing pain tolerance than passive distraction, the interpretation of results was sensitive to experimental design. Comparison of devices did not reveal significant differences in pain tolerance or pain intensity, while pain unpleasantness was significantly reduced during the MR task using a within-subject design. Our findings add to existing VR studies reporting little additional analgesic benefit of new, immersive technologies compared to traditional computers, but underscores the important impact the choice of experimental design can have on the interpretation of results.

Effect of Distraction Interventions on Anxiety in Children Undergoing Surgery: A Meta-Analysis

AbstractDue to the unfamiliarity of the surroundings, children having surgery endure worry and tension. Untreated anxiety in children impairs postoperative healing and causes changes in postoperative behavior. The purpose of this review was to determine the efficacy of distraction therapies on anxiety in children undergoing surgery. The systematic review was reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses standards. PubMed via MEDLINE, CINAHL, ProQuest, Web of Science, and the Cochrane Central Register of Controlled Trials were used to find relevant trials. Full-text papers published in English from January 1, 2000 to December 31, 2021 were included. Children undergoing surgery aged 1 to 18 years were included. A data extraction form was created to extract data from the selected studies. According to the Cochrane risk of bias assessment tool, studies were classified as “low risk,” “high risk,” or “unclear risk.” Review Manager software was used to do a quantitative meta-analysis. Thirteen studies looked at the effect of distraction intervention on children. Nine of them were selected for meta-analysis. The distraction interventions included in this review were: handheld video game, play dough and play with blocks and puzzles, tablet-based interactive distraction, animated video, painting and storytelling, age-appropriate video, distraction with video glasses, watching a movie, and bringing favorite toy during hospital stay. Meta-analysis showed that distraction interventions are effective on preoperative anxiety in children (standardized mean difference = –17.07, 95% confidence interval: 27.11–7.02, p = 0.0009).

Is tablet-based interactive distraction effective on pain and anxiety during circumcision in children? A randomized controlled trial.

Distraction is a nonpharmacological method commonly used during painful procedures in children. However, there are a few studies investigating the effectiveness of active distraction on pain and anxiety in children during circumcision. The purpose of this study was to evaluate the effectiveness of tablet-based interactive distraction on pain and anxiety in children during circumcision. To evaluate how tablet distraction could improve children's outcomes during circumcision, a single-center, nonblinded, randomized controlled, parallel group trial research design was employed. In this study, 35 children were included in tablet distraction group, which have a control group (n ¼ 35). The primary outcome measure was the Numeric Rating Scale for pain. Secondary outcome measure was the State- Trait Anxiety Scale for Children, and other outcome variables were physiological parameters and satisfaction levels. During and after the surgical procedure, pain scores (P < .001, P < .001, respectively) and pulse rates (P < .001, P < .001, respectively) were significantly lower in the tablet distraction group, whereas O2 saturation was higher than the control group (P < .001, P < .001, respectively). After the procedure, the anxiety scores were significantly lower in the tablet distraction group (P < .001), whereas the satisfaction scores were higher than control group (P < .001). This study concluded that the use of tablet distraction during circumcision has a positive effect on children's pain, anxiety, satisfaction levels, and physiological parameters.

Virtual Reality as a Form of Interactive Distraction for Pediatric Patients Receiving Immediate Hypersensitivity Skin Tests: A Randomized Controlled Trial

Children receiving Immediate Hypersensitivity Skin Tests (IHST) often experience intense itchiness at the test site prior to completion of the procedure, which can lead to incompliance and increased stress. This study assessed low-cost virtual reality (VR) with the standard of care (e.g., Look and Find or I Spy books) as forms of interactive distraction on pediatric patient’s cooperation and perception of negative procedural outcomes (i.e., itchiness and distress) for patients receiving IHST. Two hundred and twenty patients five to 12 years of age who received an IHST were randomized to either the VR (experimental) or standard of care (control) group. Compliance, coping, and perceived itch outcomes were compared between groups in addition to being compared by age category and sex. None of the primary outcomes differed significantly for patients in the control versus experimental group, although patients in the experimental group were significantly more likely to fail to complete the assessment (p = 0.034). Despite VR being a novel technology, the results showed that the VR group had similar outcomes compared to the standard of care group regarding patients’ compliance, coping, and perceived itch.

P–750 Clinical efficacy of virtual reality for acute pain and anxiety management during outpatient hysteroscopy and endometrial biopsy in subfertile patients

Abstract Study question Does the use of virtual reality (VR) headsets in diagnostic office hysteroscopy (HSC) with endometrial biopsy (EB) reduce anxiety and pain scores in the patient? Summary answer Virtual reality during office HSC do not seem to improve relaxation, anxiety, or pain scores. Physicians have a good perception of patients’ pain. What is known already Women undergoing outpatient HSC experience high levels of preoperative anxiety, which increase pain and discomfort during the procedure. The experience of pain is a complex phenomenon, which simultaneously occurs on cognitive, emotional, and behavioural levels, and is influenced by many factors. A Cochrane review failed to show a significant difference between different types of pain relief (analgesics, local anaesthetic and verbal support techniques …). VR is a multisensory immersion providing an interactive high level distraction, occupying a large portion of humans’ finite attentional resources (vision and audio), and leaving less cognitive capacity available to process pain. Study design, size, duration The sample size for this prospective randomized controlled trial was calculated at 196 patients (98 per group), considering a power of at least 80% to detect superiority of adding a VR headset versus standard care, standard deviation (SD = 2.0), using a two-sided, t-test, at significance level alpha of 0.05. The preliminary results after 1 month include a sample of 48 patients: 25 in the VR group and 23 controls. Participants/materials, setting, methods All 48 patients suffer subfertility and underwent HSC with EB at our tertiary-care fertility center. We used Oncomfort®, a commercially available VR autohypnosis relaxation program designed for perioperative settings. The headmounted smartphone display with headphones provides image sound distraction with suggestive hypnosis techniques incorporated. Before and immediately after the exam, both patients and surgeons fill out a questionnaire using the 10.0cm visual analog scale (VAS). Main results and the role of chance The mean duration of HSC was 3min43sec in the VR group, (range 2–6min), compared to 4min50 in the control group (range 1–12minutes), which was not significantly different (p = 0.09). Subjective variables of stress, anxiety and pain were evaluated at four different time points, i.e. before, during, immediately after HSC and one week later. According to VAS, stress levels did not differ significantly (p &amp;gt; 0.05) between the VR group and the control group, or within time: 5.08 to 5.36 to 3.08 vs 4.48 to 4.83 to 2.48 before, during and after HSC respectively. Fear levels prior to HSC at 4.28 for VR patients and 3.52 for controls did not increase significantly during HSC in both groups: 4.44 vs 4.17. During HSC, pain levels increased from 1.40 to 4.720 in the VR group vs 0.65 to 4.109 (NS) in the controls, to decrease again afterwards to 2.60 vs 2.17 (NS) respectively. Physicians rated the average pain levels of VR patients as 3.32 compared to 3.0 for controls, which was significantly correlated to patients’ perception (p &amp;lt; 0,005). Patients gave a positive rating to the VR experience (satisfaction score 7.17). Limitations, reasons for caution These are preliminary results, evaluating only a fourth of the required sample. A population selection bias could exist, as recruited patients were willing to accept VR. The very short induction period of 2 minutes could influence the effect of (immersiveness into) VR. Wider implications of the findings: Pain management in ambulatory procedures should be multimodal and should include both pharmacological and non-pharmacological interventions. Introducing VR might increase patient tolerance for longer or more painful procedures. Offering a range of options will increase the spectrum of successful procedures in the outpatient setting and improve patient experience. Trial registration number B.U.N. 1432020000050

P-750 Clinical efficacy of virtual reality for acute pain and anxiety management during outpatient hysteroscopy and endometrial biopsy in subfertile patients

Abstract Study question Does the use of virtual reality (VR) headsets in diagnostic office hysteroscopy (HSC) with endometrial biopsy (EB) reduce anxiety and pain scores in the patient? Summary answer Virtual reality during office HSC do not seem to improve relaxation, anxiety, or pain scores. Physicians have a good perception of patients’ pain. What is known already Women undergoing outpatient HSC experience high levels of preoperative anxiety, which increase pain and discomfort during the procedure. The experience of pain is a complex phenomenon, which simultaneously occurs on cognitive, emotional, and behavioural levels, and is influenced by many factors. A Cochrane review failed to show a significant difference between different types of pain relief (analgesics, local anaesthetic and verbal support techniques …). VR is a multisensory immersion providing an interactive high level distraction, occupying a large portion of humans’ finite attentional resources (vision and audio), and leaving less cognitive capacity available to process pain. Study design, size, duration The sample size for this prospective randomized controlled trial was calculated at 196 patients (98 per group), considering a power of at least 80% to detect superiority of adding a VR headset versus standard care, standard deviation (SD = 2.0), using a two-sided, t-test, at significance level alpha of 0.05. The preliminary results after 1 month include a sample of 48 patients 25 in the VR group and 23 controls. Participants/materials, setting, methods All 48 patients suffer subfertility and underwent HSC with EB at our tertiary-care fertility center. We used Oncomfort®, a commercially available VR autohypnosis relaxation program designed for perioperative settings. The headmounted smartphone display with headphones provides image sound distraction with suggestive hypnosis techniques incorporated. Before and immediately after the exam, both patients and surgeons fill out a questionnaire using the 10.0cm visual analog scale (VAS). Main results and the role of chance The mean duration of HSC was 3min43sec in the VR group, (range 2-6min), compared to 4min50 in the control group (range 1-12minutes), which was not significantly different (p = 0.09). Subjective variables of stress, anxiety and pain were evaluated at four different time points, i.e. before, during, immediately after HSC and one week later. According to VAS, stress levels did not differ significantly (p &amp;gt; 0.05) between the VR group and the control group, or within time 5.08 to 5.36 to 3.08 vs 4.48 to 4.83 to 2.48 before, during and after HSC respectively. Fear levels prior to HSC at 4.28 for VR patients and 3.52 for controls did not increase significantly during HSC in both groups: 4.44 vs 4.17. During HSC, pain levels increased from 1.40 to 4.720 in the VR group vs 0.65 to 4.109 (NS) in the controls, to decrease again afterwards to 2.60 vs 2.17 (NS) respectively. Physicians rated the average pain levels of VR patients as 3.32 compared to 3.0 for controls, which was significantly correlated to patients’ perception (p &amp;lt; 0,005). Patients gave a positive rating to the VR experience (satisfaction score 7.17). Limitations, reasons for caution These are preliminary results, evaluating only a fourth of the required sample. A population selection bias could exist, as recruited patients were willing to accept VR. The very short induction period of 2 minutes could influence the effect of (immersiveness into) VR. Wider implications of the findings Pain management in ambulatory procedures should be multimodal and should include both pharmacological and non-pharmacological interventions. Introducing VR might increase patient tolerance for longer or more painful procedures. Offering a range of options will increase the spectrum of successful procedures in the outpatient setting and improve patient experience. Trial registration number B.U.N. 1432020000050

The use of interactive distraction technique to manage gagging during impression taking in children: a single-blind, randomised controlled trial.

To evaluate the effect of interactive distraction technique on the severity of gagging and success of impression taking in children between age 5 and 10years. This single blind, randomised controlled trial recruited 48 children aged 5-10years requiring maxillary impressions. Selected children were randomly allocated to one of the two groups: (1) Test group, use of interactive distraction, and (2) Control group, no use of interactive distraction, during impression taking. Dental anxiety was scored using Facial Image Scale (FIS) before and after impression taking. Gagging-related Impression Success Scale (GISS) and Gagging Severity Index (GSI) were recorded by a blinded assessor. Nonparametric tests were used to compare the variables between the groups. Maxillary impressions were successfully recorded in all children in the Test group; either with no gag (87.5%) or with gag (12.5%). In 33.3% control children impressions could not be recorded. Statistically significant, strong association was found between the interactive distraction and GISS (p = 0.003, Cramer's V = 0.32). Mean GSI and post-impression FIS scores were significantly lesser in the Test group (p = 0.029 and p = 0.048, respectively). Significant increase in the mean FIS scores was observed after recording impression in the Control group. Post-impression FIS showed significant positive correlation with GSI (Test: p = 0.003, Control: p = 0.009) and significant inverse correlation with GISS (Test: p = 0.003, Control: p = 0.01). Interactive distraction technique used in this study is a simple, non-invasive and cost-effective method to effectively manage gagging and successfully record a maxillary impression in children between age 5 and 10years.

Influence of parent-provided distraction and interactive distraction with a handheld video game on the child's responses during local anesthesia administration.

To evaluate the influence of parent-provided distraction (PPD) and interactive distraction (ID) with a handheld video game (HVG) on the child's responses to local anesthesia (LA) administration during dental treatment. Children attending the department of pediatric dentistry were randomly selected and distributed to the two groups (PPD and an ID with HVG). Parents in the operatory and the principles of tell-show-do remained common in both the groups. Behavioral, physiological, and self-report measures of pain were estimated using the Face, Legs, Activity, Cry, and Consolability (FLACC) scale, pulse rate, as well as Iowa pain thermometer-revised (IPT-R) scale and compared for both groups correspondingly. The SPSS (standard statistical package) version 17.0 (SPSS Inc., Chicago, USA) was used for statistical analysis at the significance of P < 0.05. A total of 30 children (15 in each group) aged 7-11 years participated in the study. There were no significant differences observed among boys and girls (P > 0.05). The independent t-test for the pulse rate showed no significant difference between the two groups (P > 0.05). Paired t-test for pulse rate in the PPD group showed a significant difference compared to ID with the HVG group (P < 0.05). The scores for FLACC and ID with HVG, showed a statistically significant decrease in scores recorded for ID with HVG, whereas the scores recorded for FLACC did not show any statistically significant difference. Based on the study results, PPD would be the least distressful option, compared to the ID with HVG in children while administering LA.

Single-Blinded Randomized Controlled Study on Use of Interactive Distraction Versus Oral Midazolam to Reduce Pediatric Preoperative Anxiety, Emergence Delirium, and Postanesthesia Length of Stay

The purpose of this study was to compare effects of tablet-based interactive distraction (TBID; 1minute preseparation) with oral midazolam (15 to 45minutes of preseparation) on preoperative anxiety, emergence delirium, and postanesthesia length of stay in children, 4 to 12years undergoing outpatient surgery. Single-blinded prospective design with randomized assignment to TBID or oral midazolam group was conducted at a large pediatric hospital in southwestern United States. A total of 102 children and caregivers were enrolled. Outcome measures included anxiety scores at baseline, separation, and mask induction; postemergence delirium scores; caregiver ratings of child anxiety and satisfaction; and time from postanesthesia care unit arrival to discharge and posthospital behaviors. The TBID group demonstrated significantly lower anxiety at separation and mask induction (P < .001) and emergence delirium at 15minutes postawakening (P = .001), were extubated earlier (P = .007), arrived to phase II earlier (P = .03), and discharged earlier (P = .0001). TBID was more effective than oral midazolam in reducing preoperative anxiety, emergence delirium, and postanesthesia length of stay.

Interactive Distraction: The Effect of Macroeconomic News on Market Reaction to Earnings News

We show evidence that consistent with category-learning behavior, investors allocate more attention to macroeconomic news than to firm-specific news, such as earnings announcements. Despite the distracting effect of macroeconomic news on investor attention, we find that earnings announcements with concurrent macroeconomic news announcements actually have significantly stronger immediate market response and weaker post-earnings announcement drift. We hypothesize that the combined total attention to macroeconomic news and earnings announcements helps investors understand both the systematic and firm-specific components of earnings surprises. Consistent with the hypothesis, our results show that the macroeconomic news effect is mainly driven by firms with high exposure to macroeconomic news. Moreover, we show that the effect is stronger when macroeconomic news contains more information and for firms with greater information uncertainty. Finally, we provide evidence that macroeconomic news helps reduce stock return uncertainty and enhance stock price efficiency.

Children and parental anxiolysis in paediatric ambulatory surgery: a randomized controlled study comparing 0.3 mg kg−1 midazolam to tablet computer based interactive distraction

BackgroundThe operating theatre, anaesthesia induction and separation from parents create fear and anxiety in children. Anxiety leads to adverse behavioral changes appearing and sometimes persisting during the postoperative period. Our aim was to compare the effects of midazolam (0.3 mg kg−1: MDZ) for premedication with age-appropriate tablet game apps (TAB) on children anxiety during and after ambulatory surgery. MethodsA randomized controlled trial was conducted from May 16th, 2013 to March 25th, 2014 at the Children Hospital of Lyon. The primary outcome of this study was the change in m-YPAS score at the time of anaesthetic mask induction. Anxiety was also assessed in the waiting surgical area, at the time of separation with parents and when back in the ambulatory surgery ward. ResultsOne hundred and eighteen patients aged four-11 yr were recruited, 60 in the TAB Group and 58 in the MDZ Group. Main endpoint was missing for three patients from the MDZ Group. At the time of mask induction, there was no significant difference between MDZ and TAB Group for the m-YPAS score (40.5 (18.6) vs 41.8 (20.7), P = 0.99). There was no significant correlation between m-YPAS score and its evolution over the four period of time between subjects. ConclusionsWe were not able to show whether TAB is superior to MDZ to blunt anxiety in children undergoing ambulatory surgery. TAB is a non-pharmacological tool which has the capacity in reducing perioperative stress without any sedative effect in this population. Clinical trial registrationNCT 02192710

Abstract PR230

Background & Objectives: Induction of anaesthesia in children can be distressing for both the child and parent. Preoperative anxiety is associated with postoperative behavioural changes1. Parental presence does not diminish child anxiety, but promising non-pharmacological interventions include videos and computer games2. We developed a tablet-based app, RELAX Anaesthetics(RAA) for use as a distraction tool. Our aim was to compare anxiety in children during induction using either RAA or traditional toys and books. Materials & Methods: Ethics approval was obtained. 70 unpremedicated children (2-16years) were consented and randomised to either RAA or traditional distraction for induction. Anxiety was scored preop, at entry to anaesthetic room and during induction using the modified Yale Pre-operative Anxiety Scale (mYPAS)1. A low mYPAS score was defined as <34 out of 100. Results: There was no difference in age, hospital & surgical exposure, surgery and tablet usage, and more males in the RAA group. Induction was inhalational in 21% (mean(SD) age 4.9(2.7)) and intravenous in 79% (mean(SD) age 7.5(3.8)). There were fewer children with low mYPAS scores during induction in the control group (30%) than in the RAA group (65%). The number of children with low mYPAS scores at each stage and 95% confidence intervals are shown in the table.Conclusion: Tablet computers allow access to a range of child-friendly developmentally appropriate content, leading to engagement and distraction3. They can also modify the behaviour of healthcare providers to promote children’s coping. Our study showed lower anxiety scores during induction whilst using RAA compared with traditional methods, despite similar baseline scores. Interactive distraction may improve cooperation with intravenous access or mask induction. Reduced anxiety improves behavioural compliance, and may improve efficiency, as well as quality of patient-centred care.

Evaluating Robotic Surgical Skills Performance Under Distractive Environment Using Objective and Subjective Measures.

Distractions are recognized as a significant factor affecting performance in safety critical domains. Although operating rooms are generally full of distractions, the effect of distractions on robot-assisted surgical (RAS) performance is unclear. Our aim was to investigate the effect of distractions on RAS performance using both objective and subjective measures. Fifteen participants performed a knot-tying task using the da Vinci Surgical System and were exposed to 3 distractions: (1) passive distraction entailed listening to noise with a constant heart rate, (2) active distraction included listening to noise and acknowledging a change of random heart rate from 60 to 120 bpm, and (3) interactive distraction consisted of answering math questions. The objective kinematics of the surgical instrument tips were used to evaluate performance. Electromyography (EMG) of the forearm and hand muscles of the participants were collected. The median EMG frequency (EMG(fmed)) and the EMG envelope (EMG(env)) were analyzed. NASA Task Load Index and Fundamentals of Laparoscopic Surgery score were used to evaluate the subjective performance. One-way repeated analysis of variance was applied to examine the effects of distraction on skills performance. Spearman's correlations were conducted to compare objective and subjective measures. Significant distraction effect was found for all objective kinematics measures (P < .05). There were significant distraction effects for EMG measures (EMG(env), P < .004; EMG(fmed), P = .031). Significant distraction effects were also found for subjective measurements. Distraction impairs surgical skills performance and increases muscle work. Understanding how the surgeons cope with distractions is important in developing surgical education.

Effect of interactive distraction versus cutaneous stimulation for venipuncture pain relief in school age children

Introduction: Venipuncture in pediatrics is one of the most distressing events and the most routinely performed invasive procedures that the child may expose during his/her hospitalization or illness. Non-pharmacological techniques are used to reduce venipuncture related pain. Distraction is a non-pharmacological technique that draws attention of the child away from the pain. Cutaneous stimulation is an independent nursing intervention that advocated relieving pain. This study aims to examine the effectiveness of the interactive distraction versus cutaneous stimulation for venipuncture pain relief in school age children. Method: Design: Quasi experimental study was used. Setting: the study was conducted at Children Hospital that is affiliated to Ain Shams University Hospitals. Data was collected from Emergency and Pediatric Medical Ward. Sampling: purposive samples of 100 children were involved in this study they were divided into 2 equal groups, 50 children in each group. Tools of data collection, Tool 1: questionnaire sheet, Tool 2: Pain assessment tool, Tool 3: monitoring vital signs and oxygen saturation were done 15 minutes before vein-puncture and 15 minutes after vein-puncture. Results: The results revealed statistical significance difference between cutaneous stimulation and interactive distraction group. Conclusion: The present study concludes that; interactive distraction technique had a positive pain relive effect and was better than cutaneous stimulation in relieving children’s pain during vein-puncture. There is significant difference between the effect of cutaneous stimulation and distraction techniques on children’s pain during vein-puncture. Recommendations: Application of non-pharmacological pain management in hospitals as a routine care, and further studies needed to evaluate the effectiveness of other non-pharmacological management techniques.

Tablet‐based Interactive Distraction (TBID) vs oral midazolam to minimize perioperative anxiety in pediatric patients: a noninferiority randomized trial

Perioperative anxiety is a common and undesirable outcome in pediatric surgical patients. The use of interactive tools to minimize perioperative anxiety is vastly understudied. The main objective of the current investigation was to compare the effects of a tablet-based interactive distraction (TBID) tool to oral midazolam on perioperative anxiety. We hypothesized that the TBID tool was not inferior to midazolam to reduce perioperative anxiety. 108 children, ages 1-11 years, presenting for outpatient surgical procedures were prospectively randomized to oral midazolam (0.5 mg·kg(-1); 20 mg max) or TBID. The primary outcome was the change in anxiety level from baseline to parental separation and anesthetic induction. Other data collected included emergence delirium, parental satisfaction, time-to-PACU discharge, and posthospitalization behavior. The mean difference (95% CI) in the increase of anxiety at parental separation between the TBID and the midazolam group was -9 (-2.6 to -16.4), P = 0.006, demonstrating superiority to midazolam group (one-sided P = 0.003). For children 2-11 years, the mean difference (95% CI) in anxiety at induction was significant between the TBID and midazolam groups, -14.0 (-6.1 to -22.0), P < 0.001. The median (IQR) time-to-PACU discharge was 111 (75-197) min in the midazolam group and 87 (55-137) min in the TBID group, P = 0.03. Decreased emergence delirium and increased parental satisfaction were also observed in the TBID group. A TBID tool reduces perioperative anxiety, emergence delirium, and time-to-discharge and increases parental satisfaction when compared to midazolam in pediatric patients undergoing ambulatory surgery.

Interactive Versus Passive Distraction for Acute Pain Management in Young Children: The Role of Selective Attention and Development

To examine whether age and developmental differences in selective attention influence young children's differential responses to interactive and passive distraction. 65 3- to 6-year-old children underwent three cold-pressor trials while receiving no intervention, playing a video game (interactive distraction), or watching a video game (passive distraction). In addition, children completed a test of selective attention, and parents completed ratings of attention. Consistent with neurocognitive models of pain, children benefited more from interactive distraction than from passive distraction. Although older children demonstrated superior pain tolerance overall, age and selective attention skills did not moderate children's responses to the distraction intervention. These findings suggest that younger preschoolers can benefit from interactive distraction to manage acute pain, provided that the distraction activity is developmentally appropriate. Research is needed to determine whether developmental issues are more important moderators of children's responses to distraction when faced with more challenging task demands.

857 EFFECT OF DISTRACTION ON ROBOTIC SURGICAL SKILLS PERFORMANCE IN DIFFERENT LEVELS OF SURGICAL EXPERIENCE

You have accessJournal of UrologyTechnology & Instruments: Surgical Education & Skills Assessment/Ureteroscopy I1 Apr 2012857 EFFECT OF DISTRACTION ON ROBOTIC SURGICAL SKILLS PERFORMANCE IN DIFFERENT LEVELS OF SURGICAL EXPERIENCE Irene Suh, Kevin Clay, Chad LaGrange, Dmitry Oleynikov, and Ka-Chun Siu Irene SuhIrene Suh Omaha, NE More articles by this author , Kevin ClayKevin Clay Omaha, NE More articles by this author , Chad LaGrangeChad LaGrange Omaha, NE More articles by this author , Dmitry OleynikovDmitry Oleynikov Omaha, NE More articles by this author , and Ka-Chun SiuKa-Chun Siu Omaha, NE More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.950AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Operating rooms are full of distractions, which can cause impaired surgical performance and impact patient safety. Little is known whether the effects of distraction on robotic surgical performance are varied based on the level of surgical experience. Objective: Investigate the effects of distraction on robotic surgical skills performance and compare such effect among different levels of surgical experience. METHODS Ten medical students (novice), one fellow in general surgery (robot-naive) and two urological residents (robot-experienced) performed a knot-tying task using the DaVinciTM Surgical System. Subjects were exposed to three distractions: passive, active and interactive. Passive distraction entailed listening to noise (50-90dB) with an audible constant heart rate. Active distraction included listening to noise, however the heart rate changed randomly from 60 to 120 bpm and subjects had to acknowledge the change. Interactive distraction consisted of answering continuous math questions (adding or subtracting between two double digit numbers). The time to task completion (TTC) and the average speed (SPD) of the surgical instrument tips were used to evaluate the performance of knot-tying. The performance was also scored using the objective fundamentals of laparoscopic surgery guidelines. Two-way repeated-measures ANOVA were applied to examine the effects of distraction and the level of surgical experience on skills performance. RESULTS A significant distraction effect was found for both the TTC (p = 0.009) and the SPD (p < 0.010). The follow-up comparisons indicated that interactive distraction increased TTC and showed larger negative impact than active (p = 0.024) and passive (p = 0.022) distractions. A significant level of experience effect was found for the SPD (p < 0.001). Robot-experienced residents significantly moved faster than robot-naïve (p = 0.027), and novice (p < 0.001) in the first three trials. Suturing score in novice was significantly lower (p = 0.021) than both other groups. There were no significant differences between the robot-experienced subjects and robot-naïve in the knot-tying score. CONCLUSIONS Distractions can draw a subject's attention away from the knot-tying task and lead to a poor performance score. It is suggested that robotic surgical skills training in urology should be given in a distractive environment that simulates a typical operating room, which allows new urologists to learn how to filter the distractions while practicing robotic surgical skills. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e350 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Irene Suh Omaha, NE More articles by this author Kevin Clay Omaha, NE More articles by this author Chad LaGrange Omaha, NE More articles by this author Dmitry Oleynikov Omaha, NE More articles by this author Ka-Chun Siu Omaha, NE More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

The Effects of Interactive and Passive Distraction on Cold Pressor Pain in Preschool-aged Children

Using a mixed model design, this study examined the effects of interactive versus passive distraction on healthy preschool-aged children's cold pressor pain tolerance. Sixty-one children aged 3-5 years were randomly assigned to one of the following: interactive distraction, passive distraction, or no distraction control. Participants underwent a baseline cold pressor trial followed by interactive distraction trial, passive distraction trial, or second baseline trial. One or two additional trials followed. Children originally assigned to distraction received the alternate distraction intervention. Controls participated in both interactive and passive distraction trials in counterbalanced order. Participants showed significantly higher pain tolerance during both interactive and passive distraction relative to baseline. The two distraction conditions did not differ. Interactive and passive video game distraction appear to be effective for preschool-aged children during laboratory pain exposure. Future studies should examine whether more extensive training would enhance effects of interactive video game distraction.

Videogame Distraction using Virtual Reality Technology for Children Experiencing Cold Pressor Pain: The Role of Cognitive Processing

This study examined whether increasing the demand for central cognitive processing involved in a distraction task, by involving the child in ongoing, effortful interaction with the distraction stimulus, would increase children's tolerance for cold pressor pain. Seventy-nine children ages 6-15 years underwent a baseline cold pressor trial followed by two cold pressor trials in which they received interactive distraction (i.e., used voice commands to play a videogame) or passive distraction (in which they merely watched the output from the same videogame segment) in counterbalanced order. Both distraction conditions were presented via a virtual reality-type helmet. As expected, children demonstrated significant improvement in pain tolerance during distraction relative to baseline. Children showed the greatest improvement during the interactive distraction task. The effects of distraction on children's cold pressor pain tolerance are significantly enhanced when the distraction task also includes greater demands for central cognitive processing.