Anxiety Management Research Articles

O.P.23 - Communication as pillar for anxiety management in the nursing during the COVID-19: a scoping review: Presenter(s): Caroline Pereira, University of São Paulo, Brazil

O.P.23 - Communication as pillar for anxiety management in the nursing during the COVID-19: a scoping review: Presenter(s): Caroline Pereira, University of São Paulo, Brazil

Association of selective serotonin reuptake inhibitor use with marginal bone level changes around osseointegrated dental implants: A retrospective study.

Selective serotonin reuptake inhibitors (SSRIs) are used for the management of anxiety and depression. Existing evidence shows their negative impact on implant osseointegration, survival rates, and peri-implant health. Currently, there are limited data on their effect on peri-implant marginal bone levels. The primary goal of this retrospective study is to evaluate the association between SSRIs use and marginal bone level (MBL) changes around osseointegrated dental implants over time. Records from patients who received at least one dental implant between 2010 and 2021 were reviewed. Information related to medical history, SSRI use, and the implant site was obtained from patients' electronic charts. Mesial and distal MBLs were measured relative to the implant platform on digital intraoral radiographs, taken at the time of prosthesis installation and at the most recent follow-up visit. MBL changes were calculated. A total of 152 dental implants from 105 patients were included. The mean follow-up period was 46.97±21.87 months. The mean MBL change was significantly greater for SSRI users (0.41±0.76mm) compared to non-users (0.04±0.65mm) [MD=0.37mm, p=0.00, 95% CI: (-0.61)-(-0.15mm)]. Mesial MBL change of 0.42±0.84mm and 0.02±0.71mm was noted for SSRI users and non-users, respectively. The distal MBL change was 0.4±0.93mm and 0.07±0.73mm, respectively. Smoking, sex, and implant location did not seem to influence the MBL differences between groups. Use of SSRIs is associated with greater marginal bone loss around osseointegrated dental implants in function for a mean period of 3.8 years.

Virtual Reality as a Hypnotic Tool in the Management of Anxiety During the Performance of the Axillary Block.

Regional anaesthesia is a gold standard in upper limb orthopaedic surgery. Carried out on an awake patient, it can be a source of anxiety. In recent years, hypnotic techniques have been proposed in the management of perioperative anxiety. Among them, virtual reality is increasingly used as a distraction tool during anxious or painful actions despite the scarcity of proof of its benefit in the literature. Before implementing the systematic use of virtual reality when performing regional anaesthesia in our institution, we designed a study hypothesizing that the use of a virtual reality headset when performing an axillary block would reduce patient's anxiety.The study is an investigator-initiated, prospective monocentric and observational trial comparing anxiety scores of patients who underwent upper limb surgery under an axillary block with or without virtual reality headset. The perioperative anxiety was assessed by a numerical range scale before and after the peripheral nerve block performance.Between June 2021 and June 2022, 99 patients were included: 53 wearing the virtual reality headset and 46 not. The difference in numerical range scale for anxiety before and after the axillary block performance did not differ in the virtual reality group compared to the group without headset (mean = -1.9 ± 2.5 vs -1.5 ± 2.0, (p = 0.2520)). Technical difficulties reported by the operators were similar in both groups.Despite the large number of patients included, the virtual reality headset did not reduce patient's anxiety during a peripheral nerve block. Perioperative anxiety was low in all patients.

Home Milrinone in Pediatric Hospice Care of Children with Heart Failure.

The symptom profile of children dying from cardiac disease, especially heart failure, differs from those with cancer and other non-cardiac conditions. Treatment with vasoactive infusions at home may be a superior therapy for symptom control for these patients, rather than traditional pain and anxiety management with morphine and benzodiazepines. We report our experience using outpatient milrinone in children receiving hospice care for end-stage heart failure. Retrospective review of a contemporary cohort of all patients at Lucile Packard Children's Hospital, Stanford who were discharged on intravenous milrinone and hospice care between 2008 and 2021. Clinical data, including cardiac diagnosis, milrinone dose and route of administration, total milrinone days, symptoms reported, rehospitalization rates, concurrent therapies and complications were analyzed. Among 8 patients, median duration of home milrinone infusion was 191 (33, 572) days with the longest support duration 1,054 days. All (100%) patients were also receiving diuretics at the time of death. Five (63%) were receiving no other pain control medications until the active phase of dying. From milrinone initiation to last outpatient assessment, a reduction in the number of patients reporting respiratory discomfort, abdominal pain, weight loss/lack of appetite, and fatigue was observed. Six (75%) died at home. We used milrinone with oral diuretics effectively for symptom control in children with heart failure on palliative care. Our experience was that this combination can be used safely in the outpatient setting for long-term use without the addition of opiates, benzodiazepines, or supplemental oxygen in most cases.

A systematic review to assess the use of psilocybin in the treatment of headaches

IntroductionPsilocybin is a naturally occurring psychedelic compound whose effects have been seen in studies for treatment of depression, anxiety and pain management. Given its structural similarities to 5-hydroxytryptamine, a monoamine controlling brain modulation of pain input, preliminary studies sought to test serotonergic interactions of psilocybin with headaches.ObjectivesExplore efficacy of psilocybin as treatment for individuals with headaches, including migraines, essential headaches, cluster headaches and unclassified head pains.MethodsStudies were found from six major databases, with inclusion criteria consisting of participants with any type of headache using psilocybin as a treatment. Each study was independently screened by two reviewers at two stages, with inconsistencies reviewed by a third, senior reviewer.ResultsThe systematic review evaluated eight articles. Benefits of macrodosing were explored in one study which reported higher levels of pain relief in comparison to microdosing and conventional pain medications. Top benefits of microdosing as reported by participants included convenience, perceived safety and reduced side effects when compared to hallucinogenic doses of psilocybin. Participants across five studies reported improvements to their headaches as characterized by changes in frequency, intensity, duration and remission period. Reported improvements were clinically significant in the six studies and statistically significant in three papers. With psilocybin intervention, two studies reported a decrease in headache attack frequency, three studies reported a decrease in intensity, and one study indicated a decrease in duration. The greatest benefit reported was for psilocybin taken during a remission period, with the average length of that remission period between headaches extending for 91% of participants. One study focused on the dosages of psilocybin in relation to its efficacy, indicating that there was more headache pain relief amongst macrodosers, with a difference of 12.3% of participants experiencing pain reduction 3 days after dosage in comparison to microdosers. 18% of participants who experienced essential headaches also experienced hallucinations as a result of ingested psilocybin. Others showed a temporary increase in symptoms of anxiety and pain - 5.3% with microdosing and 14.1% macrodosing. One study observed an increase in average arterial pressure after ingestion.ConclusionsSix of eight screened papers showed that psilocybin was clinically significant in the treatment of headaches as captured through self-reports. While the first controlled study for psilocybin use for headaches was detailed in this study, psilocybin remains illegal in many countries, presenting a need for further regulated research.Disclosure of InterestNone Declared

Pemberdayaan Skill dan Pengetahuan Kader Kesehatan Mengenai Penanganan Kegawatdaruratan Obstetri sebagai Upaya Menurunkan Nilai Angka Kematian Ibu (AKI) di Desa Cipadang Kecamatan Gedong Tataan Kabupaten Pesawaran

Abstract: Purpose: The objectives of the implementation of this service activity are: maximizing the role and function of pregnant women cadres in Cipadang Village, Pesawaran Regency, strengthening the implementation of supervision of pregnant women cadres at the Pesawaran Regency level, and improving the quality of service and care in managing the anxiety of pregnant women during the COVID-19 pandemic in Pesawaran District. Method: The method used in the implementation of this activity is to provide counseling to the people of Cipadang Village which is carried out in two stages, namely the preparation stage and the implementation stage. The preparatory stage includes determining the target area, surveying the target area, partnering with partners, licensing the place, making the design of extension materials, and preparing the needs of cadres. While in the second stage, namely conducting a pre-test which aims to determine how far the knowledge of the participants about the topic to be given and a post-test to determine the increase in public understanding of the extension activities carried out. Results: Shows that the p-value is 0.000. This shows that there is a difference in the knowledge of the counseling participants before being given education and after being given education. Limitations: The article is only done in Cipadang Village, so socialization is needed in other villages in Pesawaran Regency. Contribution: This service activity is expected to provide scientific knowledge and skills to maternal cadres regarding the management of anxiety for pregnant women during the COVID-19 pandemic at the Pesawaran Regency community level. Keywords: 1. COVID-19 2. Pregnant mother 3. Village Cadre 4. Worry

Hubungan Tingkat Kecemasan Ibu Hamil pada Masa Pandemi Covid-19 Kepatuhan Melakukan Antenatal Care di Rumah Sakit Abdul Moeloek Bandar Lampung

Abstract: Purpose: The COVID-19 pandemic has had a negative impact on physical and mental health. During this pandemic, there has been an increase in stress and anxiety in individuals who experience it. Individuals who are susceptible to stress and anxiety, one of which is pregnant women. Maternal compliance in undergoing antenatal care is one of the efforts made to determine the health of the mother and fetus during pregnancy. This pandemic is one of the reasons that make pregnant women delay starting ANC services. Based on the background of the problem, this study was conducted to find out whether there is a relationship between the level of anxiety of pregnant women during the COVID-19 pandemic with compliance with ANC at the Cipadang Village Health Center, Pesawaran Regency. Method: This study uses an observational analytic method with a cross sectional approach. Respondents were taken using total sampling technique. The data used in this study is primary data. The independent variable in this study was the level of anxiety which was assessed using the Hamilton Anxiety Rating Scale. The dependent variable of this study is the number of ANC visits obtained through the MCH book. Results: A total of 54 pregnant women with an age range of 19-42 years, a minimum score of 0 and a maximum score of 36, the number of ANC visits at least 1 time and a maximum of 16 ANC visits. The results showed that there were 6 pregnant women (11.1%) working with a junior high school education level of 22 people (40.7%). A total of 40 (74.1%) pregnant women were multigravida. The number of ANC visits was found to be the same in each group with complete and incomplete ANC visits, with an anxiety level of 36 people (66.7%). p-value is 0.013 so that there is a significant relationship between anxiety levels and ANC compliance. Limitations: The number of subjects involved in the study was still small and subjects were not involved in each trimester. Contribution: The results of this study are expected to provide information about the importance of ANC and maintain mental health for pregnant women and be input for health agencies to pay more attention to anxiety management education related to concerns of pregnant women in conducting ANC visits during the COVID-19 pandemic. Keywords: 1. Antenatal Care 2. COVID-19 3. Pregnancy 4. Anxiety Levels

Mechanisms of change in posttraumatic headache-related disability: A mediation model.

To explore whether the association between change in headache management self-efficacy and posttraumatic headache-related disability is partially mediated by achange in anxiety symptom severity. Many cognitive-behavioral therapy treatments for headache emphasize stress management, which includes anxiety management strategies;however, little is currently known about mechanisms of change in posttraumatic headache-related disability. Increasing our understanding of mechanisms could lead to improvements in treatments for these debilitating headaches. This study is a secondary analysis of veterans (N=193) recruited to participate in a randomized clinical trial of cognitive-behavioral therapy, cognitive processing therapy, or treatment as usual for persistent posttraumatic headache. The direct relationship between headache management self-efficacy and headache-related disability, along with partial mediation through change in anxiety symptoms was tested. The mediated latent change direct, mediated, and total pathways were statistically significant. The path analysis supported a significant direct pathway between headache management self-efficacy and headache-related disability (b=-0.45, p < 0.001; 95% confidence interval [CI: -0.58, -0.33]). The total effect of change of headache management self-efficacy scores on change in Headache Impact Test-6 scores was significant with a moderate-to-strong effect (b=-0.57, p=0.001; 95% CI [-0.73, -0.41]). There was also an indirect effect through anxiety symptom severity change (b=-0.12, p=0.003; 95% CI [-0.20, -0.04]). In this study, most of the improvements in headache-related disability were related to increased headache management self-efficacy with mediation occurring through change in anxiety. This indicates that headache management self-efficacy is a likely mechanism of change of posttraumatic headache-related disability with decreases in anxiety explaining part of the improvement in headache-related disability.

Alcohol use in adult patients with autism spectrum disorder (ASD). Case report

IntroductionPatients with autism spectrum disorder are characterized by high anxiety when facing social situations and dealing with interpersonal relationships on a daily basis. Although initially because of their rigid personality with the norm, and their tendency to social distancing, we do not have in mind this pathology as the most likely to develop a substance use disorder. However, it is observed in the literature a remarkable percentage of patients who resort to consumption, mainly alcohol, as an anxiolytic to be able to interact in society.ObjectivesTo show the case of a 19-year-old adult with a diagnosis of ASD who resorts to alcohol consumption in her daily life as a strategy to manage anxiety in social situations.MethodsCase report and literatura reviewResultsThis is a 19-year-old woman with a recent diagnosis of ASD. She is studying biotechnology and lives with her parents and 3 siblings. The patient reports difficulty in social relationships since early childhood, with experiences of school bullying. She expresses desire to relate with others, although she does it in an inadequate way, with difficulty in detecting nonverbal language, irony and anger when she does not understand a joke. The patient confesses that since she was 16 years old she has consumed alcohol to mitigate the anxiety caused by facing a group of people. She says that she feels that it relaxes her and facilitates interaction, making it more fluid and less tense. However, she recognizes that initially she used to drink 1 or 2 beers, but now she needs to drink up to 2 glasses of gin, recognizing this as something problematic.ConclusionsThe literature shows how patients with ASD can also present substance use disorder. It has been shown that about 10% of these patients have an abusive use of alcohol. Other samples show wider ranges (7-71%) of prevalence of alcohol consumption in patients with autism. In relation to cannabis, it is seen that around 3% of these patients consume it. These patients seek its anxiolytic effect and to reduce mental health symptoms. In addition, the purchase of alcohol does not involve high social interaction to obtain it, since it is a substance that can be purchased legally. It is important to explore alcohol consumption in consultation with patients with ASD to help them develop more functional anxiety management strategies.ReferencePrevalence of psychiatric disorders in adults with autism spectrum disorder: A systematic review and meta-analysis. Lugo-Marín.J et al. 2019. Research in Autism Spectrum Disorders Volume 59, March 2019, Pages 22-33Disclosure of InterestNone Declared

Asthma and anxiety development in Australian children and adolescents

Evidence has suggested a bidirectional association between both the effects and onset of asthma and anxiety. The direction of this association in children and adolescents is less clear. The study evaluates whether anxiety in children is associated with the development of later asthma or, by contrast, whether asthma in children precedes anxiety. Parental reports from 9369 children at two age points (4-5 and 14-15 years old) and from baby (B) (recruited at birth in 2004) and kindergarten (K) (recruited at 4-5 years of age in 2004) cohorts of the Longitudinal Study of Australian Children (LSAC) were analyzed. Asthma cases were defined as reports of doctor-diagnosed asthma and the use of asthma medication or/and wheezing. Scores of the Strengths and Difficulties Questionnaire (SDQ) defined anxiety. We found a unidirectional association between asthma in children aged 4-5 years and future anxiety development in weighted generalized linear adjusted models (B cohort OR (CI 95%)=1.54 (1.14-2.08); K cohort OR (CI 95%)=1.87 (1.40-2.49)). Children with asthma (no anxiety at 4 years) had a higher prevalence of anxiety in adolescence compared with nonasthmatics (B cohort=26.8% vs 17.6%: K cohort=27.7% vs 14.3%). Anxiety in childhood was not associated with the development of asthma from 6 years old to adolescence. Australian children with asthma have a greater risk of developing anxiety from 6 to 15 years old. This suggests that early multidisciplinary intervention may be required to support children with asthma to either prevent the increased risk of anxiety and/or promote optimal anxiety management.

Designing a Stress and Anxiety Support Tool to Help Young Adults with Autism in Daily Living

Abstract Individuals with autism may experience higher stress and anxiety levels for longer periods than their neurotypical peers. Traditional techniques to provide stress relief and anxiety management include support, which reminds people of how to face stressful situations. Some technological proposals supporting the user include strategies for detecting and monitoring stress levels. In this research, we conducted an iterative user-centered study aiming to understand how young adults with autism deal with stress in real-life situations. We proposed a set of five design principles that will serve as guidelines to develop assistive anxiety management technology for individuals with autism. We then developed a set of low-fi prototypes and selected SATORI, a support tool composed of three interfaces, to help young adults with autism autonomously manage the anxiety caused by stressful situations in their daily life. We evaluated our proposed design principles using SATORI with eight young adults with autism. The results show a positive perception of the design principles on what SATORI is based on, as participants perceived that SATORI could help them in their daily life to manage stress and channel anxiety.

Boredom Susceptibility and Quit Smoking: The Role of Anxiety Symptoms

Boredom is one of the main reported motives for smoking. However, scarce research has examined the relationship between boredom susceptibility and abstinence achievement in treatment-seeking smokers. The aim of this study is to examine the mediating effect of anxiety symptoms in the relationship between boredom susceptibility and abstinence at the end of a smoking cessation treatment. The sample was composed of 481 Spanish smokers who received a cognitive-behavioral treatment to quit (M age= 45.51, SD = 11.16; 60.6% female). The Boredom Susceptibility subscale of the Sensation Seeking Scale Form-V and the Beck Anxiety Inventory were used. Pearson correlations and mediation analyses were conducted to examine the relationships between the study variables. Boredom susceptibility was significantly and positively correlated to anxiety symptoms, but not to abstinence. Anxiety symptoms were significantly and negatively correlated to abstinence. A significant indirect effect of boredom susceptibility on abstinence at the end of treatment through anxiety symptoms was found. There was no direct relation between boredom susceptibility and abstinence. These findings extend previous literature by showing that higher boredom susceptibility is associated with less likelihood to be abstinent at the end of the treatment through higher anxiety symptoms. These results highlight the relevance of considering the inclusion of boredom and anxiety management techniques in smoking cessation interventions.

An anxiety management intervention for people with substance use disorders (ITASUD): An intervention mapping approach based on Peplau's theory.

The comorbidity of anxiety and drug use disorders complicates treatment prognosis, and one of the greatest challenges is to address the environmental and behavioral factors involved. The aim of this study was to describe the uses of intervention mapping in the design of a theory and evidence-based complex intervention to develop skills around the management of anxiety for cocaine users in outpatient addiction treatment. The six steps of the intervention mapping approach, which are needs assessment, creation of matrices of performance objectives, selection of methods and practical strategies, program development, adoption and implementation, and evaluation were applied to develop the Interpersonal Theory of nursing to Anxiety management in people with Substance Use Disorders (ITASUD) intervention. The theory used for the conceptual model was interpersonal relations theory. All theory-based methods and practical applications were developed at the individual level, acting in behavioral, interpersonal, organizational and community environments. The intervention mapping provided a broad overview of the problem and outcome expectations. The ITASUD intervention consists of five consecutive sessions of 110-min targeting individual determinants of anxiety (knowledge, triggers, relief behaviors, self-efficacy and relations), delivered by a trained nurse using Peplau's concepts of interpersonal relations. Intervention Mapping is a multi-step process that incorporates theory, evidence, and stakeholder perspectives to ensure that implementation strategies effectively address key determinants of change. The intervention mapping approach increases the effectiveness of the intervention since the matrices provide a broad view of all factors that affect the problem and facilitate replication through transparency of the determinants, methods, and applications used. ITASUD addresses all factors that play an important role in substance use disorders based on a theoretical basis, which provides the translation of evidence from research into effective practice, policy, and public health improvements.

Effect of MBSR, DBT and CBT on the hypertension patients with depression/anxiety: Protocol of a systematic review and Bayesian network meta-analysis.

Hypertension, one of the most common chronic diseases worldwide, usually requires lifetime managing blood pressure (BP) with medications. Due to quite large number of hypertension patients co-exist with depression and/or anxiety, and non-cooperated with medical instruction, consequently management of BP is impaired with serious complications, resulting in compromised quality of life. Consequently quality of life of such patients is impaired with serious complications. Therefore, management of depression and/or anxiety is equally important as the treatment of hypertension. Depression and/or anxiety are independent risk factors of hypertension, which is supported by the finding that there is close correlation between hypertension are depression/or anxiety. Psychotherapy (non-drug treatment) maybe useful for hypertensive patients with depression and/or anxiety to improve their negative emotions. We aim to quantify the effective of psychological therapies in the management of hypertension patients with depression or anxiety, by comparing and ranking a network meta-analysis (NMA). Literature search for randomized controlled trials (RCTs) will be performed in five electronic databases from inception to December 2021, including PubMed, the Cochrane library, Embase, Web of Science, and China Biology Medicine disc (CBM). The search terms mainly include "hypertension", "mindfulness-based stress reduction" (MBSR), "cognitive behavioral therapy" (CBT) and "dialectical behavior therapy" (DBT). Cochrane Collaboration quality assessment tool will be used for the risk of bias assessment. A Bayesian network meta-analysis will be performed, using WinBUGS 1.4.3, and Stata 14 will be applied to draw the network diagram, while RevMan 5.3.5 will be used to produce funnel plot for assessing the risk of publication bias. Recommended rating, development and grade methodology will also be utilized to assess the quality of evidence. Effect of MBSR, CBT and DBT will be evaluated by traditional meta-analysis directly and Bayesian network meta-analysis indirectly. Our study will provide the evidence on the efficacy and safety of psychological treatments in the hypertension patients with anxiety. There is no research ethical requirement because this is a systematic review of published literature. The results of this study will be published in a peer-reviewed journal. Prospero registration number: CRD42021248566.

Midwifery Acupuncturists' Management of Antenatal Anxiety and Depression: Data from a Survey in Aotearoa (New Zealand).

The goal of this research was to explore how New Zealand midwifery acupuncturists manage mild-to-moderate antenatal anxiety and depression (AAD). A survey (Surveymonkey®) on midwives' perceptions of acupuncture for treating AAD was distributed late in 2019 to midwives who completed a Certificate in Midwifery Acupuncture. Data were collected on referrals and on acupuncture and complementary and alternative medicine use for AAD and associated symptoms of concern (SoC), such as low-back and pelvic pain (LBPP), sleep issues, stress, other pain, and pregnancy issues. Descriptive analysis was used to report data. Of 119 midwives, 66 responded (55.5%). For AAD and SoC, midwives mostly referred patients to general practitioners and counselors, and administered acupuncture themselves. Acupuncture was most accessed for LBPP (n = 38; 70.4%), sleep (n = 31; 57.4%), anxiety (n = 27; 50.0%); stress (n = 26; 48.1%), and other pain (n = 20, 37.0%). Massage was second most-accessed for LBPP (n = 36; 66.7%), sleep (n = 25; 46.3%), and stress (n = 24; 44.4%). For depression, treatments were herbs (n = 16; 29.6%), homeopathy (n = 14; 25.9%), and acupuncture and massage (both n = 13; 24.1%). Acupuncture was most used for other pregnancy issues: birth preparation (n = 44, 88.0%); assisted labor induction (n = 43; 86.0%): nausea and vomiting (n = 43; 86.0%); breech (n = 37; 74.0%); and headaches/migraines (n = 29; 58.0%). Acupuncture is commonly used by midwife acupuncturists in New Zealand to treat a range of pregnancy issues, including anxiety, SoC for AAD, and other pregnancy issues. Further research would be beneficial.

Effectiveness of physical activity interventions for improving depression, anxiety and distress: an overview of systematic reviews

ObjectiveTo synthesise the evidence on the effects of physical activity on symptoms of depression, anxiety and psychological distress in adult populations.DesignUmbrella review.Data sourcesTwelve electronic databases were searched for eligible studies...

Zebrafish, a biological model for pharmaceutical research for the management of anxiety.

The zebrafish (Danio rerio) is a valuable animal model rapidly becoming more commonly used in pharmaceutical studies. Due to its low-cost maintenance and high breeding potential, the zebrafish is a suitable substitute for most adult rodents (mice and rats) in neuroscience research. It is widely used in various anxiety models. This species has been used to develop a conceptual framework for anxiety behavior studies with broad applications in the laboratory, including the study of herbal and chemical drugs. This review discusses the latest studies of anxiety-related behavior in the zebrafish model.

Nanoformulations as a strategy to overcome the delivery limitations of cannabinoids.

Medical cannabis has received significant interest in recent years due to its promising benefits in the management of pain, anxiety, depression and neurological and movement disorders. Specifically, the major phytocannabinoids derived from the cannabis plant such as (-) trans-Δ9 -tetrahydrocannabinol (THC) and cannabidiol (CBD), have been shown to be responsible for the pharmacological and therapeutic properties. Recently, these phytocannabinoids have also attracted special attention in cancer treatment due to their well-known palliative benefits in chemotherapy-induced nausea, vomiting, pain and loss of appetite along with their anticancer activities. Despite the enormous pharmacological benefits, the low aqueous solubility, high instability (susceptibility to extensive first pass metabolism) and poor systemic bioavailability restrict their utilization at clinical perspective. Therefore, drug delivery strategies based on nanotechnology are emerging to improve pharmacokinetic profile and bioavailability of cannabinoids as well as enhance their targeted delivery. Here, we critically review the nano-formulation systems engineered for overcoming the delivery limitations of native phytocannabinoids including polymeric and lipid-based nanoparticles (lipid nano capsules (LNCs), nanostructured lipid carriers (NLCs), nanoemulsions (NE) and self-emulsifying drug delivery systems (SEDDS)), ethosomes and cyclodextrins as well as their therapeutic applications.

Improving Ambulatory Surgery Environments: The Effects on Patient Preoperative Anxiety, Perception, and Noise.

The study aimed to comparatively evaluate three types of preoperative care environment in terms of patient experience outcomes including patient preoperative anxiety, perceived environmental qualities, and noise level. Preoperative anxiety is a major healthcare problem causing delays, complications, dissatisfaction, and rising healthcare costs. The design of preoperative spaces may play an important role in reducing preoperative anxiety and improving outcomes. Anonymous questionnaire surveys were conducted with 228 patients in the three types of preoperative bays that varied in terms of bay size and the amount of hard-wall partitions between bays to compare patient self-reported anxiety and perceived environmental qualities. Sound level measurements were conducted throughout the three preoperative care units. Female patients in the preoperative unit with largest bays and full hard-wall partitions between bays reported significantly lower levels of subjective anxiety (p's = .002, <.001) and higher levels of perceived environmental qualities on privacy, cleanliness, noise, and pleasantness (p's from <.001 to .017) than patients in the units with smaller bays and no or partial hard-wall partitions. Similar but less clear pattern was found among male patients. The lowest average noise levels were recorded in the unit with largest bays and full hard-wall partitions between bays (2.3-6.1 decibels lower than the other units). The design of preoperative care environment may contribute to the better management of preoperative anxiety. Further efforts in research and design are needed to maximize the benefits in clinical, experiential, and financial outcomes.

Immersive and Non-Immersive Virtual Reality for Pain and Anxiety Management in Pediatric Patients with Hematological or Solid Cancer: A Systematic Review.

Invasive and painful procedures, which often induce feelings of anxiety, are necessary components of pediatric cancer treatment, and adequate pain and anxiety management during these treatments is of pivotal importance. In this context, it is widely recognized that a holistic approach, including pharmacological and non-pharmacological modalities, such as distraction techniques, should be the standard of care. Recent evidence suggested the use of virtual reality (VR) as an effective non-pharmacological intervention in pediatrics. Therefore, this systematic review aims to analyze previously published studies on the effectiveness of VR for the management of pain and/or anxiety in children and adolescents with hematological or solid cancer. Medline, SCOPUS, Web of Science, ProQuest, CINAHL, and The Cochrane Central Register of Controlled Trials were used to search for relevant studies in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist. Randomized controlled trial, crossover trial, cluster randomized trial, and quasi-experimental studies were included. Thirteen studies, published between 1999 and 2022, that fulfilled the inclusion criteria were included. Regarding the primary outcomes measured, pain was considered in five studies, anxiety in three studies, and the remaining five studies analyzed the effectiveness of VR for both pain and anxiety reduction. Our findings suggested a beneficial effect of VR during painful vascular access procedures. Limited data are available on the reduction of anxiety in children with cancer.