Anxiety In Patients Research Articles

The Effect of Self-Management on Patients with Chronic Diseases: A Systematic Review and Meta-Analysis.

Chronic diseases significantly impact global morbidity and mortality, affecting millions. Self-management interventions are crucial for improving patient health outcomes. This study explores the effects of self-management interventions on the quality of life (QOL), self-efficacy, depression, and anxiety of patients with chronic diseases. Relevant studies were searched from PubMed, EMBASE, and Web of Science. Two reviewers independently screened the literature, evaluated the risk of bias assessment, and extracted characteristics and outcomes among patients with chronic diseases. For each included study, we calculated the standardized mean difference (SMD) and 95% confidence interval (CI) of the main outcomes. When deemed feasible, the heterogeneity of the study was explored by meta-analysis and subgroup analysis. Thirty-four studies involving a total of 7603 patients with chronic diseases were included. Self-management interventions significantly improved quality of life (Higher-better QOL and Lower-better QOL), self-efficacy, and reduced depression symptoms compared to usual care (95%CI 0.01 to 0.15, p = 0.03; 95%CI -0.49 to -0.08, p = 0.006; 95%CI 0.19 to 0.62, p < 0.001; 95%CI -0.23 to -0.07, p < 0.001). However, no significant effect was found for anxiety (95%CI -0.18 to 0.03, p = 0.18). In the heterogeneity analysis, Lower-better QOL and self-efficacy were all higher than 50% (I2 = 80%, 87%). After the subgroup analysis, the heterogeneity of Lower-better QOL and self-efficacy was less than 50% (I2 = 0%, 16.1%). Subgroup analyses revealed that studies with mean age greater than 60 years old and follow-up times greater than 6 months were more effective in improving patients' Lower-better QOL (p = 0.03, p = 0.004), whereas follow-up times less than 6 months were better at reducing patients' anxiety symptoms (p = 0.03). Self-management interventions are more effective than routine care in managing chronic diseases, significantly improving patients' quality of life, self-efficacy, and reducing depressive symptoms, but they did not show significant improvements in anxiety symptoms. Overall, self-management interventions for chronic diseases can help patients adapt to the changes brought about by the disease and self-manage diseases to prevent disease progression.

Virtual reality in specialized dentistry: employing virtual reality for the alleviation of pain and anxiety in hereditary angioedema patients.

Following an episode of hereditary angioedema (HAE), dental anxiety commonly arises, and many patients find it challenging to access proper care. While the use of virtual reality (VR) for pain and anxiety management in dentistry is on the rise, its application in individuals with angioedema remains largely unexplored. In a case series conducted at a specialized dental clinic, three patients with a history of acute angioedema attacks and dental anxiety engaged with 360° VR videos while seated in the dental chair, utilizing a virtual reality device. Three patients with hereditary angioedema were treated by subjecting them to virtual immersion using VR glasses. Intraoperative reactions were analyzed using VAS scales in order to report the patients' level of anxiety and pain. The outcomes, evaluated through a standard observation tool, surveys, and interviews, encompass the assessment of patient anxiety and pain, responses to VR, and the evaluation of system usability along with its impact on the dental team's workflow Three individuals underwent examination, from which three reliable questionnaires were obtained, demonstrating a success rate of 99.9%. The group included one male and two females, with their ages spanning from 6 to 58 years. The findings revealed an average anxiety score of 1.80 with a standard deviation of 0.6 points, and an average pain score of 1.98 with a standard deviation of 0.3, thus validating full immersion in distraction. Statistical analysis using independent-sample t-tests and ANOVA indicated no significant differences in anxiety levels among the patients based on gender. Both patients wore the VR device throughout the procedure, expressing that it was comfortable, diverting, and held the potential to alleviate anxiety and pain. The dentist noted a positive influence on patient anxiety levels and procedure completion times, expressing an intention to continue employing VR with other angioedema patients and across diverse clinical populations. Virtual reality can be an excellent distraction tool in patients with hereditary angioedema who present at least one acute attack per year.

Relationship Between Anxiety and Events Chemotherapy-Induced Nausea Vomiting (CINV) Breast Cancer Patients with Chemotherapy in Jember, East Java, Indonesia

In Indonesia and worldwide, breast cancer accounts for the greatest number of cancer patients. Chemotherapy is the treatment used to treat breast cancer patients; however, it might cause One of the psychological adverse effects that chemotherapy usually causes for individuals with breast cancer is anxiety. Chemotherapy-Induced Nausea Vomiting (CINV) is the most common physical adverse effect experienced by breast cancer patients receiving chemotherapy. This cross-sectional study employs certain research approaches. Patients receiving chemotherapy for breast cancer at the RSD Dr. Soebandi Jember and Baladhika Husada Jember Hospital made up the study's population. This research was conducted for one month, and the number of samples used in this research was 120. Anxiety measurement uses a questionnaire Hamilton Anxiety Rating Scale (HAM-A) to measure levels of anxiety, and the Multinational Association of Supportive Care in Cancer (MASCC) Antiemesis Tool (MAT) to measure Chemotherapy Induces Nausea and Vomiting (CINV). Data analysis with a paired sample t test using the IBM SPSS v.25 for Windows programme. The results of the Pearson correlation test between anxiety and CINV in breast cancer patients undergoing chemotherapy showed a significance value of 0.00 or &lt;0.05, which means there is a correlation between anxiety and CINV experienced by respondents. The higher the level of anxiety, the more CINV complaints the patient will experience. Vice versa, the lower the level of anxiety, the CINV experienced by the patient will be minimal. Keyword: anxiety, CINV, Breast Cancer, Chemotherapy

The Efficacy of Laughter Therapy on Psychological Symptoms in People With Cancer: A Systematic Review and Meta-Analysis of Randomized Controlled Studies.

Cancer patients generally have high stress levels, which often leads to depression, anxiety and other psychological problems. Laughter therapy has been used to relieve stress, depression and anxiety in cancer patients, but its efficacy is uncertain. The study aims to summarize evidence on the efficacy of laughter therapy on psychological symptoms of people with cancer. A search was conducted in 10 electronic databases for randomized controlled trials (RCTs) reported before May 2023. This systematic review was reported based on the PRISMA 2020 statement. The evaluation of methodological quality and risk of biases were conducted by the Cochrane Risk of Bias Assessment tool version 2, and evidence evaluation was conducted using the GRADE pro online assessment tool. Statistical analysis adopted the Review Manager version 5.4 software. A total of eight studies were included involving 543 participants. Meta-analysis showed that laughter therapy plus routine nursing produced more positive effects than routine nursing in relieving stress (SMD=-1.18, 95% CI -1.73, -0.62, p<0.0001), depression (SMD=-1.05, 95% CI -1.30, -0.81, p<0.00001) and anxiety (SMD=-0.81, 95% CI -1.20, -0.43, p<0.0001). Laughter therapy could effectively relieve stress, depression and anxiety of cancer patients. Future studies should improve the methodological quality of randomized controlled trials, conduct appropriate follow-up, and report details of follow-up. Additionally, it should perform multi-center and large-sample studies, and combine both subjective and objective outcome indications to enhance the persuasiveness of evidence supporting the effectiveness of laughter therapy. PROSPERO register: CRD 42023452739.

The Hope Therapy Effect Toward Depression, Anxiety, and Stress of Tuberculosis Patients with Multi-Drug Resistance at Jayapura’s Healthcare Center, Papua

Background: Indonesia is the third country with a high-rate case of tuberculosis with multi-drug resistance, for a percentage of 5% per 100.000 population. In Papua, TB-MDR becomes the main problem of health with a successful percentage of medication at 68.7%, an indicator of WHO higher than 85%. The complexity and the prolonged occurrence make the patients to have mental health illnesses, such as depression, anxiety, and stress. The field data of depression cases consisted of 65 patients. 50% with had mild depression, 20% with moderate, and 25.55 with severe. Patients with anxiety ranged from 16.7% to 37.29%. Patients with severe stress consisted of 20%. The mental illness health problems for TB-MDR patients required the roles of the nurses, such as counseling based on HOPE therapy. Purpose: Analyzed the effects of HOPE therapy to manage depression, anxiety, and stress levels. Methods: Quasi-experimental research applied a systematically assigned control group. The population consisted of patients with TB-MDR receiving medication at Jayapura's healthcare center, 40 individuals. Results: HOPE therapy effects for depression, stress, and anxiety levels applied the Wilcoxon test. The obtained result was a p-value lower than 0.05. The results indicated the effect of HOPE therapy medication on depression, stress, and anxiety levels. The intervention group had decreased depression, stress, and anxiety levels with p-values of 0.043 and 0.012. The results contradicted the control group. The obtained p-value was higher than 0.05, indicating no effect. The p-values were 0.721, 0.532, and 0.670. Conclusion: HOPE therapy was useful for TB-MDR patients with mental illness. The administered HOPE therapy for patients could improve their confidence and hopes to live better and recover.

Investigation of Depression, Anxiety, Sleep Quality, and Fatigue in Thalassemia Major Patients: A Study of the Correlation Between Sleep Quality and Laboratory Findings

Investigation of Depression, Anxiety, Sleep Quality, and Fatigue in Thalassemia Major Patients: A Study of the Correlation Between Sleep Quality and Laboratory Findings

PATHOPHYSIOLOGY AND MANAGEMENT OF CUSHING SYNDROME: A SYSTEMATIC REVIEW OF CURRENT AND FUTURE PERSPECTIVES

Objective: The general objective of this study is to analyze the scientific literature on Cushing's Syndrome (CS), seeking to identify the main clinical manifestations, complications, and the impact on patients' quality of life. Methodology: Searches were performed in the PubMed Central (PMC) databases, using three descriptors in combination with the Boolean term “AND”: Cushing Syndrome, Clinical Manifestations, Complications, and Quality of Life. A total of 161 articles were found, which were subsequently submitted to the selection criteria. Twenty-two studies were selected to compose this systematic review, of which 12 were used. Results: Cushing's Syndrome is a condition characterized by hypercortisolism, which results in a wide range of clinical manifestations. Complications associated with CS include visceral obesity, arterial hypertension, diabetes mellitus, dyslipidemia, osteoporosis, and myopathy. In addition, CS has a significant impact on patients' mental health, including depression, anxiety, and cognitive impairment. Therapeutic approaches range from transsphenoidal surgery, radiotherapy, to targeted drug treatments to normalize cortisol levels and address comorbidities. Conclusion: CS is associated with several comorbidities that affect multiple body systems, resulting in a significant impact on patients' quality of life. Early diagnosis and multidisciplinary treatment are essential to improve clinical outcomes and quality of life in these patients.

The Impact of Visual Distraction Interventions on Patients' Pain and Anxiety During Colonoscopy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Patients undergoing colonoscopy may experience psychological distress related to the procedure, which may deter adherence and acceptance of future colonoscopies. Visual/audiovisual distraction interventions to alleviate colonoscopy-related pain and anxiety have been developed. This study aims to investigate the impact of these interventions on colonoscopy-related outcomes. We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) testing the efficacy of visual/audiovisual distraction. Eligible studies were systematically retrieved by searching PubMed, EMBASE, WOS, SCOPUS, and Cochrane through June 2024 and extracted by 2 investigators. Continuous and dichotomous outcome variables were pooled using Cohen's d and risk ratio (RR) with confidence interval (CI) using Stata MP version 17. We assessed heterogeneity using the χ2 test and I2 statistic (PROSPERO ID: CRD42024555902). We included 13 RCTs with 1439 patients randomized to an active intervention (n=804) or usual care (n=635). Only 3 RCTs were endoscopists-blinded studies, whereas the rest were open-label. The interventions included playing nature scene videos, real-time videos of the colonoscopy, or movies preferred by the patients. The active intervention arm was associated with a significant reduction in the pain experienced during colonoscopy (Cohen's d: -0.57, 95% CI [-0.79, -0.35], P<0.0001), reduced anxiety related to colonoscopy (Cohen's d: -0.66, 95% CI [-1.15, -0.18], P=0.01), and increased patients' satisfaction (Cohen's d: 0.65, 95% CI [0.49, 0.80], P<0.0001) compared with patients who received the usual care during colonoscopy. There were no significant differences between both groups in the willingness to re-undergo the procedure (RR: 1.11, 95% CI [0.98, 1.25], P=0.09), analgesia use (Cohen's d: -0.21, 95% CI [-0.42, 0.0], P=0.05), or total procedure duration (Cohen's d: -0.12, 95% CI [-0.24, 0.0], P=0.06). Visual/audiovisual distraction interventions decrease colonoscopy-associated pain and anxiety and increase patients' satisfaction. These are promising interventions to improve patient compliance and quality of care during colonoscopy.

Comparative evaluation of anxiety levels among adult patients undergoing dental treatment in pediatric and conventional operatory: a randomised clinical trial

Background: Individuals of all ages often experience anxiety before undergoing dental procedures. Therefore, it's crucial for dentists to create a calming operatory environment with distraction techniques to help alleviate adult patient anxiety. This clinical trial evaluated adult patient anxiety in both conventional and pediatric operatory rooms. Methods: This prospective split-mouth randomized controlled clinical trial was 11 conducted between November 2023 and April 2024. Twenty-four adult patients (13 females and 11 12 males) with a mean age of 37±4.53 years participated in this study. Each participant (n=24) received 13 both conventional and pediatric operatory. Pre- and post-operative pulse rates and anxiety scores 14 were measured using a pulse oximeter and modified Corah’s dental anxiety scale, respectively, in both 15 operatory rooms. Results: The study found a statistically significant decrease in both pulse rate and anxiety scores post-operatively in both operatory settings (p&lt;0.05). However, the reduction in anxiety was more pronounced in the pediatric operatory compared to the conventional operatory (p=0.0433). Participants reported greater comfort and reduced anxiety in the pediatric setting, with 83% favoring its vibrant ambiance and 87% feeling less anxious after treatment in this environment. Conclusions: The vibrant environment of a pediatric dentistry operatory, featuring colorful walls, television, music, and other engaging elements can serve as a more effective for reducing anxiety compared to the plain and monotonous ambiance of the operatory.

The Effect of Music Distraction on Dental Anxiety During Invasive Dental Procedures in Children and Adults: A Meta-Analysis.

Background: Dental anxiety and odontophobia are common issues, leading to challenges with oral hygiene and dental health. Music distraction offers an effective and side effect-free solution to alleviate pain and increase the acceptability of dental treatments. Our meta-analysis aimed to assess the efficacy of music distraction in reducing patient anxiety during invasive dental procedures in children and adults. Methods: The PubMed, Web of Science, and Embase databases were searched for clinically controlled trials, using the keywords "music" and "dental anxiety". The main outcome measured was the anxiety score. A meta-analysis was conducted using a random-effects model to estimate the standardized mean differences (SMDs). The subgroup analyses were conducted based on age groups, music preferences, and music styles. The research protocol has been registered with PROSPERO (Registration ID: CRD42022357961). Results: A total of 24 controlled clinical trials involving 1830 participants met the inclusion criteria for the meta-analysis. Music distraction significantly reduced dental anxiety during invasive procedures under local anesthesia (SMD, -0.50; 95% CI, -0.80 to -0.21; p = 0.0009; I2 = 83%). Our subgroup analysis revealed that music distraction was more effective in adults (SMD, -0.51; p = 0.0007) than in children (SMD, -0.47; p = 0.13) in reducing dental anxiety. Regarding music selection, music chosen by the participant (SMD, -1.01; p = 0.008) demonstrated more anxiolytic effects than by the author (SMD, -0.24; p = 0.02). Regarding music styles, classical music (SMD, -0.69; p = 0.009) was associated with better anxiolytic effects in adults. Conclusions: Our meta-analysis supports the use of music to alleviate dental anxiety during invasive procedures. Listening to classical or customized music can serve as an effective adjunct to outpatient surgical care in dental clinics.

Bibliometric Analysis: The Impact of Anxiety on Patiens With Chronic Kidney Disease With The Logo of Therapy and Cognitive Behavior Therapy in Indonesia

The study conducted a bibliometric analysis of the impact of anxieties on patients with chronic kidney disease in an effort to lessen patient anxiety. This bibliometric analysis looks at research activities in Indonesia and globally using publication data from the Scopus database. In bibliometric analysis, quantitative techniques are employed to assess data and generate representative images. It is acknowledged that this study is a valuable tool for assessing research topic characteristics, publication outputs, and composition and structure. Between 1955 and 2023, attempts to lower anxiety through cognitive behavioral and logotherapy were successful, despite a lack of significant overall growth.

Real-world effectiveness of primary care psychological therapy for depression and anxiety in patients with coronary heart disease

Abstract Background Depression and anxiety are often inadequately treated in patients with coronary heart disease (CHD), despite mental health issues being associated with poorer quality of life, higher cardiovascular morbidity, and higher mortality. Talking therapies, such as cognitive behavioural therapy, are the recommended first-line treatment for depression and anxiety symptoms in CHD patients. However, the evidence for their effectiveness was considered low in a recent Cochrane review, and trial participants may not represent patients treated in routine clinical settings. Purpose To assess the effectiveness of routinely-delivered talking therapies in patients with CHD from nationwide primary care talking therapy services in England, and to compare their treatment outcomes to patients without a CHD diagnosis. Methods Healthcare records from 1.9 million patients who completed a course of treatment (≥2 treatment sessions) via NHS Talking Therapies for anxiety and depression (NHS TTad) between 2012-2019 were linked to Hospital Episode Statistics, the Mental Health Services Data Set, and death records. Standard NHS TTad outcome indicators (recovery, reliable improvement, and reliable deterioration) were examined in three groups, with (1) any CHD (n=41,317; ICD-10=I20-I25), (2) acute coronary syndromes (ACS, n=29,991; I21, I22, I20.0), and (3) chronic CHD (n=40,524; I20.1-I20.9, I23-I25) at baseline. Effect sizes for pre-post treatment changes in depression and anxiety symptom measures (PHQ-9 and GAD-7) were calculated using the adapted Cohen’s d for within-subjects design (dav). Outcomes were also compared to those of propensity-score matched control groups without the relevant diagnoses, using logistic regression. Results After completing a course of talking therapy, 49.8% (95%CI=49.3;50.3) of patients with CHD recovered from depression or anxiety, 69.4% (95%CI=69.0;69.9) saw reliable improvement in symptoms, and 7.3% (95%CI=7.0;7.5) experienced reliable deterioration in symptoms. There were large reductions in both depression (dav=-1.02) and anxiety symptoms (dav=-1.03) on average. Compared to a control sample of patients with no diagnosis of CHD, those with a CHD diagnosis were less likely to recover (OR=0.87[95%CI=0.84;0.89]) or reliably improve (OR=0.84[95%CI=0.81;0.87]) and more likely to reliably deteriorate (OR=1.28[95%CI=1.21;1.36]), when matched on age, sex, ethnicity, deprivation, baseline depression and anxiety symptom scores, self-reported long-term health condition, and waiting times between referral, assessment, and treatment. The findings were consistent for patients with ACS and those with chronic CHD. Conclusions Nearly half of CHD patients who received primary care talking therapy recovered, in line with the UK Government target of 50% recovery for the services. Nevertheless, compared to otherwise similar patients without CHD, those with CHD at baseline had worse psychological treatment outcomes.

Assessing the impact of implantable loop recorder placement on anxiety level

Abstract Background Anxiety is a prolonged state of apprehension or worry that can be an independent predictor of cardiovascular events, associated with a 48% increased risk of cardiac death. About one-third of patients with arrhythmias present with high anxiety levels, and subsequently worse quality of life. In our experience of patient care, many patients feel anxious about the possibility of an arrhythmia that could lead to their demise, especially if their symptoms are undiagnosed. Purpose Our project aims to explore the change in patients’ anxiety levels following implantable loop recorder (ILR) placement. Methods This is a survey-based observational study that was performed in an outpatient clinic and hospital using validated General Anxiety Disorder-7 (GAD-7) questionnaires. Individuals who met indications to undergo ILR implantation including palpitations, syncope, subclinical atrial fibrillation, and cryptogenic stroke underwent baseline assessment of anxiety prior to implantation. Individuals had repeat assessments at 6 weeks and 12 weeks post-implantation to evaluate the effect of ILR placement. Results Our study included 50 individuals. Out of the initial subjects, 10/25 females and 11/25 males were lost to follow-up. The average initial GAD-7 score was 3.3 (Range 0, 15), average 6-week score was 1.6 (Range 0, 14), and average 12-week score was 0.9 (Range 0, 10). Total decrease in GAD-7 score after 6 weeks of having ILR was 50%. Total decrease in GAD-7 score after 12 weeks of ILR was statistically significant at 73% (P=0.03). Females showed greater improvement of GAD-7 scores in comparison to males at 6 weeks (67% vs 36%) and 12 weeks (81% vs 66%). Conclusion Studies have suggested an overall decreased level of anxiety in patients receiving implantable devices that have the potential to treat arrhythmias such as implantable cardiac defibrillators and pacemakers. Our results suggest that the benefit may extend to implantable devices that seek to provide further diagnostic information and aid in the prognostication of disease burden. As seen in our study population, GAD-7 scores showed dramatic improvement with greater percentage in female than male population. After the placement of loop recorders, many patients experience a sense of security with having a device that monitors them. Our study is the first to address the association between ILR and anxiety. Future studies evaluating this association would help increase the power of the study.Figure 1:Bar graph of GAD-7 Scores

Interaction of 4-ethyl phenyl sulfate with bovine serum albumin: Experimental and molecular docking studies.

4-ethyl phenyl sulfate (EPS), a protein-bound uremic toxin found in serum of patients suffering from autism spectrum disorders (ASD) and chronic kidney disease (CKD). As per recent advances in the field, gut metabolites after their formation goes to blood stream crosses blood brain barrier and causes neuro related problems. Increased levels of 4-EPS in human body causes anxiety in patients and its role remains elusive. 4-EPS interacts with serum albumin in human body and thus, a model study of interaction of BSA with 4-EPS is presented in support of it. Absorption spectroscopy result demonstrated decrease in bovine serum albumin (BSA) absorption upon interaction with increasing concentration of EPS in a range from 2 μM to 100 μM. Moreover, this interaction was confirmed by the fluorescence quenching in presence of metabolite. The change in secondary structure was demonstrated by circular dichroism, synchronous fluorescence and Fourier transform infra-red spectroscopy. Docking studies reveals binding score of -5.28 Kcal mol-1, demarking that 4-EPS is involved in interaction with BSA via amino acid residues, forming the stable complex. This interaction study may be helpful in devising strategies for the treatment of chronic kidney disease and other neuro related diseases, by producing synthetic compound that competes with albumin binding sites to allow 4-EPS clearance from the body.

Symptoms of Anxiety and Depression (SAD) in patients undergoing transcatheter aortic valve implantation. A multicentre Australian experience: The SAD-TAVI Study

Abstract Background Symptoms of anxiety and/or depression (SAD) commonly co-exist in severe aortic stenosis, associated with increased morbidity and mortality following transcatheter aortic valve implantation (TAVI). Despite this, mental health remains under-researched in the TAVI literature. Purpose To characterise the prevalence of SAD in those undergoing TAVI and identify patient phenotypes at highest risk of these symptoms. We also aimed to examine how SAD evolve following TAVI and establish factors predictive of improvement and regression in mental health. Methods Retrospective review of prospectively collected data from patients undergoing TAVI between 2018 and 2023 included in an Australian TAVI registry. Results Of 1279 patients, median age was 82 (IQR 77, 87), 41% were female and median STS score was 3.9 (2.3, 5.9). 353 (28%) patients reported moderate or worse SAD at baseline. Of this group, 260 (74%) had complete resolution in symptoms within 30-days. Body Mass Index&amp;lt;25 (adjusted odds ratio [aOR] 3.4, p&amp;lt;0.001), vascular site complications (aOR 3.4, p=0.029) and non-home discharge (aOR 2.4, p=0.036) independently predicted failed improvement in SAD. Onset of new SAD was uncommon, present in only 72 (8%) patients. Non-home discharge (19% vs 8%, p=0.006) and a composite endpoint of stroke, acute myocardial infarction, and heart-failure readmission (11% vs 4%, p=0.012) were more prevalent in this cohort. Conclusion Symptoms of anxiety and depression are common but under recognised in severe aortic stenosis. TAVI is highly effective at improving these symptoms. Regular screening for mental health should be adopted as a standard of care in TAVI.Evolution of SAD Following TAVI

Assessment of quality of life and ICD shock-related anxiety in Asian patients with implantable cardioverter defibrillator in the PainFree SST study

Abstract Background The implantable cardioverter defibrillator (ICD) reduces mortality in patients at risk of sudden cardiac death. However, it is not known if the psychological status of ICD patients differs by geography. The aim of this analysis is to compare Quality of Life (QoL) and ICD shock-related anxiety between ICD patients in Asian with those in other countries. Methods The PainFree SST study was a prospective, multicenter, global study that enrolled 2770 patients including 225 from from Asia (181 from Japan, 25 from India, and 19 from Malaysia). The EuroQol 5-D (EQ-5D) measured QoL and the Florida Shock Anxiety Scale (FSAS) measured ICD shock-related anxiety. These questionnaires were administered bi-annually and monthly for 6 months after a shock. Change in QoL and shock anxiety was analyzed used linear mixed models for repeated measures. Results: Both the EQ-5D health score and FSAS score were higher in Asian patients compared to patients in the other countries post-implant (EQ-5D: 69.5 ± 18.3 points vs 66.5 ± 19.3 points, p&amp;lt;0.0001, FSAS: 19.7 ± 9.4 points vs 16.4 ± 7.7 points, p&amp;lt;0.0001), and stayed higher for the entire follow-up period (Figure 1). The EQ-5D health score was significantly reduced after a shock (Asian: -18.1 points, p&amp;lt;0.0001; other countries: -7.5 points, p&amp;lt;0.0001) with a greater reduction in Asian patients (p=0.0035) . Recovery in the month following a shock was greater in Asian patients (+19.8 vs +3.6 points, p&amp;lt;0.0001). The FSAS score was significantly increased after a shock (Asian: +6.4 points, p&amp;lt;0.0001; other countries: +4.8 points, p&amp;lt;0.0001) and the increase was similar between geographies (p=0.20). The recovery effect at 1 month was greater in Asian patients (-5.8 vs -1.7 points, p=0.0003) (Figure 2). Conclusions Asian patients were more anxious about a shock in spite of greater QoL, compared with those in other countries. After a shock, Asian patients had a greater decrease in QoL and a similar increase in anxiety but recovery was greater in both measures in the month following a shock.Figure 1Figure 2

Anxiety or depression in heart failure across the ejection fraction spectrum

Abstract Background Anxiety or depression are commonly described in patients with heart failure (HF) but few data exist on characteristics and clinical outcomes associated with anxiety or depression across the different HF phenotypes. Purpose To assess the prevalence of patient characteristics and clinical outcomes associated with anxiety or depression in patients with HF with preserved, mildly reduced and reduced ejection fraction (HFpEF, HFmrEF, and HFrEF). Methods Patients enrolled in the Swedish Heart Failure Registry between 2000-2021 were included. Self-reported anxiety or depression was collected using EuroQoL 5-dimensional questionnaire (EQ-5D) at baseline and follow-up visits. Anxiety or depression was categorized as "not anxious or depressed", "moderately anxious or depressed" or "severe anxious or depressed". The independent associations between baseline characteristics and presence of anxiety or depression were assessed by a multivariable multinominal regression analysis. Cox proportional hazards regressions were performed to model the time to first event according to levels of anxiety or depression. Outcomes included all-cause death and all-cause hospitalizations. Results A total of 45,247 patients were included among whom 58% reported none, 38% moderate and 5% severe anxious or depressed with similar distribution across the HF phenotypes (Figure). Several characteristics were associated with anxiety or depression with the strongest ones for severe versus none being higher NYHA class (OR 3.10 (2.77-3.47)), liver disease (OR 1.99 (1.56-2.55)), in-patient setting (OR 1.62 (1.43-1.84)), smoking (OR 1.75 (1.52-2.00)) while others were inversely related including male sex (OR 0.51 (0.46-0.56)), higher age (OR 0.60 (0.53-0.67)), referral to HF nurse clinic (OR 0.82 (0.72-0.94)) and higher income level (OR 0.68 (0.62-0.76)). The risk of all-cause death and all-cause hospitalizations increased with increasing levels of anxiety or depression across all HF phenotypes during 12 months of follow up. Severe anxiety or depression had a stronger association with all-cause death in hospitalized patients and all-cause hospitalizations in out-patients. Conclusion In this large contemporary cohort of patients with HF in a real-world setting, anxiety or depression was frequently and similarly distributed across all HF phenotypes. Higher NYHA class, liver disease and in-patient setting were strongly associated with the anxiety or depression while male sex, higher age, and higher income were inversely related with anxiety or depression. Anxiety or depression was significantly associated with worse outcomes at 12 months follow up.Proportion anxiety or depression

Assessing the Use of BotulinumtoxinA for Hyperactive Urinary Tract Dysfunction a Decade After Approval: General Versus Local Anesthesia for BotulinumtoxinA Detrusor Injection

Background: The onabotulinumtoxinA detrusor injection (OnabotA DI) was approved a decade ago for the treatment of patients with idiopathic overactive bladder (iOAB) or neurogenic detrusor overactivity (nDO) dysfunction who had not been treated successfully otherwise. The procedure is usually performed under local anesthesia (LA), and various approaches have been investigated to make the procedure as painless as possible. We examined the level of anxiety and pain experienced by patients who wanted to have the procedure performed under LA or general anesthesia (GA). Material and Methods: Patients scheduled for OnabotA DI were able to choose the anesthesia procedure (LA or GA). The Amsterdam Preoperative Anxiety and Information Scale (APAIS) was used to grade anxiety before anesthesia or before the procedure itself. Intra- and postoperative pain was determined using the Visual Analogue Scale (VAS). Various established questionnaires (including the Urinary Distress Inventory UDI-6), as well as a postoperative satisfaction questionnaire, were used to evaluate the success of the therapy. Results: In total, 104 patients (93 F, 11 M; age 64.0 (22–89) years; 80× iOAB, 24× nDO) were evaluated. OnabotA-DI was performed with LA in 72 patients and GA in 32. Stratified by first versus repeat injection in the LA group, there was a significant decrease in the Anxiety Score in the first vs. repeat injection group (p = 0.038). The LA group showed higher concerns in the anesthesia questions of the Amsterdam Preoperative Anxiety and Information Scale (APAIS) than the GA group (OR: 0.29, 95%CI: 0.02–1.74). The VAS Pain Score during the procedure was significantly lower in the GA group compared to the LA group (LA: 3.3 ± 2.2, GA group 1.5 ± 1.5; p &lt; 0.001). There were no differences in the success of therapy. Despite the fear and pain, patients preferred LA to GA. Conclusions: This study shows that the anxiety and pain burden of patients undergoing OnabotA-DI under LA is significant in comparison to GA during the first injection, but insignificant for following injections. Overall, LA is favored over GA.

Postoperative complications and symptoms of anxiety and depression in patients with gastric and esophageal cancer: a retrospective cohort study

ABSTRACT Context. Gastric and oesophageal cancers are common. They are also expected to increase in incidence in the next few years and are characterized by poor prognosis. Surprisingly, whereas the incidence of severe anxiety and depression is high in patients with gastric and oesophageal cancers, the influence of symptoms of depression and anxiety on postoperative complications has barely been explored. Methods. In a retrospective study based on a prospectively collected database, 629 cancer patients were enrolled. Symptoms of depression and anxiety (Hospital Anxiety and Depression Scale scores) and sociodemographic and medical information were collected immediately after diagnosis and before any treatment. The surgical approach (i.e. gastrectomy or oesophagectomy) and postoperative complications according to the Clavien–Dindo classification were collected after surgery. Results. After controlling for known medical predictors (i.e. surgical strategy, alcohol and tobacco consumption, American Society of Anaesthesiologists classification physical status score) of postoperative complications, no effect of symptoms of depression or anxiety was detected. Discussion. The observed results are surprising given the literature. However, several potential arguments can be put forwards regarding methods and measures, controlling variables, and conceptual distinctions. Despite the absence of significant results, this topic should be more deeply investigated by applying methodological and conceptual adjustments.

The Mediating Role of Cancer Self-Efficacy in the Relationship Between Mindfulness and Death Anxiety in Patients with Cancer

Background: Investigating the relationship between mindfulness, cancer self-efficacy, and death anxiety in patients with cancer is crucial for understanding how these factors influence emotional well-being. Insights from such research can guide the development of psychological interventions aimed at enhancing quality of life for cancer patients. Objectives: The primary objective of this study was to explore the relationship between mindfulness and death anxiety in cancer patients, focusing on the mediating role of cancer self-efficacy. Methods: This study employed a descriptive correlational design and utilized structural equation modeling (SEM) to examine the relationships. A convenience sample of 302 cancer patients from Tehran (2023) completed three questionnaires: The Death Anxiety Scale, the Mindfulness Questionnaire, and the Cancer Behavior Inventory. Structural equation modeling was used to evaluate the proposed model, while the bootstrap method assessed the indirect effects. Results: The study found a significant negative relationship between mindfulness and cancer self-efficacy, and between cancer self-efficacy and death anxiety (P &lt; 0.001). There was no direct relationship between mindfulness and death anxiety; however, cancer self-efficacy was found to mediate this relationship (P &lt; 0.001). The model demonstrated a good fit with indices: RMSEA = 0.065, CFI = 0.96, and TLI = 0.95. Conclusions: These findings suggest that mindfulness indirectly reduces death anxiety in cancer patients by enhancing cancer self-efficacy. This highlights the potential effectiveness of mindfulness-based interventions in improving the emotional and psychological health of individuals diagnosed with cancer