Post-procedural Anxiety Research Articles

Disease-specific patient-reported quality of life after fenestrated/branched endovascular aortic aneurysm repair

ObjectivesFenestrated-branched endovascular technology (F/B-EVAR) is increasingly used to repair complex aortic aneurysms. While reintervention, morbidity and mortality after F/B-EVAR have been well-characterized, studies on patient-reported quality of life (QOL) after F/B-EVAR have been limited in their use of non-specific instruments and measures. We report on disease-specific QOL in patients that underwent F/B-EVAR using a validated QOL survey for aortic aneurysms. MethodsProspectively maintained databases were used to contact living patients that underwent F/B-EVAR for pararenal or thoracoabdominal aortic aneurysms at two institutions. Eligible patients (n = 286) were asked to complete a disease-specific QOL survey previously validated in patients that underwent repair of an infrarenal abdominal aortic aneurysm. An emotional impact score (EIS) from 0-100 was derived from the survey with higher scores indicating more emotional impact and worse QOL. Respondent behavior change following F/B-EVAR was evaluated in four domains (strenuous activity, travel, heavy lifting, and sexual activity) previously identified by patients to be most impacted by an aortic aneurysm. ResultsIn total, 234 patients (82%) completed surveys. Mean post-operative interval to survey completion was 3.4 ± 2.8 years. Mean EIS was 16 (range 0-91) for all patients surveyed, with higher mean EIS among those within the first year after F/B-EVAR (20 vs 14). Most respondents demonstrated limited adverse emotional impact after F/B-EVAR. However, the 4th quartile of EIS was broad (22-91), indicating that a subset of respondents had significantly worse QOL after repair. While most patients reported no post-procedure change in each of the activity domains, over 40% of patients did report decrease in strenuous activity and heavy lifting after F/B-EVAR. Those with decreased activity after repair had corresponding deficiencies in disease-specific knowledge for the domains of heavy lifting (P <.001) and sexual activity (P = .17). ConclusionsThe majority of patients who underwent F/B-EVAR in this cohort had low emotional impact on their QOL after repair. One-quarter of patients did report significant post-procedure anxiety about their aneurysm, with improvement observed beyond one year after repair. Most patients reported unchanged or decreased activity levels following F/B-EVAR, and less aneurysm-specific patient knowledge was associated with decreased activity after repair. These findings are similar to those seen in prior work using this survey instrument in patients that underwent infrarenal aneurysm repair. This work confirms the feasibility of using this survey to evaluate QOL in patients with complex aortic disease. Longitudinal evaluation in these patients may identify those at high-risk for worse QOL after F/B-EVAR.

Exploring Relations Between Unique Patient Characteristics and Virtual Reality Immersion Level on Anxiety and Pain in Patients Undergoing Venipuncture: Secondary Analysis of a Randomized Control Trial.

Virtual reality (VR) is a well-researched digital intervention that has been used for managing acute pain and anxiety in pediatric patients undergoing various medical procedures. This study focuses on investigating the role of unique patient characteristics and VR immersion level on the effectiveness of VR for managing pediatric pain and anxiety during venipuncture. The purpose of this study is to determine how specific patient characteristics and level of immersion during a VR intervention impact anxiety and pain levels for pediatric patients undergoing venipuncture procedures. This study is a secondary data analysis of 2 combined, previously published randomized control trials on 252 pediatric patients aged 10-21 years observed at Children's Hospital Los Angeles from April 12, 2017, to July 24, 2019. One randomized clinical trial was conducted in 3 clinical environments examining peripheral intravenous catheter placement (radiology and an infusion center) and blood draw (phlebotomy). Conditional process analysis was used to conduct moderation and mediation analyses to assess the impact of immersion level during the VR intervention. Significant moderation was found between the level of immersion and anxiety sensitivity when predicting postprocedural anxiety (P=.01). Patients exhibiting the highest anxiety sensitivity within the standard of care yielded a 1.9 (95% CI 0.9-2.8; P<.001)-point elevation in postprocedural anxiety relative to individuals with high immersion levels. No other significant factors were found to mediate or moderate the effect of immersion on either postprocedural anxiety or pain. VR is most effective for patients with higher anxiety sensitivity who report feeling highly immersed. Age, location of the procedure, and gender of the patient were not found to significantly impact VR's success in managing levels of postprocedural pain or anxiety, suggesting that immersive VR may be a beneficial intervention for a broad pediatric population. ClinicalTrials.gov NCT04268901; https://clinicaltrials.gov/study/NCT04268901.

Virtual reality to reduce periprocedural anxiety during invasive coronary angiography: rationale and design of the VR InCard trial

IntroductionPatients undergoing invasive coronary angiography (ICA) experience anxiety due to various reasons. Procedural anxiety can lead to physiological and psychological complications, compromising patient comfort and overall procedural outcomes. Benzodiazepines are...

The effect of virtual reality glasses applied during intrauterine device insertion on pain, anxiety and satisfaction: Randomized controlled study.

This study was carried out to determine the effect of the use of "virtual reality glasses," on anxiety, pain, and satisfaction level in order to reduce anxiety and pain during intrauterine device (IUD) insertion, which is a painful and stressful procedure for women and to divert attention to increase satisfaction. This randomized controlled study in the gynecology clinic of a state hospital with 80 women who were accepted to participate in the study. Data were collected using structured patient information form, numerical pain rating scale, state-trait anxiety inventory, patient satisfaction evaluation form, and virtual reality glasses. Post-procedural pain scores in the control group after IUD application were higher than post-procedural pain in the virtual reality group. Measurements of post-procedure anxiety in the control group were higher than measurements of post-procedural in the virtual reality group. Satisfaction levels of women with virtual reality glasses during IUD insertion were also found to be high. It was determined that the use of virtual reality glasses, one of the methods of distraction during IUD insertion, was effective in reducing pain and anxiety and increasing patient satisfaction.

Effectiveness of Intellectual Memory Recall and Multifaceted Distraction Techniques in Reducing Anxiety among Children during Radiovisiography: A Randomised Clinical Trial

Introduction: Dental anxiety is anticipatory in nature, and the manifestation of the anxiety is due to uncertainty about a future threat and the inability to mitigate or avoid it. Distraction with a multisensory approach aids in better managing the anxious child. Aim: To compare the efficiency of two different play techniques, namely Intellectual Memory Recall (IMR) game and Multifaceted Distraction (MFD) game, in reducing procedural anxiety during Radiovisiography (RVG) among 4 to 10-year-old children. Materials and Methods: It was a randomised clinical study conducted in the Department of Paedodontics and Preventive Dentistry, GITAM Dental College and Hospital, Visakhapatnam, Andhra Pradesh, India from July 2023 to September 2023 with a sample size of 90 children selected based on baseline anxiety using the Modified Faces version of the Modified Child Dental Anxiety Scale (MCDASf). The children were randomly allocated into three groups: Group IMR (n=30), Group MFD technique (n=30), and the control group-Tell Show Do (TSD) (n=30). The pre- and postprocedural anxiety of the children was measured using the RMS Pictorial Scale. The obtained readings were tabulated, and anxiety variation was statistically analysed using the student t-test (intragroup comparison) and one-way Analysis of Variance (ANOVA) (intergroup comparison). The frequency of anxiety reduction among children was analysed using the Chisquare test. Results: Total 90 chidren {males-38(42.22%) and females52(57.78%)} with a mean age of 7.09±1.68 years were found eligible and participated in the study. The Multifaceted Distraction (MFD) Technique was the most effective and significantly reduced anxiety in 96.67% of children (n=29), followed by IMR (n=27; 86.67%), and TSD (56.67%). Conclusion: Both the MFD and IMR techniques have been found to be efficient in reducing procedural anxiety compared to the TSD technique. These techniques are cost-effective and easily understood by all children, making them potential alternatives to conventional behavioural guidance methods.

Virtual reality and noise canceling headphone distraction during pediatric dermatologic procedures.

Pain and anxiety related to medical procedures have long been recognized as a significant healthcare concern. If a patient's procedural pain and anxiety are not addressed, long-term physical and psychological sequelae including increased perceived pain, anxiety, disruptive behavior, trauma reactions, or refusal of future procedures can occur. The objective of our study was to assess the utility of a virtual reality (VR) headset or noise-canceling headphones (HP) compared to treatment as usual (TAU) in reducing pain and anxiety during pediatric dermatology procedures. Results indicated a significant difference between pre- versus post-procedure anxiety in the VR and HP groups but not the TAU group suggesting non-pharmacologic technology-based interventions such as VR and headphones may reduce patients' anxiety during pediatric dermatology procedures.

Effectiveness of virtual reality in managing pain and anxiety in adults during periprocedural period: a systematic review and meta-analysis.

Patients undergoing medical procedures often experience pain and anxiety. These periprocedural outcomes can be overcome by providing a distraction using virtual reality (VR), decreasing their perception. VR has proved effective in reducing pediatric pain and anxiety; however, limited studies have confirmed its effectiveness in adults. We performed a systematic review and meta-analysis on the effectiveness of VR, as opposed to standard care, in reducing periprocedural pain and anxiety in adults. A systematic search of randomized controlled trials was conducted using the databases of MEDLINE, Cochrane CENTRAL, and Scopus. Trials involving patients (> 18years) undergoing elective medical procedures conducted with or without local anesthesia and participating in VR therapy were included. Primary outcomes were pre-procedural anxiety, post-procedural anxiety, and intra-procedural pain. Pre-procedural pain, post-procedural pain, and intra-procedural anxiety were secondary outcomes. Data from 10 studies shortlisted for inclusion revealed no significant association between the use of VR and lower pre-procedural anxiety compared to standard care (p > 0.05) (SMD = -0.02, 95% CI = -0.18 - 0.14, P = 0.81) but demonstrated that the use of VR was significantly associated with a reduction in post-procedural anxiety (SMD = -0.73, 95% CI = -1.08 - -0.39, P < 0.0001), intra-procedural pain (SMD = -0.61, 95% CI = -1.18 - -0.04, P = 0.04), and post-procedural pain (SMD = -0.25, 95% CI = -0.44 - -0.05, P = 0.01). The use of VR caused a significant reduction in post-procedural anxiety, intra-procedural pain, and post-procedural pain in adults undergoing medical procedures, although the findings were insignificant concerning pre-procedural anxiety.

Does Structured Informational Care Reduce Anxiety In Patients Undergoing MRI? A Quasi-Experimental Study.

To assess the anxiety level in patients undergoing magnetic resonance imaging, and to see if structured informational care reduces anxiety compared to conventional approach. The quasi-experimental study was conducted Dow Institute of Radiology, Dow University of Health Sciences Karachi, Pakistan from January 2020 to June 2021, and comprised adult patients of either gender undergoing magnetic resonance imaging of brain / cervical spine for the first time. They were divided into S-arm group exposed to structured information with pictures, recordings and videos, and C23 arm group exposed to conventional information. The primary outcome was anxiety, measured by Beck Anxiety Inventory. Data was analysed using SPSS 11. Of the 280 subjects, 140(50%) were in the S-arm; 65(46.4%) males and 75(53.6%) females with mean age 41.1±15.2 years. The C-arm had 140(50%) subjects; 78(55.7%) males and 62(44.3%) females with mean age 44.2±13.9 years (p>0.05). The pre-procedure anxiety score of C-arm was 11.3±7.7 compared to 9.6±7.7 in S-arm (p=0.062. Post-procedure anxiety score in S-arm was 9.8±9.0 compared to 1.49±4.5 in C-armB (p<0.001). Structured informational care aimed at familiarising the patient to the magnetic resonance imagaing machine and describing the relaxing manoeuvres during examinationI was found to be a cost-effective and simple method to alleviate anxiety in patients.

The Effect of Using a Stress Ball During Endoscopy on Pain, Anxiety, and Satisfaction: A Randomized Controlled Trial.

A stress ball is a simple and effective distraction method during painful procedures. The aim of this study was to evaluate the effect of using a stress ball during endoscopy on patients' pain, anxiety, and satisfaction levels. The randomized controlled study included 60 patients who underwent endoscopy in a training and research hospital in Istanbul. Patients were randomly assigned to the stress ball group or the control group. Patients in the stress ball group ( n = 30) squeezed a stress ball during endoscopy, whereas the control group ( n = 30) received no intervention during endoscopy. Data were collected using a sociodemographic form, a postendoscopy questionnaire, the Visual Analog Scale to assess pain and satisfaction, and the State-Trait Anxiety Inventory. Pain scores did not differ significantly between the groups before ( p = .925) or during ( p = .149) the endoscopy procedure but were significantly lower in the stress ball group after the procedure ( p = .008). Similarly, preprocedure anxiety scores were comparable ( p = .743), whereas postprocedure anxiety scores were significantly lower in the stress ball group ( p < .001). The satisfaction score after endoscopy was higher in the stress ball group, but the difference was not statistically significant ( p = .166). This study suggests that use of a stress ball during endoscopy reduces patients' pain and anxiety levels.

Patient expectations and experiences with loop electrosurgical excision procedure in inpatient and outpatient settings.

Loop electrosurgical excision procedure (LEEP) for high-grade squamous intraepithelial lesion is performed in both an inpatient setting under general anaesthesia and an outpatient setting under local anaesthesia. Efficacy and safety are comparable and outpatient LEEP may save time and cost in the Australian setting. We aim to compare patient satisfaction with inpatient LEEP compared to outpatient LEEP for Australian best practice. This was a prospective quantitative and qualitative cohort study. An online questionnaire was sent to patients undergoing inpatient and outpatient LEEP to assess satisfaction with the procedure. Further histopathological and demographic data were also collected from the medical records. Groups were compared using Fischer's exact test and pain scores were compared using non-parametric tests. Ninety-three outpatients and 52 inpatients responded to the survey. No difference was found between groups with regard to rate of positive histopathological margins or number of passes required. Outpatients found the procedure to be more convenient than inpatients (P= 0.007), and experienced more pain during the procedure than the inpatient group (P< 0.001). There was no significant difference in pain scores following the procedure or post-procedure anxiety. Outpatient LEEP is an acceptable and well-tolerated procedure, comparable to inpatient LEEP. Regardless of the option chosen, patients are highly likely to be satisfied with their choice. Increased efforts should be made to reduce pre-procedural anxiety, which may in turn reduce expectations and experiences of pain.

P16 Using virtual reality to help manage needle phobia in juvenile idiopathic arthritis

Case report - IntroductionNeedle phobia is a common issue amongst children, particularly with long-term illnesses requiring repeated interventions. Psychological interventions such as coping strategies and distraction techniques can be effective in many of these children, but is not universally successful. Recent research has reportedthat the use of virtual reality (VR) headsets as a distraction technique can be effective at alleviating both pain and fear in children receiving intravenous (IV) injections, cannulation and venepuncture. Although use of VR distraction is becoming more widespread in some disciplines (such as paediatric oncology/A&E), it is yet to be widely adopted in paediatric rheumatology.Case report - Case descriptionWe report the case of a 9-year-old boy (ME) who in early 2019 developed psoriatic juvenile idiopathic arthritis (JIA) and an associated severe, widespread plaque psoriasis causing him substantial discomfort and distress. He has been treated with subcutaneous adalimumab biosimilar 40 mg fortnightly and oral methotrexate 20 mg weekly, alongside Keppra 1000 mg twice daily for epilepsy. Although he is just tolerating the subcutaneous adalimumab, he is requiring intermittent steroid joint injections under general anaesthetic for recurrent flares of his polyarticular arthritis and regular monitoring phlebotomy. He has been developing progressive needle phobia over the past 8 months, with superimposed anxiety about general anaesthetics with particular fear of the anaesthetic provoking an epileptic seizure.Despite psychological intervention to teach coping strategies and standard play therapy distraction techniques, both phlebotomy and cannulation for general anaesthetics have become more distressing and challenging for him. During two recent day case admissions for joint injections, despite premedication with sedatives, distraction techniques and psychology interventions, he became so distressed that attempts to anaesthetise him had to be abandoned. This has resulted in prolonged periods of continuing joint inflammation and pain. Discussion with local paediatric oncology colleagues resulted in a suggestion of using recently acquired VR headsets as an effective distraction technique. He has had a previous positive experience of using VR headsets in a play environment. He is receiving VR training intervention from the oncology team and is now fully engaged with the idea of using VR to distract him from negatively focussing on his next planned general anaesthetic intervention.Case report - DiscussionUnmanaged needle-related procedural pain in children is associated with increasing pain and stress in subsequent procedures and fear/avoidance of medical care which can affect compliance in chronic disease management. The psychological distress for children with needle phobia can add to existing psychological impact from JIA and increase family stress of caring for an ill child. The cost of poor management of needle-phobic children can be considerable, with cancelled or increased time for procedural interventions and restricted therapeutic interventions. Needle phobias in childhood may persist into adulthood.Employing distraction techniques when children undergo medical procedures can help them reduce anxiety. VR is a method of captivating an individual’s interest in a virtual environment and can help divert attention from potentially distressing situations in the real world. Recent studies have reported VR as an effective distraction technique in children. Chan (2019) reports that VR significantly decreased the pain and post procedural anxiety experienced by children aged 4—11 years old during venepuncture/IV cannulation compared to controls. The majority of children in the VR group expressed interest in utilising VR again in the future, to improve their experience of IV injections. Chen (2020) subsequently reported a randomised controlled trial which significantly reduced pain and fear experienced from IV injections by the children in the VR group.There are cost implications to both buying VR headsets/software and training play specialists/specialist nurses to use the equipment effectively. Furthermore, the acceptability of using VR with regards to the child’s age, engagement with age-appropriate software packages and whether a passive VR or a more interactive ‘gaming’ experience is preferred should be considered. The use of VR is not a panacea, but is potentially effective as an additional new tool in clinicians’ efforts to reduce the impact of needle phobia.Case report - Key learning pointsAddressing needle phobia in children can require novel strategies.VR has shown success as a distraction technique to alleviate pain and fear in children undergoing needle related procedures.The implementation of VR in paediatric rheumatology has cost and staff training implications.The use of age-appropriate software and an individual child’s preference for passive/active interaction with VR should be considered.

Effect of a Musical Intervention During the Implantation of a Central Venous Catheter or a Dialysis Catheter in the Intensive Care Unit: A Prospective Randomized Pilot Study.

Listening to music may reduce anxiety during medical procedures. However, the magnitude of any effect may differ with respect to patient and procedure. We evaluated the effect of a musical intervention on patient anxiety during a central venous catheter or dialysis catheter implantation in an intensive care unit. A prospective single-center controlled open-label 2-arm randomized trial was conducted in a medical intensive care unit (ICU) from February 2018 to February 2019. Patients undergoing central venous catheterization were randomized to listening to music or not during the procedure. Patients randomized to music listened to the Music Care application via headphones. The primary outcome was the change in anxiety assessed on a 100-mm Visual Analogue Scale between the beginning and end of the catheterization procedure. Secondary outcomes included postprocedural pain. We included 37 patients in the musical intervention group and 35 in the standard care group. The primary reasons for intensive care unit admission were the need for a central catheter for chemotherapy for hematologic malignancy and sepsis and/or septic shock in both groups. Postprocedural anxiety and pain assessments were missing in 1 (2.7%) and 4 (11.4%) patients in the intervention and standard care groups. We found no between-group difference in change in anxiety score: median -1 (interquartile range, -3 to 0) vs 0 (-3 to 0) in the musical intervention and standard care groups (median difference, -1 [-2 to 0]) (P = .24). Postprocedural pain score did not differ between the groups: median 0 (0-2) and 0 (0-3.75) in the musical intervention and standard care groups (median difference, -0 [0-0]) (P = .40). To account for missing outcome assessments, sensitivity analyses were performed using 2 extreme scenarios, one favoring the standard care group (scenario 1) and the other favoring the intervention group (scenario 2). In either scenario, change in anxiety score did not differ between the intervention and standard care groups: -1 (-3 to 0) vs 0 (-4 to 0) (P = .88) in scenario 1 and -1 (-3 to 0) vs 0 (-2.75 to 1) (P = .07) in scenario 2. In this first randomized pilot study of musical intervention for central venous catheterization in awake patients in the intensive care unit, the musical intervention did not reduce patients' anxiety as compared with usual care.

Influence of Music Therapy to Reduce Anxiety During Periodontal Surgical Procedures

Objectives: To evaluate the influence of music in reducing patients’ anxiety during periodontal surgery. Methods: This is a clinical trial of involving fifteen patients undergoing periodontal surgery. Patients indicated for periodontal surgery were invited to participate in the study, and randomly assigned to music (n=8) or control (n=7) groups. Participants’ dental anxiety were determined using the Corah Dental Anxiety Scale (CDAS) before and after the surgery, while their blood pressure (BP) and heart rate (HR) were recorded at pre-, intra- and post-procedures. Paired t-test was used to compare the statistical significant difference between pre- and postprocedural anxiety for both groups. Result: The participants of this study consist of 22 patients that underwent periodontal surgery procedures, with majority of the subjects (53.3%) were males (n=8) and the mean age was 50.8 (SD=13.21). The measurement of blood pressure increased in patients allocated in music group compared to control group were statistically significant with (p&lt;0.05). Conclusion: Our study suggests that music may reduce patients’ anxiety while undergoing periodontal surgery. More details on the type and intensity of music may provide further value to the finding.

Effectiveness of virtual reality immersion on procedure-related pain and anxiety in outpatient pain clinic: an exploratory randomized controlled trial.

BackgroundThe study investigated virtual reality (VR) immersion in alleviating procedure-related pain in patients with chronic pain undergoing fluoroscopy-guided minimally-invasive intervention in a prone position at an outpatient clinic.MethodsIn this prospective randomized controlled study, 38 patients undergoing lumbar sympathetic ganglion block were randomized into either the VR or the control group. In the VR group, procedure-related pain was controlled via infiltration of local anesthetics while watching a 30-minute VR hypnotic program. In the control group, the skin infiltration alone was used, with the VR device switched off. The primary endpoint was an 11-point score on the numerical rating scale, indicating procedure-related pain. Patients’ satisfaction with pain control, anxiety levels, the need for additional local anesthetics during the procedure, hemodynamic stability, and any adverse events were assessed.ResultsProcedure-related pain was significantly lower in the VR group (3.7 ± 1.4) than in the control group (5.5 ± 1.7; P = 0.002). Post-procedural anxiety was lower in the VR group than in the control group (P = 0.025), with a significant reduction from pre-procedural anxiety (P < 0.001). Although patients’ satisfaction did not differ significantly (P = 0.158) between the groups, a higher number of patients required additional local anesthetics in the control group (n = 13) than in the VR group (n = 4; P = 0.001). No severe adverse events occurred in either group during the study.ConclusionsVR immersion can be safely used as a novel adjunct to reduce procedural pain and anxiety during fluoroscopic pain intervention.

Lavender Aromatherapy for Anxiety and Pain During Multichannel Urodynamics: A Randomized Controlled Pilot Trial.

Our objective was to determine if there is a difference in anxiety during urodynamics in women given lavender aromatherapy (lavender) versus placebo. This was a randomized, controlled trial of women scheduled for urodynamic testing with baseline anxiety. Participants rated their anxiety and pain immediately before the examination and then were randomized to lavender or placebo. Anxiety and pain were assessed immediately after catheter placement and 15 minutes after termination of the study. Data for 40 women who received lavender and 38 women who received placebo were available for analysis. Decrease in anxiety from baseline to catheter placement (-2 vs -0.5, P = 0.01) and 15 minutes post procedure was significantly greater in the lavender group. Postprocedure anxiety was lower in the lavender group compared with controls (0 vs 0.5, P = 0.001). No differences were seen in pain. Lavender aromatherapy reduces anxiety during urodynamics.

Auricular acupressure and auricular acupuncture as an adjunct for pain management during first trimester aspiration abortion: A randomized, double-blinded, three-arm trial

ObjectivesTo measure pain and anxiety during first trimester uterine aspiration when using auricular acupressure or acupuncture as an adjunct to usual care. MethodsThis randomized, double-blinded, three-arm trial enrolled patients undergoing an aspiration procedure for an induced abortion, a miscarriage, or other abnormal intrauterine pregnancy. Trial participants received auricular acupressure, auricular acupuncture, or placebo immediately prior to their procedures. The study began with 1:1:1 randomization, but later overenrolled into the acupressure group after providing retraining for greater fidelity to that intervention. All participants received ibuprofen and a paracervical block. Participants reported pain and anxiety levels via visual analog scores (0–100). Our analysis compared pain scores of those receiving acupressure versus placebo, and those receiving acupuncture versus placebo. ResultsWe randomized 177 participants over nine months and excluded data from four participants. We analyzed data from 70 participants who received acupressure, 51 who received acupuncture, and 52 who received placebo. The groups had similar baseline characteristics, including baseline pain and anxiety scores. For acupressure, acupuncture, and placebo groups, respectively, immediate post-procedure median pain scores were 50, 55, 47.5 (p = 0.88); maximum pain scores during the procedure were 77, 79, 79.5 (p = 0.96); postprocedure anxiety scores were 26, 28, and 21 (p = 0.47). The acupressure group results were similar before and after retraining. ConclusionsReceiving auricular acupressure or acupuncture did not result in lower pain or anxiety scores among women undergoing vacuum aspiration compared to a placebo group. ImplicationsThe results of this trial were null, thus differing from our previous study that had shown a benefit from auricular acupuncture. Given the conflicting results, incorporating these acupuncture techniques into abortion practice would be premature.

The use of virtual reality in reducing anxiety during cast removal: a randomized controlled trial.

PurposeWhile virtual reality (VR) has been shown to be an effective distractor in children across a range of procedures, no studies have looked at its use within paediatric orthopaedics. The purpose of this study was to look at the use of VR in reducing anxiety levels in children during cast removal. In addition, the study aimed to find ways to enhance the efficiency of future VR trials in paediatrics.MethodsA non-blinded randomized control trial took place in children aged four to 18 years. Intraprocedural anxiety was measured using the Children’s Emotional Manifestation Scale (CEMS), while pre- and post-procedural anxiety was measured using the Short State Anxiety Inventory Scale. Additional data was collected on trait anxiety, nausea levels, desire for future VR use and areas of improvement for future VR studies.ResultsA total of 90 subjects were included in the study (control n = 45, intervention n = 45) with a mean age of 10.25 years (sd 3.35). Post-procedural anxiety and intraprocedural anxiety were 18% (p = 0.03) and 24% (p = 0.01) lower in the VR group, respectively, with the CEMS facial component showing a 31% (p < 0.001) reduction in the VR group. In all, 99% (n = 89) of subjects experienced no nausea, with one patient experiencing mild nausea that may have been present prior to VR use. Finally, 90% (n = 81) of subjects said they would like to use VR again, 1% (n = 1) said ‘no’ and 9% (n = 8) said ‘maybe’.ConclusionVR appears to be an effective distraction technique in reducing anxiety levels in children during cast removal.

DENTAL PATIENTS;

Introduction: Dental anxiety is a prevalent condition found among children as well as among adults of all ages. It is a kind of fear associated with dental procedures. Study Design: Randomized control trial. Setting: Outpatient setting of the department of Operative Dentistry at the Liaquat University of Medical &amp; Health Sciences. Period: January 2014 to December 2014. Methods: Two hundred participants were enrolled in the study, 100 participants in intervention arm and 100 participants in the control arm. Purposive sampling technique was used. Pre and post procedure anxiety was assessed using the dentist rating of patient’s scale. Music intervention was provided to the participants randomized in the intervention arm whereas routine treatment was provided to both group. Multiple Linear Regression test was used for the statistical analysis. Results: The study found an association between music and the post procedure anxiety score. The anxiety score of the participants who received the music intervention was 0.17 units lower than those who didn’t receive the intervention. Conclusion: Music intervention can play an effective role in relaxing the anxious patient coming for the dental procedure, besides trying to make the dentist office less fearful and less anxiety provoking.

The influence of using music during spinal-epidural anesthesia on parturient in emergency cesarean section

Objective To observe and compare influences of music use during spinal-epidural anesthesia on parturient anxiety, pain and satisfaction in emergency cesarean section. Methods One hundred and ten parturients for emergency cesarean section were divided randomly into two groups, with 55 parturients each. The music group listened to the patient′s preferred music on a mobile phone through an external amplified speaker, the control group did not listen music. All women received a standardized spinal-epidural anesthesia. The outcomes included obstetric parameters, hemodynamic parameters, anxiety, pain and patient satisfaction. Results A total of 99 parturients were included in the statistical analysis. The music group experienced low anxiety as measured by Numeric Rating Scale (NRS) and State Anxiety Inventory (S-AI) scores immediately after spinal-epidural anesthesia (P 0.05). A higher patient satisfaction rate was observed in the music group during the whole process of anesthesia (P<0.05). The desire for music use for future spinal-epidural anesthesia was higher in the music group (P<0.05). Conclusions Music use during spinal-epidural anesthesia in emergency cesarean section promotes lower postprocedure anxiety and provides a higher patient satisfaction for emergency cesarean section. Key words: Music; Cesarean section, emergency; Anixiety; Pain; Satisfaction

Glanuloplasty Experiences in the Distal Hypospadias Surgery: A Prospective Comparative Study Focusing on the Patients and Parents

Aim: We aimed to investigate whether there was any difference between the postoperative complications of distal hypospadias patients undergoing MAGPI procedure whose urethral stents were left or removed and to determine pre and post-procedure anxiety levels of patients' parents regarding the current congenital penile disease of their children. Materials and Methods: Patients with urethral stents (group A) was hospitalized for one day. Patients without urethral stents (group B) were discharged on the same day. Patients were evaluated postoperatively regarding the characteristics of the patients and surgical complications. Health anxiety level affecting attitudes towards parents (group A1, B1 and C1) of children with hypospadias and circumcised were assessed with the Beck Anxiety Inventory (BAI) in the first admission and at the first postoperative month. Parents whose children underwent circumcision as a control group were compared with parents of the study groups. Results: Meatal regression and chordee were not observed in any patients, postoperatively. Urethral fistula encountered occurred in 2 (0.83%) and 2 (0.71%) patients in group A and B, respectively. For meatal stenosis, the same ratios and numbers were also present in the groups. Reoperation was performed in 8 (1.53%) patients in both groups. Parents of study groups in the first admission and postoperatively had a high BAI score when compared with parents of the control group, which was statistically significant (p = 0.00). Conclusions: Follow-up without a postoperative urethral catheter in cases of distal hypospadias corrected by MAGPI modifications seems to be more appropriate. Complications may diminish over time with different MAGPI modifications. Hypospadias, a congenital anomaly, has significant psychosocial effects on both the patient and the parent. These effects may be reduced for parents by psychosocial support and training which begins immediately after the birth of their babies.