Pre-procedural Anxiety Research Articles

THE EFFECTS OF VIRTUAL REALITY ON PAIN, ANXIETY, AND COMFORT DURING THE CHEST TUBE REMOVAL PROCEDURE: A RANDOMIZED CLINICAL TRIAL

PurposeThe purpose of the current study is to determine the effects of virtual reality on pain, anxiety, and comfort during chest tube removal. Materials and MethodsThe research was conducted in the Cardiovascular Surgery Department of Atatürk University Health Practice and Research Hospital between January 2023 and April 2024. The study was performed as a randomized controlled experimental trial with a pretest-posttest control group. Eighty-two patients (41 in the intervention group and 41 in the control group) were included in the research. Patients in the intervention group watched a video with virtual reality glasses during chest tube removal. The “Descriptive Information Form,” “Visual Analog Scale,” “Verbal Pain Scale,” “State Anxiety Inventory,” and “Comfort Scale” were used to collect data. Number, percentage, mean, standard deviation, chi-square, paired sample t-test, independent sample t-test, Mann-Whitney U test, Wilcoxon test, and linear regression analysis were used in data evaluation. Our study was recorded in the Clinical Trials database with protocol number “NCT06550323.” ResultsThe groups had similar descriptive characteristics (p>0.05). The pre-procedural mean pain, anxiety, and comfort scores were similar in the two groups (p>0.05). The post-procedural mean VAS and verbal pain scores, mean anxiety, and comfort scores of the intervention group were lower in comparison with the control group (p<0.05). ConclusionThe research findings showed that virtual reality significantly reduced pain and anxiety while increasing comfort levels during chest tube removal. Therefore, it is recommended that virtual reality be used during chest tube removal.

Association between pre-procedural anxiety and vomiting in children who undergo procedural sedation and analgesia in the emergency department

IntroductionChildren presenting to the emergency department (ED) often require procedural sedation and analgesia (PSA) prior to procedures. Although ketamine is used widely for PSA safely, there is a risk of adverse effects. Among them, vomiting is significant as it occurs in about 10% of patients and can potentially endanger the airway. Because there is evidence that post-operative complications might be due to anxiety prior to the operation, this study aims to investigate the association between pre-procedural anxiety and vomiting in the ED.MethodsIn this cohort study, a convenient sample of children aged 2 to 14 years who were a candidate for PSA with ketamine in the ED were enrolled. Anxiety was evaluated using the short version of the modified Yale preoperative anxiety scale (mYAS). Vomiting was recorded during the period of hospitalization in the ED and 24 h after discharge by a phone call. Association between anxiety level and vomiting was analyzed using the independent samples t-test and multivariable logistic regression was used to control for covariates.Results102 children were enrolled and 93 were included in final analysis. The mean age of participants was 3.95 ± 1.79 years and 55.9% were male. According to the mYAS, the mean score of anxiety was 48.67 ± 21.78 in the waiting room and 59.10 ± 23.86 in the operating room. The mean score of anxiety was 58.3±25.3 and 51.0±20.7 in the vomiting and non-vomiting groups, respectively. At least one episode of vomiting was reported in 23 children of which, 19 took place in the hospital and 4 after discharge. No significant association was observed between pre-procedural anxiety and the occurrence of vomiting. On univariate regression model, the odds ratio of the association between mean anxiety and vomiting was 1.02 (CI 95%: 0.99–1.04) (P-value: 0.16). On the multivariable logistic regression model, after adjusting for all the covariates, the odds ratio was 1.03 (CI 95%: 1.0–1.05) (P-value: 0.05).ConclusionThe present study showed that anxiety before procedural sedation and analgesia with ketamine in children was not associated with the incidence of vomiting.

Infectious Diseases-Approved Virtual Reality Goggles for Common Procedures in Pediatric Surgical Patients.

Background/Objective: Virtual reality (VR) technology has been reported as effective in mitigating fear, anxiety, and pain in children undergoing various medical procedures. Our aim was to test the effectiveness of non-sponge-coated mobile phone-operated VR goggles approved by infectious diseases (ID) control in pediatric surgical patients. Methods: A prospective randomized trial in which pre-procedural and post-procedural heart rate, fear, and anxiety, and post-procedural pain were measured in pediatric surgical patients assigned to receive standard care versus standard care and VR goggles. The patients underwent line insertions, peripheral venipunctures for blood draws, drain removals, and wound care. Results: The control group and the intention-to-treat group were each randomly assigned twenty-four patients. Since eight patients who received VR goggles removed them prior to completion of the procedure, the study group included sixteen patients. In the study group, heart rate, fear, and anxiety scores were significantly lower after the procedure as compared to prior to the procedure. In the control group, these parameters were similar before and after the procedure. Post-procedural decrease in fear and anxiety was significant when comparing VR to control. However, despite better post-procedural physiological and emotional scores in the VR group as compared to control, the differences were not statistically significant. Pre-procedural anxiety was significantly higher in the study group. Conclusions: ID-approved VR goggles can reduce fear and anxiety associated with procedures commonly performed in pedicatric surgical patients. However, since increased baseline anxiety might be associated with VR, a higher benefit might be achieved if goggles were worn only by children who express a clear desire to use them.

Effect of preprocedure anxiety and oestrogen levels on Postoperative Nausea and Vomiting in patients undergoing diagnostic laparoscopy and hysteroscopy for infertility: A prospective observational pilot study

Effect of preprocedure anxiety and oestrogen levels on Postoperative Nausea and Vomiting in patients undergoing diagnostic laparoscopy and hysteroscopy for infertility: A prospective observational pilot study

Effectiveness of Video Assisted Teaching on Knowledge and Pre-procedure Anxiety Level of Patients Undergoing Upper GI Endoscopy

An endoscopy is a procedure in which doctor uses specialized instruments to view and operate on the internal organs and vessels.People often found anxious towards hospital environment itself. There no intervention was provided to re-leave from anxiety among the patients. So the researchers aimed to assess the effectiveness of video assisted teaching regarding upper GI endoscopy to improve knowledge and thereby reduce the anxiety among the patients in Government General Hospital, Puducherry.The present study was adopted quantitative quasi experimental research design. The 50 samples were selected by purposive sampling technique with inclusion and exclusion criteria. Pre test data was collected by using self-administered structures questionariesand video assisted teaching programme regarding endoscopy to the samples. The video contains introduction, functions, procedure and visualization of the endoscopy.The researchers accompany each sample during the endoscopy. Post test data was collected after endoscopy with the same questionnaire.The results revealed that, pre and post test mean score of knowledge was 5.26±2.562 and 11.12±0.480. The calculated paired ‘t’ value is 16.421 which was statistically significant at the p level 0.000. The pre and post test mean score of anxiety was 39.64±9.021 and 68.14±3.995. The calculated paired ‘t’ test value was 18.475 which was statically significant at the p level 0.000. The test results infer that, the video assisted programme was effective in improving knowledge and relive in pre procedure anxiety among the clients undergoing endoscopy.The chi-square value reveals that the level of knowledge was significant to gender and educational status at the p level 0.005 respectively and the level of anxiety was significant to educational status at the p level 0.005. The researchers recommended all the therapeutic and diagnostic procedures must be educated among the patients will help to gain complete success.

Virtual reality simulations to alleviate fear and anxiety in children awaiting MRI: a small-scale randomized controlled trial.

Up to 75% of paediatric patients experience anxiety and distress before undergoing new medical procedures. Virtual reality is an interesting avenue for alleviating the stress and fear of paediatric patients due to its ability to completely immerse the child in the virtual world and thus expose them to the sights and sounds of an MRI before undergoing the exam. We aimed to explore the impact of virtual reality exposure on reducing fear and anxiety in paediatric patients scheduled to undergo an MRI. We hypothesised that patient who had undergone VR exposure before the MRI would experience lower levels of fear and anxiety and subsequently have a higher MRI success rate. We conducted a prospective randomized control trial in a tertiary paediatric hospital over three weeks. Inclusion criteria comprised children aged 4 to 14 undergoing MRI without medical contraindications for VR use. Thirty patients (16 in VR, 14 in control) were included in the study. The VR room, created in-house by a researcher, that the VR group experienced, simulated MRI room with typical sounds for up to 5min before their actual MRI. Fear and anxiety were measured using the FACES scale before and after MRI for the control group as well as after VR exposure for the VR group. The VR group exhibited a significant reduction in anxiety post-VR exposure regarding the upcoming MRI (p = 0.009). There was no significant difference with regards to fear and anxiety between the VR and control groups before or after the MRI exam. There was no significant difference between the MRI exam success rates. VR exposure effectively reduces pre-MRI anxiety in paediatric patients who are about to undergo the exam, this is important as it alleviates the psychological burden on the child. This research is in line with previous findings, showing the validity of VR as a method of reducing pre-procedural paediatric anxiety and suggesting that complex VR experiences may not be necessary to have a significant impact. There is, however, a need for further investigation in this field using larger and MRI-naïve groups of patients.

Effect of information delivery techniques in reducing pre-procedural anxiety in computed tomography

ObjectivesPatients undergoing medical procedures often experience heightened anxiety, which can affect their experience and overall health. The current study aimed at looking at a quality improvement initiative to compare written and audiovisual information delivery methods to reduce anxiety prior to Computed Tomography (CT). MethodsIn this prospective interventional study, we assessed state and trait anxiety in patients scheduled for their first CT scan. Three PDSA cycles were carried out over six months, with each cycle lasting for two months each. The participants were divided into three groups, the baseline, written, and audiovisual intervention groups. Anxiety levels were assessed using the State-Trait Anxiety Inventory (STAI) questionnaire. State anxiety is a temporary emotional response, while trait anxiety reflects enduring personality characteristics. ResultsThe mean age of participants was 43.26 years (SD 15.07) in the baseline group, 39.9 years (SD 14.72) in the written group, and 48.59 years (SD 13.54) in the audiovisual group. For state anxiety, the baseline mean was 58.4 (SD 6.9), notably reduced to 43.2 (SD 5.5) with written intervention and to 38.6 (SD 7.7) with audiovisual intervention (p < 0.001). Trait anxiety scores remained relatively stable in all groups (p = 0.31). ConclusionBoth written and audiovisual interventions successfully alleviate pre-imaging anxiety in patients undergoing CT scans. The findings underscore the superior efficacy of audiovisual materials in achieving a more substantial reduction in state anxiety compared to written information. These findings are particularly relevant in resource limited settings where simple interventions show significant improvements.

532 Patient Journey Posters Reduce Pre-Procedural Anxiety in Day Surgery

532 Patient Journey Posters Reduce Pre-Procedural Anxiety in Day Surgery

The Effects of Music Therapy on Patients Undergoing Colonoscopy in a Tertiary Care Hospital at Karachi, Pakistan: A Comparative Study

A colonoscopy is a procedure commonly used for the diagnosis of colorectal diseases but may be associated with high levels of anxiety and discomfort, which can lead to complications during sedation and decreased patient comfort and cooperation. This study was conducted at a tertiary care hospital in Karachi to assess the effectiveness of music therapy on pre-procedural anxiety, sedation requirements, pain, and procedure duration among patients undergoing colonoscopies. This comparative study included 110 outpatients. The intervention arm received non-lyrical soft music through earphones before and during the colonoscopy procedure, while the control group did not receive any music. In the intervention arm, significant reductions were seen in pre-procedural anxiety scores (p < 0.001), physiological measures (p < 0.001), sedation doses (p < 0.001), and procedure durations (p < 0.05). Control arm showed an increase in heart rate and systolic blood pressure (p < 0.001). Pain scores were similar for both groups. Music therapy is an effective tool to reduce patient anxiety pre- procedure. It is a simple, safe, and noninvasive relaxing intervention that could be used as an adjunct to sedative medications before and during the colonoscopy procedure.

The effect of a biofeedback-based virtual reality game on pain, fear and anxiety levels during port catheter needle insertion in pediatric oncology patients: A randomized controlled study

PurposeIt is essential to control pain, fear, and anxiety related to medical procedures to improve the well-being of the child and family trying to cope with the disease process. This study investigated the impact of the biofeedback-based virtual reality game (BioVirtualPed) on pain, fear, and anxiety levels during port needle insertion in pediatric oncology patients (POPs). MethodsThis randomized controlled study was conducted at a hospital between August and December 2023 involving 62 POPs aged 6–12 and their mothers. The intervention group wore a virtual reality headset and a respiratory sensor during the procedure. Data were collected using the Descriptive Information Form, Wong-Baker Pain Assessment Scale, Child Fear Scale, Children's State Anxiety, Satisfaction Scoring-Visual Analog Scale, and ADXL354 Sensor. Statistical analysis was performed using IBM SPSS for Windows Version 24.0. ResultsThe intervention group showed lower mean pain scores than the control group (p < 0.001). There was no difference in pre-procedure fear and anxiety scores between groups (p > 0.05 and p > 0.05, respectively). Post-procedure fear and anxiety scores were lower in the intervention group (p < 0.001 and p < 0.001, respectively). The intervention group's mean respiratory rates were lower (p < 0.001), and their satisfaction scores were higher (p < 0.001). Agreements between POPs and mothers on pain, fear, and anxiety scores were good and excellent across groups (p < 0.001). ConclusionsThe BioVirtualPed reduced procedure-related pain, anxiety, and fear, increased care satisfaction, and had a positive effect on the mean respiratory rate, hence it shows promising results, but these findings need further comfirmation.

The midterm psychological effect of cast removal procedures in children.

This study aimed to compare the course of anxiety change in children who used headphones during cast removal with controls in midterm follow-up. Sixty-six patients who underwent forearm fracture treatment with closed reduction and long arm casting between June 2021 and March 2023 were retrospectively reviewed. Patients were divided into two groups based on the use of headphones (n=27; 21 males, 6 females; mean age: 8.0±1.8 years; range, 6 to 12 years) or not (n=39; 27 males, 12 females; mean age: 8.9±1.8 years; range, 6 to 12 years) during cast removal with an oscillating saw. Primary outcome measures included preprocedure, postprocedure, and six-month anxiety assessments with the State-Trait Anxiety Inventory. There was an acute increase in the mean state anxiety scores after the procedure, which returned to below baseline at the six-month follow-up in the headphone (31.4±8.3, 33.3±8.7, and 25.1±4.1, respectively) and control groups (34.9±11.1, 37.4±9.5, and 27.3±5.3, respectively). The mean trait anxiety scores before the procedure, after the procedure, and at six months remained similar in the headphone (33.6±3.0, 34.6±3.2, and 32.4±2.8; p>0.05) and control groups (34.1±2.7, 33.7±3.0, and 33.7±3.0, p>0.05). This study suggests that the acute anxiety during cast removal did not create anxiety sequelae in the sixth month regardless of headphone use.

Substance Use and Anxiety About Pain Among Patients Seeking Abortion Services.

To evaluate how recent opioid, marijuana, and cannabidiol use affects pre-procedure pain-related anxiety for patients seeking abortion. We conducted a prospective, cross-sectional anonymous survey of patients seeking abortion assessing recent substance use and anxiety about pain during and after abortion. We compared substance users' and non-users' anxiety scores. Among 217 participants, recent opioid users (5.3%) had higher median anxiety scores for pain during (7.0 vs 6.0; p=0.33) and after (8.0 vs 6.0; p=0.01) abortion than non-opioid users. Anxiety scores were similar for marijuana and cannabidiol users. Assessing recent opioid use may help guide counseling for anxiety about abortion.

Preprocedural Video Education on Liver Ablation Treatment

BackgroundAnxiety is a common problem in patients scheduled for a procedure, and their level of anxiety increases as the procedure date approaches; pre-procedural anxiety is observed in hepatocellular carcinoma (HCC) patients scheduled for liver ablation treatment. There is currently a lack of standardized education provided to patients about liver ablation treatment, which may contribute to patients’ anxiety. PurposeTo test the effectiveness of a pre-procedural video educational tool to reduce patient anxiety and increase knowledge in HCC patients in an interventional radiology clinic setting. MethodsThis was a quasi-experimental, single-arm study, with a pre-test/post-test. Participant recruitment was based on a convenience sample. Inclusion criteria included: patients ages 18 and older; have biopsy-proven HCC or have a liver mass suspicious for HCC based on LI-RADS criteria imaging; no prior liver ablation treatment within three months of study onset. Participants watched a 7:04 minutes video and completed a 40-item State-Trait Anxiety Inventory and 10-item Knowledge Questionnaire before and after the video intervention to assess changes in anxiety and knowledge. Demographic variables evaluated included age, gender, education, and primary language. ResultsThere were 16 participants who met inclusion criteria. The state anxiety scores were significantly lower after the intervention (Md = 33.50, n = 16) compared to before (Md = 47.50, n = 16), z = −2.67, p = .009, with a medium effect size, r = 0.47. The trait anxiety scores did not show sufficient evidence for a difference after the intervention (Md = 40.00, n = 16) compared to before (Md = 39.50, n = 16), z = 0.71, p = .50, with a small effect size, r = 0.13. The knowledge scores were significantly higher after the intervention (Md = 9.00, n = 16) compared to before (Md = 2.00, n = 16), z = −3.53, p = .0005, with a large effect size, r = 0.62. A nonparametric bootstrap and nonparametric permutation test also showed evidence for a difference in mean between the distributions of the state anxiety and knowledge pre- and post-intervention scores. DiscussionThe results of this study showed evidence for the effectiveness of video education in decreasing anxiety and increasing knowledge in HCC patients. A standardized pre-procedural video educational tool can be a useful practice across all interventional radiology departments as it is associated with improved quality of care and positive health outcomes.

Assessment of Pre-Procedural Anxiety and Its Impact on Pain and Difficulty of Office Hysteroscopy

Assessment of Pre-Procedural Anxiety and Its Impact on Pain and Difficulty of Office Hysteroscopy

(262) Virtual Reality for Improved Vasectomy Experience: Insights from a Single-Center Clinical Trial

Abstract Introduction Vasectomy is a widely performed procedure for male sterilization, with an estimated 33 million procedures conducted annually worldwide. Although vasectomy is generally safe and associated with minimal complications, concerns over procedural pain and anxiety can deter patients from pursuing the procedure. To address these concerns, innovations such as no-needle and no-scalpel techniques have been adopted to minimize pain during vasectomy. However, anticipated pain and anxiety remain significant barriers for patients. Therefore, optimizing patient comfort during procedures performed under local anesthesia is crucial for improving outcomes and satisfaction. Virtual reality (VR) devices have emerged as a promising non-pharmacological intervention for pain modulation in various medical fields. VR technology has demonstrated pain reduction and anxiety alleviation in pediatric burn therapy, physical therapy, dental procedures, and more. The adult urologic community has also embraced VR, with positive results observed in surveillance cystoscopy and office-based prostate biopsy procedures. However, limited research exists on the use of VR headsets during vasectomy, with only one previous non-randomized trial reporting high patient satisfaction but no improvement in pain or anxiety. In this ongoing single-center, randomized, open-label clinical trial, we present interim data evaluating the effectiveness of the SmileyScope VR device in reducing anxiety and pain during in-office vasectomy performed with local anesthesia. Objective The primary objective of this study is to evaluate the efficacy of virtual reality (VR) devices in alleviating peri-procedure anxiety and pain during in-office vasectomy performed with local anesthesia. The secondary goal of this study is to compare the effectiveness of interactive VR, enabling patient control of the experience, with static VR, which does not provide patient control. Methods The study enrolled patients who were scheduled for in-office vasectomy with a single urologist. The patients were randomly assigned to one of three groups: the control group receiving standard in-office vasectomy without a VR headset, the static VR intervention group, or the interactive VR intervention group. The primary outcome measures included patient-reported pain and anxiety levels before and after the procedure, along with heart rate measurements recorded using a wearable device. Results Interim analysis of this ongoing study includes data from a total of 58 men. 20 men were in the control group, 19 in the static VR arm, and 19 in the interactive VR arm. There was no observed difference in subjective pain scores or heart rate variability during the procedure. However, patients who wore a VR headset reported a significantly lower level of pre-procedure anxiety (P = 0.0700). Conclusions Anticipation of periprocedural pain and anxiety are barriers to vasectomy utilization. Initial results from our ongoing randomized clinical trial indicate that the utilization of virtual reality is feasible, safe, and effective in reducing pre-procedure anxiety in patients undergoing vasectomy. Disclosure No.

The Role of Anxiety Scales and Serum Copeptin Levels in Determining the Preprocedure Anxiety Status of Patients Who Undergo Fiberoptic Bronchoscopy and Endobronchial Ultrasonography

Introduction. Fiberoptic bronchoscopy (FOB) and endobronchial ultrasonography (EBUS) are safe and frequently used minimally invasive procedures. However, the decision to undergo an interventional procedure causes anxiety development and negative consequences in the individual. Objective. To determine the role of the State‐Trait Anxiety Inventory (STAI), Beck Anxiety Inventory (BAI), visual analog scale (VAS), and serum copeptin levels, their sensitivity, specificity, and the correlation between them in the anxiety levels of patients before undergoing FOB and EBUS. Method. A total of 219 patients who were scheduled to undergo FOB/EBUS were included in this prospective observational study. Demographic data were recorded. Patients’ anxiety levels before the procedure were evaluated using STAI‐SA, STAI‐TA, BAI, and VAS. Copeptin levels were measured before and after the procedure. Results. Patients were moderately anxious according to STAI‐SA, STAI‐TA, and VAS and were mildly anxious according to the BAI. Women and patients aged under 65 years were significantly more anxious. All scales were positively correlated. Serum copeptin levels before the procedure were 5.8 ± 4.8 and 4.3 ± 3.9 ng/mL afterwards, with a significant difference between them. The specificity and sensitivity of VAS were found to be the highest. Conclusion. All anxiety scales are correlated with each other, and we recommend VAS as a powerful alternative for determining anxiety levels in terms of easier understanding and implementation. Serum copeptin levels before the procedure were significantly higher than afterwards and may be used as a potential biomarker for preprocedural anxiety.

Causes of intraprocedural discomfort in colonoscopy: a review and practical tips.

Colonoscopy is a commonly performed procedure in the United Kingdom and the gold standard for diagnosis and therapy in the gastrointestinal tract. Increased levels of pain during colonoscopy have been associated with reduced completion rates and difficulties in maintaining attendance for repeat procedures. Multiple factors play a role in causing discomfort intra-procedurally: patient factors, such as gender, anatomy and pre-procedure anxiety; operator factors, such as patient position and level of experience and other factors, such as bowel preparation and total procedure time. A literature search was performed to identify papers that explained how patient, operator and endoscopy factors influenced pain and discomfort in endoscopy. A further search then also identified papers describing solutions to pain and discomfort that have been explored. After review of the literature, key methods are selected and discussed in this paper. Solutions and aids that can resolve and improve pain and discomfort include endoscopic methods such as variable stiffness and ultrathin scopes. Operator improvements in techniques and ergonomics alongside the use of newer technologies such as propelled endoscopy, computer-assisted endoscopy and task distraction. To improve patient experience and outcomes, the investigation and research into improving techniques to reduce pain is crucial. This review aims to identify the modifiable and non-modifiable factors associated with intra-procedural discomfort during colonoscopy. We discuss established methods of improving pain during colonoscopy, in addition to newer technologies to mitigate associated discomfort.

THE IMPACT OF PATIENT ANXIETY AND PAIN PERCEPTION ON THE ADEQUACY OF THYROID FINE-NEEDLE ASPIRATION BIOPSY SAMPLES: A PROSPECTIVE STUDY.

Fine-needle aspiration biopsy (FNAB) is the most accurate diagnostic method to assess the malignancy risk of thyroid nodules. However, non-diagnostic results may delay diagnosis, cause unnecessary interventions, and distress patients. We aimed to determine whether a correlation exists between patients' situational anxiety, pain perception and non-diagnostic cytology results. The prospective study included patients who underwent thyroid FNAB at the Endocrinology Clinic of Sultan Abdulhamid Training and Research Hospital between 11/2022 and 02/2023. The State-Trait Anxiety Inventory (STAI) questionnaire and visual analogue scale (VAS) assessed situational anxiety and pain in patients undergoing biopsy procedures. We evaluated whether the STAI-S and VAS score is related to non-diagnostic results. Of the 119 patients included in the study, 98 were female, and 21 were male. 25 (21%) nodules were non-diagnostic. The patients' mean STAI-S score before the biopsy was 47.31±12.37, and the mean VAS score after the thyroid biopsy was 2.57±1.51. A statistically significant relation was found between the patient's STAI-S score and VAS score and the cytology result of non-diagnostic (p= 0.001 and p=0.008). In univariate logistic regression, high pre-procedural anxiety (OR:3.09, 95% CI:1.07-8.94, P =0.037) and VAS score (OR:1.57, 95% CI: 1.17-2.10, P =0.002) were associated with non-diagnostic cytology. In multivariate logistic regression analysis, VAS score (OR: 1.59, 95% CI: 1.07-2.34, p=0.019) was still an independent factor related to specimen adequacy. Anxiety level and pain perception during FNAB may be considered risk factors for non-diagnostic cytology. Thus, reducing anxiety and pain may decrease the incidence of non-diagnostic outcomes.

Surgeon reported measures of stress and anxiety prior to and after elective gynecological surgery.

Performing surgical procedures is a recognized source of stress for surgeons. Vocational stress is an important contributor to performance, patient care, and burnout with dispositional and environmental factors contributing. Accurately assessing surgeon stress is critical to measuring effectiveness of stress reduction programs. The primary aim was to identify differences between surgeons' self-reported anticipated stress and anxiety prior to gynecological surgery, compared with their recollection of experienced stress and anxiety during surgery. Secondary aims assessed any differences by level of training, surgical type, and surgeon role. Attending and resident gynecologists performing routine elective surgeries completed a visual analog scale (VAS) assessing perceived stress and the State-Trait Anxiety Inventory (STAI) prior to and immediately after completing 161 elective surgeries including total laparoscopic hysterectomy, laparoscopic excision of moderate-severe endometriosis, or hysteroscopic myomectomy. Eight attending gynecologists and nine residents participated. Residents commenced as primary surgeon in 62/90 (69%) procedures. Stress experienced during surgery was greater than anticipated in 92/161 (57%) surgery episodes (mean VAS increase: 3.9; 95% CI: 1.1-6.8, p = 0.009). State anxiety was greater than anticipated in 99/161 (62%) episodes (mean state anxiety increase: 4.4; 95% CI: 3.0-5.8, p < 0.001). Greater preprocedural anticipatory stress and anxiety was observed in residents vs. attending gynecologists (VAS 51.9 vs. 22.8, p < 0.001; state anxiety 38.3 vs. 28.1, p < 0.001) and in primary vs. assistant surgeons (VAS 47.2 vs. 29.9, p < 0.001; state anxiety 36.9 vs. 28.3, p < 0.001). Intraoperative stress and anxiety were greater in primary surgeons (VAS 50.4 vs. 30.5, p < 0.001; anxiety 41.3 vs. 32.5, p < 0.001) and residents (VAS 43.4 vs. 31.7, p < 0.001; anxiety 53.5 vs. 33.7, p < 0.001) compared with assistants and attending gynecologists. Perceived stress and anxiety were positively correlated at both timepoints (r = 0.68, p < 0.001; r = 0.82, p < 0.001). When asked to reflect on stress experienced during surgery, our data show that stress during surgery is greater than anticipated for many surgical episodes. Self-reported stress symptoms commence prior to surgery and are more commonly reported by surgeons operating as primary surgeon and by those in training. Future research should focus on determinants of presurgical stress and examine when stressors become inhibitory to performance.

The Effects of White Noise on Preprocedural Anxiety and Vital Signs Among Older Adults Undergoing Colonoscopy

PurposeA significant portion of individuals undergoing colonoscopy report stress and anxiety before the procedure. The efficacy of white noise as a nonpharmacological intervention on state anxiety and vital signs of individuals waiting for colonoscopy has not been investigated in previous studies. The current study aimed to analyze the effect of white noise on preprocedural anxiety and vital signs among older adults undergoing colonoscopy. DesignA pre-test/post-test quasi-experimental study. MethodsSubjects (N = 60) were older adults in the colonoscopy unit and divided into experimental (n = 30) and control groups (n = 30). The subjects in the experimental group listened to the white noise via binaural headphones for 20 minutes, while the control group received routine pre-endoscopic care. State anxiety and vital signs were assessed before and after intervention using the State-Trait Anxiety Inventory and vital signs monitor, respectively. The data were analyzed using SPSS-25 software. FindingsNo statistically significant differences were found between the two groups on demographic characteristics, state-anxiety, systolic and diastolic blood pressure, pulse rate, and respiratory rate before the intervention (P > .05). A significant difference was found between the experimental and control groups in terms of state-anxiety (P = .00) and pulse rate (P = .003) after the intervention. No significant differences were found between the two groups in terms of systolic blood pressure (P = .69), diastolic blood pressure (.59), and respiratory rate (P = .164) after the intervention. ConclusionsThis study provides preliminary evidence supporting the use of white noise in older adults undergoing colonoscopy to reduce anxiety. The authors recommend that this intervention, as a nonpharmacological and easily administered approach, is adopted to reduce precolonoscopy anxiety. Continued investigation into the effect of white noise on vital signs is recommended.