Pre-procedural Anxiety Research Articles

Use of video-based multimedia information to reduce anxiety before office hysteroscopy.

IntroductionUse of multimedia tools has been shown to improve patient comprehension, reduce pre-procedural anxiety, and increase patient satisfaction in various surgical settings.AimTo investigate the impact of video-based multimedia information (MMI) on the anxiety levels of patients undergoing office hysteroscopy (OH).Material and methodsAll consecutive women aged 18–65 years and scheduled for diagnostic OH were enrolled in this prospective randomized study. Subjects were assigned to receive video-based MMI or conventional written information (controls). The trait and state anxiety were assessed using the State and Trait Anxiety Inventory (STAI) before the MMI or written information. STAI-state (STAI-S) was repeated after application of the MMI or written information. All patients underwent a standardized transvaginal hysteroscopy procedure by the same gynecologist. Following the hysteroscopy, patient satisfaction and procedural pain were ranked using a Likert scale and visual analogue scale.ResultsFifty-two patients were randomized to receive a video-based MMI, and 52 patients were randomized to receive written information. Post-information STAI-S score was significantly lower in the MMI group than that of the written information group (45.0 ±8.0 vs. 49.4 ±8.4, p < 0.001, 95% CI for the difference: 1.36–7.79). Moreover, the satisfaction rate of the video group was significantly higher than the satisfaction rate of the controls (92.3% vs. 63.5%, p < 0.001). VAS score of procedural pain was similar for the two groups.ConclusionsA video-based MMI before OH might be preferred to conventional information methods in order to reduce the pre-procedural anxiety and to increase patients’ satisfaction.

563 High Rate of Discordant Pain Levels Reported by Patients and Physicians During Gastrointestinal Endoscopy

INTRODUCTION: Procedural sedation is given to reduce patient anxiety, discomfort, pain and to improve outcomes in endoscopy. Data are limited regarding patient satisfaction with endoscopy. Our goal was to evaluate physician perceptions of patient pain and anxiety before and after endoscopy and factors associated with their correlation. METHODS: We performed a prospective study of 233 consecutive patients who received procedural sedation during endoscopy from August to November 2018 at the Portland VA Medical Center. Patients were given a pre-endoscopy survey to assess expectations and a post-endoscopy survey to assess procedural satisfaction, and physician were given a post-endoscopy survey only. Outcomes included expected and actual pain, anxiety, and sedation level during endoscopy and was reported on a scale from 0 to 5. RESULTS: Upper endoscopy, colonoscopy, and bi-directional endoscopy were performed in 30%, 60%, and 10% of cases, with an average procedural time of 19.1 minutes. Midazolam and fentanyl were most commonly used for sedation with an average dose of 4.0 ±0.1 mg and 102.5 ± 2.7 mcg, respectively. A minority of patients reported alcohol, marijuana, non-opiate pain medication, and opiate use (39%, 15%, 19%, and 16%, respectively). Pre-procedural anxiety and expected level of pain significantly improved with patient's post-procedural assessment (Tables 1 and 2). The average difference of anxiety and pain levels pre-endoscopy and post-endoscopy was 0.48 and 0.41, respectively. There was poor concordance between the physician's perceived patient pain and patient reported pain level during endoscopy (61%) with an overall Cohen's kappa of 0.258. Several factors associated with reduced patient and physician pain correlation included the presence of mental health disorders and use of benzodiazepines, SSRI, or SNRI (Table 3). Despite the discordance, the majority of patients reported satisfaction in pain control and would return for a repeat procedure (85% and 95%, respectively). CONCLUSION: Patients reported higher levels of pre-procedure anxiety and expected pain than actual anxiety and pain post-procedure. Physicians have poor concordance with patients with respect to pain levels, especially with more severe pain scores and in the presence of mental health disorders. Patients at high risk for discordance may benefit from more thorough pre-procedural counseling and a lower threshold for escalating doses of sedation during endoscopy.

2885 Reducing Anxiety in Patients Undergoing First-Time Colonoscopy: A Pilot and Feasibility Study for a Randomized Controlled Trial

INTRODUCTION: Patients undergoing colonoscopy may experience pre-procedure anxiety, which is associated with increased pain and might affect the willingness to undergo subsequent studies. We hypothesised that a brief psychological intervention would reduce anxiety before colonoscopy. The aim of the pilot study was to evaluate the feasibility of conducting a randomized, controlled trial (RCT) of the efficacy of a psychological intervention (PsI) in reducing anxiety levels in adult patients undergoing first-time colonoscopy under conscious sedation. METHODS: We performed a mixed method, double-blinded RCT of adult patients undergoing first-time colonoscopy. Eligible patients were randomized to a PsI vs. sham PsI. The primary outcome was feasibility, with success defined a priori as recruitment rate &gt;50%. All participants had an anxiety assessment pre- and post-intervention using State-Trait Inventory for Cognitive and Somatic Anxiety (STICSA) score.Pre- and post-intervention scores were compared within and between groups. Secondary outcomes included sedation dose, patient comfort, cecal intubation rate and willingness to repeat colonoscopy. RESULTS: In total, 130 patients were recruited from 180 eligible participants (72%). Eighty were randomized and completed the study (44%).Failure to randomize recruited patients was due to logistical scheduling issues after patient arrival (26/50: 52%). Baseline characteristics were similar among groups (Table 1). In the PsI group, pre- and post-intervention median STICSA scores were 29 and 24 (P &lt; 0.001), respectively. In the sham group, pre and post median scores were 31 and 25 (P &lt; 0.001), respectively. There were no significant differences between the groups for any other secondary outcomes (Table 2). Although not statistically significant, the PsI group had fewer patients unwilling to repeat a colonoscopy and a higher cecal intubation rate than the sham PsI group. CONCLUSION: We have shown that it is feasible to recruit patients to an RCT evaluating PsI in colonoscopy and identified potentially remediable administrative challenges that reduced study completion rates. In addition, anxiety scores in both groups improved following colonoscopy although we did not observe a significant difference between treatment arms. Both findings are key to adjust future study design (e.g. a third arm that receives usual care). Currently, a qualitative assessment is underway to evaluate participant and staff acceptance of the study design and intervention.

Educational virtual reality videos in improving bowel preparation quality and satisfaction of outpatients undergoing colonoscopy: protocol of a randomised controlled trial

IntroductionColonoscopy is the reference method in screening and diagnosis of colorectal neoplasm, but its efficacy is closely related to the quality of bowel preparation. Poor patient compliance is a major...

Notions of Preprocedural Patient Anxiety in the Realm of IR.

To determine the views and current practice preferences of interventional radiologists and allied healthcare providers regarding management of preprocedural anxiety. From March to April 2018, members of the Society of Interventional Radiology were surveyed regarding their opinions in the assessment and management of patient anxiety. Degree of responsibility for the management of anxiety was also queried through the use of a scale (1= no responsibility; 2= some responsibility; 3= major responsibility). Of 1163 respondents (23.8% response rate), most described preprocedural anxiety as somewhat to very important in their practice (n= 961, 82.6%), somewhat to very important to the patients (n= 1087, 93.5%), and at least sometimes interfering with delivery of care (n= 815, 70.1%). Most respondents did not measure preprocedural anxiety directly (n= 953, 81.9%), but would address it if raised by the patient (n= 911, 82.9%). Patient education (n= 921, 79.1%), medications (n= 801, 68.8%), and therapeutic or empathetic interactions (n= 665, 56.4%) were most preferred to manage anxiety. Radiologists, nurses, patients, primary care providers, family members, and psychologists or psychiatrists were all allocated responsibility to reduce anxiety. Interventional radiologists and other providers are aware of the importance of preprocedural anxiety. Despite the notion that most radiologists did not address anxiety directly, most indicated a willingness to discuss the issue if raised by patients. Patient education, medications, and several other techniques are preferred to manage preprocedural anxiety. Responsibility to reduce anxiety is perceived to be shared among radiologists, nurses, patients, family members, and other health care providers.

PF733 COMBINED ORAL ANALGESIA AND ANXIOLYSIS FOR PAIN ASSOCIATED WITH BONE MARROW ASPIRATION AND BIOPSY

Background:Bone marrow aspiration and biopsy (BMAB) is a painful procedure, and the commonly adopted local infiltration anesthesia (LIA) with lidocaine is unable to relieve the pain during the most uncomfortable phases, or the anticipatory anxiety related to pain recalling thereafter. As there are no formal guidelines for adding a sedoanalgesic premedication before beginning the BMAB, many combinations have been adopted by several authors.Aims:Our randomized and patient blinded trial aimed to evaluate, as primary end point, the efficacy and safety of opioid and benzodiazepine agent combination plus LIA in patients who underwent BMAB for hematological malignancies. Two secondary end points were: 1) to define if patients who already underwent to BMAB without LIA prefer sedoanalgesia; 2) to demonstrate if sedoanalgesia can influence the quality of the biological specimen harvested.Methods:Patients were randomly assigned into two arms for receiving either placebo plus LIA (standard group, 48,6%) or oral fentanyl citrate 200 mcg + oral midazolam 5 mg in addition to LIA (combo‐group, 51,4%) during BMAB. Pre‐procedural anxiety and procedural pain were assessed according to the Numered Rating Scale (NRS: 0–10), dividing the time of the procedure into five intervals (T0, T1, T2a, T2b, and T3) and evaluating discomfort grade during each moment of procedure in both groups. Cognitive function was measured before and 30 minutes after the procedure. Possible side effects were recorded, as well as the adequacy of tissue samples harvested. A total number 116 patients were enrolled in the study. 9 patients did not meet inclusion criteria and were excluded. 52 patients were randomized and assigned to standard group and 55 to combo group.Results:At T2b and T3 (corresponding to the biopsy time and time after the biopsy, respectively) there was a significantly lower (p &lt; 0.05) perception of pain in the patients who received sedoanalgesia (combo‐group) compared to those who did not (standard group). Moreover, 100 % of the patients in combo group who had previously undergone this procedure without premedication reported that they would prefer sedoanalgesia for the subsequent procedures.Summary/Conclusion:Administration of oral analgesia and anxiolysis is a safe and feasible option to be used in outpatient setting; sedoanalgesia is very effective in reducing pain during the biopsy and it diminishes the anticipatory anxiety related to a painful procedure. Patients should have the possibility to choose between local anesthesia alone or sedoanalgesia plus local anesthesia.

Combined oral administration of analgesia and anxiolysis for pain associated with bone marrow aspiration and biopsy.

e18313 Background: Bone marrow aspiration and biopsy (BMAB) is a painful procedure, and the commonly adopted local infiltration anesthesia (LIA) with lidocaine is unable to relieve the pain during the most uncomfortable phases, or the anticipatory anxiety related to pain recalling thereafter. As there are no formal guidelines for adding a sedoanalgesic premedication before beginning the BMAB, many combinations have been adopted by several authors. Our randomized and patient blinded trial aimed to evaluate, as primary end point, the efficacy and safety of opioid and benzodiazepine agent combination plus LIA in patients who underwent BMAB for hematological malignancies. Two secondary end points were: 1) to define if patients who already underwent to BMAB without LIA prefer sedoanalgesia; 2) to demonstrate if sedoanalgesia can influence the quality of the biological specimen harvested. Methods: Patients were randomly assigned into two arms for receiving either placebo plus LIA (standard group, 48,6%) or oral fentanyl citrate 200 mcg + oral midazolam 5 mg in addition to LIA (combo-group, 51,4%) during BMAB. Pre-procedural anxiety and procedural pain were assessed according to the Numered Rating Scale (NRS: 0-10), dividing the time of the procedure into five intervals (T0, T1, T2a, T2b, and T3) and evaluating discomfort grade during each moment of procedure in both groups. Cognitive function was measured before and 30 minutes after the procedure. Possible side effects were recorded, as well as the adequacy of tissue samples harvested. A total number 116 patients were enrolled in the study. 9 patients did not meet inclusion criteria and were excluded. 52 patients were randomized and assigned to standard group and 55 to combo group. Results: At T2b and T3 (corresponding to the biopsy time and time after the biopsy, respectively) there was a significantly lower ( p&lt; 0.05) perception of pain in the patients who received sedoanalgesia (combo-group) compared to those who did not (standard group). Moreover, 100 % of the patients in combo group who had previously undergone this procedure without premedication reported that they would prefer sedoanalgesia for the subsequent procedures. Conclusions: Administration of oral analgesia and anxiolysis is a safe and feasible option to be used in outpatient setting; sedoanalgesia is very effective in reducing pain during the biopsy and it diminishes the anticipatory anxiety related to a painful procedure. Patients should have the possibility to choose between local anesthesia alone or sedoanalgesia plus local anesthesia.

Acupuncture for Vasectomy Pre-procedural Anxiety and Pain Control in the Primary Care Setting

Acupuncture for Vasectomy Pre-procedural Anxiety and Pain Control in the Primary Care Setting

The relationship between pain at IUD insertion and negative perceptions, anxiety and previous mode of delivery

Objective: The aim of the study was to better understand the relationship between pain during intrauterine device (IUD) insertion and anxiety, negative perceptions of IUDs and previous mode of delivery, in parous women. Methods: We conducted a prospective cohort study between June and September 2018 in 210 women who opted for IUD placement for contraception. Sixty-six women who had previously had only vaginal delivery under epidural analgesia were allocated to the epidural delivery group; 60 women who had previously had at least one vaginal delivery without epidural analgesia were allocated to the vaginal delivery group; and 84 women who had previously had only caesarean delivery were allocated to the caesarean delivery group. Participants’ levels of anxiety before insertion were measured using the Beck Anxiety Inventory; participants’ levels of pain (anticipated pain and pain at the various stages of IUD insertion and 15 min after the procedure) were assessed using a visual analogue scale. Results: While the experience of caesarean delivery and pre-procedure anxiety were found to be associated with higher pain scores, the presence of negative perceptions of IUDs was the most significant predictor of pain during IUD insertion (p < .001). Experience of vaginal delivery under epidural analgesia was associated with lower pain scores at IUD insertion (p < .001). Conclusion: Fear of IUD insertion pain, pre-procedure anxiety and negative perceptions of IUDs may lead women to anticipate or feel a higher level of pain. Patient education to correct negative perceptions of IUDs and counselling to inform women of the true benefits and risks of IUDs and lower pre-procedure anxiety are a suggested strategy to manage IUD insertion pain in parous women.

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.

04:03 PM Abstract No. 148 Views of pre-procedural anxiety assessment and management according to interventional radiologists: a survey of SIR members

04:03 PM Abstract No. 148 Views of pre-procedural anxiety assessment and management according to interventional radiologists: a survey of SIR members

La rilevazione e il trattamento del dolore durante le procedure di emodinamica e elettrofisiologia: uno studio descrittivo multicentrico

Coronary interventions and electrophysiology procedures may be painful both during and shortly after the procedure. To assess the onset of pain and anxiety in patient undergoing coronary interventions and electrophysiology procedures; to describe the administration (frequency, timing, dosage and outcomes) of analgesics and anxiolytics before, during and after the procedure. A descriptive multicenter study was carried out. Pain and anxiety were measured with a 10-point visual analogue scale (VAS) before, during, after the procedure and for the following 24 hours. Patient were asked to rate their satisfaction for the information received and pain control. Data on 230 patients were collected. The most performed procedure was the transradial coronary catheterization (68.7%). The pacemaker/defibrillator implantation resulted the most painful procedure (median 4, IQR 3-6) and also the most anxious (median 5, IQR 2-6). 13 Patients received an analgesic during the procedure for a low-to-severe pain; during the following 24 hours 34 patients (5 undergoing transradial coronary catheterization and 29 the implant of pacemaker/cardiac-defibrillator) suffered from severe pain and with the exception of 5, all requested pain relief. Satisfaction for pain control was inadequate for patients who underwent electrophysiology procedures and 55 patients would have needed more information on pain. Pain control and patient satisfaction may be improved, pre-procedural anxiety needs more attention and better information on the procedure should be provided.

A Novel Clinician-Orchestrated Virtual Reality Platform for Distraction During Pediatric Intravenous Procedures in Children With Hemophilia: Randomized Controlled Trial.

BackgroundNeedles are frequently required for routine medical procedures. Children with severe hemophilia require intensive intravenous (IV) therapy to treat and prevent life-threatening bleeding and undergo hundreds of IV procedures. Fear of needle-related procedures may lead to avoidance of future health care and poor clinical outcomes. Virtual reality (VR) is a promising distraction technique during procedures, but barriers to commercially available VR platforms for pediatric health care purposes have prevented widespread use.ObjectiveWe hypothesized that we could create a VR platform that would be used for pediatric hemophilia care, allow clinician orchestration, and be safe and feasible to use for distraction during IV procedures performed as part of complex health care.MethodsWe created a VR platform comprising wireless, adjustable, disposable headsets and a suite of remotely orchestrated VR games. The platform was customized for a pediatric hemophilia population that required hands-free navigation to allow access to a child’s hands or arms for procedures. A hemophilia nurse observing the procedure performed orchestration. The primary endpoint of the trial was safety. Preliminary feasibility and usability of the platform were assessed in a single-center, randomized clinical trial from June to December 2016. Participants were children with hemophilia aged 6-18 years. After obtaining informed consent, 25 patients were enrolled and randomized. Each subject, 1 caregiver, and 1 hemophilia nurse orchestrator assessed the degree of preprocedural nervousness or anxiety with an anchored, combined modified visual analog (VAS)/FACES scale. Each participant then underwent a timed IV procedure with either VR or standard of care (SOC) distraction. Each rater assessed the distraction methods using the VAS/FACES scale at the completion of the IV procedure, with questions targeting usability, engagement, impact on procedural anxiety, impact on procedural pain, and likability of the distraction technique. Participants, caregivers, and nurses also rated how much they would like to use VR for future procedures. To compare the length of procedure time between the groups, Mann-Whitney test was used.ResultsOf the 25 enrolled children, 24 were included in the primary analysis. No safety concerns or VR sickness occurred. The median procedure time was 10 (range 1-31) minutes in the VR group and was comparable to 9 (range 3-20) minutes in the SOC group (P=.76). Patients in both the groups reported a positive influence of distraction on procedural anxiety and pain. Overall, in 80% (34/45) of the VR evaluations, children, caregivers, and nurses reported that they would like to use VR for future procedures.ConclusionsWe demonstrated that an orchestrated, VR environment could be developed and safely used during pediatric hemophilia care for distraction during IV interventions. This platform has the potential to improve patient experience during medical procedures.Trial RegistrationClinical Trials.gov NCT03507582; https://clinicaltrials.gov/ct2/show/NCT03507582 (Archived by WebCite at http://www.webcitation.org/73G75upA3)

Impact of Parental Acute Psychological Distress on Young Child Pain-Related Behavior Through Differences in Parenting Behavior During Pediatric Burn Wound Care.

Pediatric burn injuries and subsequent wound care can be painful and distressing for children and their parents. This study tested parenting behavior as a mediator for the relationship between parental acute psychological distress and child behavior during burn wound care. Eighty-seven parents of children (1-6-years-old) self-reported accident-related posttraumatic stress symptoms (PTSS), pre-procedural anxiety, general anxiety/depression symptoms, and guilt before the first dressing change. Parent-child behavior was observed during the first dressing change. Mediation analyses identified three indirect effects. Parental PTSS predicted more child distress, mediated through parental distress-promoting behavior. Parental guilt predicted more child distress, mediated through parental distress-promoting behavior. Parental general anxiety/depression symptoms predicted less child coping, mediated through less parental coping-promoting behavior. Parents with accident-related psychological distress have difficulty supporting their child through subsequent medical care. Nature of parental symptomology differentially influenced behavior. Increased acute psychological support for parents may reduce young child procedural pain-related distress.

Effects of a Psychological Preparation Intervention on Anxiety Associated with Pediatric Anorectal Manometry.

Background and Aims High-resolution anorectal manometry (HRM) is associated with significant patient and parent anxiety, which can impact the success and efficiency of the procedure. The nature of HRM necessitates cooperation of an alert child. This study examined effects of psychoeducation intervention on decreasing procedural distress in both pediatric patients and their parents. Methods A prospective randomized study of children aged 3–12 years, undergoing HRM, was performed utilizing child-centric educational video. Patients received either psychological preparation intervention or treatment-as-usual. Distress was assessed through self-reported and parent-reported anxiety measures (STAIC-S; STAI-S), physiological arousal measurements, and an observational scale of procedural distress (PBCL). Results A total of 63 children, aged 3–12 yrs (6.7 ± 2.5), completed the study. Measures of observed and reported distress and anxiety (PBCL; STAIC-S) were significantly less in children receiving intervention. Parents of children in the intervention group also reported significantly less preprocedural anxiety (STAI-S). Effects on physiological arousal were mixed, with significant preprocedural decrease in systolic blood pressure but no difference in heart rate from baseline. Conclusions Preprocedural psychological preparation was effective in decreasing pediatric patient and parental self-reported anxiety associated with HRM. Intervention decreased physician time necessary to successfully complete the study and significantly decreased the number of times patients had to endure balloon inflation.

Influencing Vaccinations: A Buzzy Approach to Ease the Discomfort of a Needle Stick—a Prospective, Randomized Controlled Trial

BackgroundThe rate of annual influenza immunization in both the general public and health care workers is less than desirable. Mechanisms to improve compliance with recommendations are needed; prevention of immunization site pain has been suggested as a viable route because fear of pain and needles has been cited as a barrier. AimsThis study aimed to evaluate the impact of thermomechanical stimulation (Buzzy) on postprocedure pain ratings during vaccination in adults. DesignThis was a randomized controlled trial of Buzzy during immunization. SettingsThree hospitals and two community health centers which are part of a large, integrated health system. Participants/SubjectsEmployees presenting to employer-sponsored annual influenza vaccination clinics. MethodsA 10-cm visual analog scale was used to rate preinjection anxiety and expectation of pain as well as postprocedure pain scores; participants also rated their satisfaction with the vaccine injection on a 10-point Likert scale. ResultsIn total, 497 employee volunteers were recruited to participate. Preprocedure anxiety was similar between the experimental and control groups (1.53 vs. 1.48, p = .82), whereas self-reported postprocedure pain scores were significantly lower in the group that received the Buzzy during injection (0.87 vs. 1.12, p = .035). Mean satisfaction scores did not vary between the intervention and control groups (9.11 vs. 9.09, p = .87); however, more participants rated their experience as better than previous vaccination experiences in the Buzzy group than control (62.0% vs. 23.9%, p < .0001). ConclusionsThese results suggest that Buzzy reduced pain experienced by adults undergoing annual influenza vaccination and may improve overall experience. Buzzy can be used in adult patients to reduce pain during immunization and is especially effective in those with high levels of anxiety.

Anxiety Associated with Colonoscopy and Flexible Sigmoidoscopy: A Systematic Review.

Addressing procedure-related anxiety should improve adherence to colorectal cancer screening programs and diagnostic colonoscopy. We performed a systematic review to assess anxiety among individuals undergoing colonoscopy or flexible sigmoidoscopy (FS). We searched multiple electronic databases for studies evaluating anxiety associated with colonoscopy or FS published from 2005 to 2017. Two reviewers independently identified studies, extracted data, and assessed study quality. The main outcomes were the magnitude of pre-procedure anxiety, types of concerns, predictors of anxiety, and effectiveness of anxiety-lowering interventions in individuals undergoing lower endoscopy. The protocol was prospectively registered in PROSPERO. Fifty-eight studies (24,490 patients) met the inclusion criteria. Patients undergoing colonoscopy had a higher mean level of anxiety than that previously reported in the general population, with some studies reporting more than 50% of patients having moderate-to-severe anxiety. Areas of anxiety-related concern included bowel preparation, difficulties with the procedure (embarrassment, pain, possible complications, and sedation), and concerns about diagnosis; including fear of being diagnosed with cancer. Female gender, higher baseline anxiety, functional abdominal pain, lower education, and lower income were associated with greater anxiety prior to colonoscopy. Providing higher-quality information before colonoscopy, particularly with a video, shows promise as a way of reducing pre-procedure anxiety but the studies to date are of low quality. A large proportion of patients undergoing colonoscopy report anxiety before the procedure. Improvement in pre-procedure information delivery and evaluation of approaches to reduce anxiety is required, especially for those with predictors of pre-procedure anxiety.

Ambulatory colonoscopy under sedoanalgesia in adult patients with and without irritable bowel syndrome: A prospective, cross-sectional, and double-blind comparison.

It is unclear whether patients with irritable bowel syndrome (IBS) require a high dose of sedatives during colonoscopy. In this study, we investigated the pre-procedural anxiety levels, sedative consumption, procedure times, complications, and patient's satisfaction between patients with IBS and controls for ambulatory colonoscopy under sedation. Rome III criteria were used in the diagnosis of IBS. Anxiety levels were measured using Spielberger's State-Trait Anxiety Inventory (STAI) and Beck Anxiety Inventory (BAI). Patients received a fixed dose of midazolam (0.02 mg/kg), fentanyl (1 μg/kg), ketamine (0.3 mg/kg), and incremental doses of propofol under sedation protocol. Demographic data, heart rate, blood pressure, and oxygen saturation were measured. Procedure times, recovery and discharge times, drug doses used, complications associated with the sedation, and patient's satisfaction scores were also recorded. The mean Trait (p=0.015), State (p=0.029), Beck anxiety scores (p=0.018), the incidence of disruptive movements (p=0.044), and the amount of propofol (p=0. 024) used were significantly higher in patients with IBS. There was a decline in mean systolic blood pressure at the 6th minute in patients with IBS (p=0.026). No association was found between the sedative requirement and the anxiety scores. Patients with IBS who underwent elective colonoscopy procedures expressed higher pre-procedural anxiety scores, required more propofol consumption, and experienced more disruptive movements compared with controls. On the contrary, the increased propofol consumption was not associated with the increased pre-procedural anxiety scores.

Effectiveness of Two Different Methods for Pain Reduction During Insulin Injection in Children With Type 1 Diabetes: Buzzy and ShotBlocker.

Repeated injections may prevent children from performing insulin administration (skip dosing) and may cause anxiety. To compare the effect of ShotBlocker and the combination of vibration and cold application (Buzzy) in reducing pain during insulin administration in children. This research was designed as a randomized controlled experimental study. The study sample consisted of 60 children aged between 6 and 12years who were diagnosed as having type 1 diabetes and received insulin from the Child Endocrinology Department of the medical faculty in Eskisehir Osmangazi University between May 2015 and June 2017. The children were randomized into the Buzzy (n=20), ShotBlocker (n=20), and control (n=20) groups. Three instruments were used to obtain the research data: Interview and Observation Form, Children's Anxiety and Pain Scale (CAPS), and Faces Pain Scale-Revised (FPS-R). The mean age of the children was 9.43±2.18years (range 6-12years). There were no significant differences among preprocedural anxiety levels of the study groups in terms of self-, parent-, and observer-reported levels (p=.935, p=.374, and p=.680, respectively). Children in the control group had higher levels of pain than children in the Buzzy and ShotBlocker groups (p=.008, p=.007, and p>.001, respectively). There was a significant difference between the groups with procedural anxiety levels reported by the family and observer (p=.006 and p=.002, respectively), favoring the intervention groups. Nurses should be aware of pain during insulin injection and use methods for pain relief accordingly. ShotBlocker is recommended as a helpful option in cases where a pain control method is required.

A New Mobile Application to Reduce Anxiety in Pediatric Patients Before Bone Marrow Aspiration Procedures.

Insufficient preparation for children who are undergoing bone marrow aspiration can cause anxiety and negative outcomes. Nonpharmacological therapies have been proven to reduce fear in children who are undergoing painful procedures. We have therefore developed a mobile application to help reduce these patients' anxiety by providing them with procedural information and coping skills. This single-blinded, randomized controlled trial included 60 patients age 5 to 12 years old who were undergoing bone marrow aspiration procedures in Thailand that were conducted between May 2015 and May 2016. Sixty participants were randomly assigned to the intervention group (mobile application added to usual care) or the control group (usual care only). Preprocedural anxiety levels were evaluated by visual analog scales (child anxiety visual analog scale); this was repeated in the intervention group immediately after patients used the mobile application. On the day of the procedure, the patients' cooperation levels were assessed by using the modified Yale Preoperative Anxiety Scale. The total amount of sedative drugs that were used was also recorded. The paired t test and the Wilcoxon signed rank test were used to analyze within-person change, whereas the t test and the Wilcoxon rank sum test were used for group comparisons. The child anxiety visual analog scale score of patients in the intervention group decreased significantly after they used the mobile application (P < .0012). The modified Yale Preoperative Anxiety Scale score of patients in the intervention group was significantly lower than that in the control group (P < .01). There was no difference in sedative use between the 2 groups. This mobile application possibly had effectiveness in routine use for reducing anxiety and increasing patients' cooperation in bone marrow aspiration procedures.