Pre-procedural Anxiety Research Articles

A Quasi Experimental Study to Evaluate the Effectiveness of Audio-Visual Education on Anxiety among patients undergoing Coronary Angiography at selected hospital, Coimbatore

Coronary angiography is the most widely used interventional and diagnostic procedure for coronary artery disease. The patient experiences the pre-procedural anxiety prior to coronary angiography. The main aim of the study was to identify the effectiveness of audio-visual education on anxiety among patients undergoing coronary angiography. Quasi experimental posttest only control group design was adopted in the study. By using Non probability purposive sampling technique 60 participants were selected and 30 were assigned to the experimental and control group respectively. The demographic variables, clinical variables were collected from the patients undergoing coronary angiography. Audio- Visual Education was provided to the patients in the experimental group for 15 minutes. Routine nursing care was provided to patients in the control group. After audio-visual education, Post-test was conducted by using the State anxiety inventory scale for both experimental and control group. It was identified that the calculated mean level of anxiety in the experimental and control group was 34.3 and 61.2 respectively with the mean difference of 26.9. Likewise the standard deviation of the experimental and control group was 10.9 and 7.9 respectively. The calculated ‘t’ value 10.79 was greater than the table value of 1.96 at 0.001 level of significance. Hence, it was concluded that Audio-visual education is an effective method in reducing the anxiety among patients undergoing coronary angiography.

Reduction of pre-procedural anxiety for repeat sessions in extracorporeal shockwave lithotripsy (ESWL) reduces pain intensity: A prospective observational study.

Pain control is a major determinant for successful stone clearance in extracorporeal shockwave lithotripsy (ESWL) for urolithiasis. Pain perception during ESWL may be influenced by patient factors like gender, age, body habitus and anxiety level, and stone related factors like size, laterality and location of stone. We investigated in general, the confounding patient and stone factors influencing pain perception during ESWL with importance given to procedural anxiety in first and the subsequent session of ESWL. This was a prospective observational study of all new consecutive patients who underwent ESWL for a period of 1 year at a tertiary Urological Centre. Demographic and stone anthropometry were analyzed. Pre-procedural anxiety was assessed prior to procedure using hospital anxiety and depression score (HADS) and pain was scored using numerical rating scale-11 at baseline, 30-minutes (i.e., during) and 24 hours after ESWL. Univariate and multivariate analysis for confounding factors included HADs were performed for pain perception. A P value < .05 was considered to be statistically significant. For the study duration, 119 patients were recruited and 72 of them returned for a second session. Procedural anxiety was the only independent factor affecting pain score in ESWL for the first session in multivariate analysis. A statistically significant reduction of mean procedural anxiety score from 6.7 ± 4.5 to 3.2 ± 2.7 (P < .05) for the second ESWL session was observed (n = 72). This was in conjunction with statistical reduction of mean pain score 30 minutes after ESWL from 5.2 ± 2.1 to 4.2 ± 2.1 (P < .05). Patients with HADS ≥ 8 had statistically significant higher mean pain score at all 3 intervals in the first ESWL session. This study has shown that pre-procedural anxiety mainly anticipatory, reduces and shows reduction in pain intensity among patients undergoing repeat ESWL. Hence, anxiety reducing methods should be explored in patients undergoing ESWL to avoid unnecessary analgesic use.

Hypnosis associated with 3D immersive virtual reality technology during bronchoscopy under local anesthesia.

BackgroundPatients undergoing flexible bronchoscopy under local anesthesia usually experience anxiety before and during the procedure. Different non-pharmacological techniques, including music and hypnosis, are used to distract patients’ attention, and to reduce anxiety. The new technique “virtual reality hypnosis (VRH)”, defined as a hypnotic induction suggestion delivered by personalized virtual reality software, can generate a simulation of a lifelike environment. No study has described the use of VRH during bronchoscopy. The objective is to investigate the anxiety reducing effect and the satisfaction of patients, physicians, and nurses using VRH during bronchoscopy.MethodsVRH was proposed to all patients who experienced anxiety before undergoing flexible bronchoscopy under local anesthesia. Local anesthesia was performed using 5% lidocaine spray only. No sedation was used. After the procedure, patients, physicians and nurses filled a standardized satisfaction form.ResultsTwenty consecutive patients who reported pre-procedure anxiety were included. The sex ratio was 16 women/4 men, the median age was 65 years. Eight patients (40%) had undergone a previous bronchoscopy under local anesthesia. The median duration of the procedure was 10 minutes, and all procedures were completed. The median level of anxiety of patients decreased from 9/10 before the procedure to 4/10 during the procedure. The median satisfaction rate regarding the use of VRH was 10/10. All patients agreed to use VRH again in case of a new bronchoscopy procedure.ConclusionsThis preliminary report has shown that VRH was useful to reduce patients’ anxiety during bronchoscopy under local anesthesia. VRH was easily implemented in the routine practice.

TCT-261 Impact of Virtual Reality on Pre-Procedural Anxiety Prior to Heart Catheterization: The VR-THEIA Study

TCT-261 Impact of Virtual Reality on Pre-Procedural Anxiety Prior to Heart Catheterization: The VR-THEIA Study

Association of Pre-procedural Anxiety With Procedure-Related Pain During Outpatient Pediatric Burn Care: A Pilot Study.

The relationship between preprocedural anxiety and pain is not clear but has the potential to change the way pediatric patients need to be cared for prior to burn procedures. Using results from our recent randomized clinical trial among outpatient burn patients (n = 90) aged 6-17 years, the objective of this subsequent analysis was to assess whether preprocedural anxiety was associated with self-reported and researcher-observed pain scores. Anxiety before the dressing change was assessed using an abbreviated State-Trait Anxiety Inventory for Children (range 6-21) and reported with 95% confidence intervals (CI). Self-reported pain was reported using a Visual Analog Scale (range 0-100) and observed pain was assessed using the Face, Legs, Activity, Cry, and Consolability-revised scale. Over half of patients (58.9%) reported mild anxiety (score < 12) and about 5% of patients reported severe anxiety (score > 16). Younger children (6-8 years) reported higher anxiety scores than older children (15-17 years), but the difference did not achieve statistical significance (mean = 12.7, 95% CI: 11.5 to 13.9, P = .09). Nonparametric spearman correlation indicated that anxiety score was significantly correlated with observed pain (P = .01) and self-reported overall pain neared statistical significance (P = .06). In the final logistic regression of reporting moderate-to-severe pain (pain score > 30), the association between anxiety scores and self-reported overall moderate-to-severe pain was statistically significant (P = .03) when adjusting for race, healing degree, and pain medication use within 6 hr prior to burn dressing care. This pilot study provides preliminary data showing that anxiety before outpatient pediatric burn dressing changes is significantly associated with self-reported overall moderate-to-severe pain.

Pre-Procedural Anxiety and Associated Factors Among Women Seeking for Cervical Cancer Screening Services in Shenzhen, China: Does Past Screening Experience Matter?

BackgroundResearch gaps exist in addressing the psychological harm related to the cervical cancer screening. Anxiety is the most common distress driven by the screening procedures, which may be affected by past screening experience (PSE) but with uncertainty. This study aimed to evaluate the pre-procedural anxiety in cervical cancer screening and to identify the influence attributed to PSE.MethodsA cross-sectional survey targeted women seeking for cervical cancer screening services was conducted from June 5th to December 31st, 2020 in Shenzhen. The 20-item state anxiety scale of the State-Trait Anxiety Inventory (STAI-S) was applied to measure pre-procedural anxiety, in which a score of 40 or higher was regarded with anxiety symptom. Logistic regression models were established to explore potential associated factors of pre-procedural anxiety both for women with and without PSE.ResultsOverall, 3,651 women were enrolled, in which 36.1% had never been screened and the remaining 63.9% had been screened at least once before. Women without PSE demonstrated more prevalent pre-procedural anxiety (74.5% vs. 67.8%, P <0.001) than their experienced counterparts. Among women without PSE, having heard of cervical cancer screening was associated with a lower likelihood of pre-procedural anxiety (OR: 0.37, 95%CI: 0.25~0.56). Among experienced women, participating three or more times screening was negatively associated with anxiety symptom (OR: 0.67, 95%CI: 0.53~0.84), however, both receiving screening within three years (OR: 1.58, 95%CI: 1.27~1.97) and unknowing previous screening results (OR: 1.42, 95%CI: 1.11~1.82) increased the susceptibility of pre-procedural anxiety.ConclusionsWomen participating in cervical cancer screening commonly present pre-procedural anxiety. The association between PSE and pre-procedural anxiety may be influenced by past screening times, interval, and results. Psychological counseling according to women’s PSE before cervical cancer screening is warranted of necessity.

Patient satisfaction after distal upper limb surgery under WALANT versus axillary block: A propensity-matched comparative cohort study

Distal upper limb surgery is performed under WALANT (Wide Awake Local Anesthesia No Tourniquet) in many outpatient centers because the benefits are numerous: simple, low-cost technique, with fast turnover and short length of stay. In view of a paucity of data concerning patient satisfaction, this non-randomized cohort study was designed to compare EVAN-LR anesthesia satisfaction questionnaire results (information, pain, expectation, attention, discomfort: 0–100 points) between patients receiving WALANT or axillary nerve block (AxB). After IRB approval, patients (>18 years, stable ASA 1–3) scheduled for outpatient distal upper limb surgery were prospectively enrolled in the two groups. At discharge, patients in both groups received standard information on postoperative recovery and care, with a multimodal analgesic regime (acetaminophen and ketoprofen for 5 days). The primary endpoint was EVAN-LR score before discharge. Secondary endpoints were pain relief and side-effects over a 7-day period. Results were recorded as median and 25–75% interquartile range. Propensity-score-matched analysis was performed. Over the study period, from October 2019 to November 2020, 183 patients were included; 48 WALANT patients were propensity-score matched to 48 AxB patients. Pre-procedural APAIS anxiety score was lower in the WALANT than the AxB group: 9 (IQR, 6–12) vs 12 (IQR, 8-14) (p = 0.01). EVAN-LR scores were similar between the WALANT (78 [72–82]) and the AxB group (73 [67–80]). Incidences of paresthesia and of pain (NRS pain score, opioid rescue) were similar. WALANT patients had shorter length of stay: 135 (110–175) min vs 170 (110–250) min (p = 0.01). The present study demonstrated that WALANT was associated with a high level of patient satisfaction. For clinical relevance and quality of care, WALANT should be proposed in first line for distal limb surgery.

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.

Effect of Pre-procedure Anxiety Levels on Post-procedure Pain Scores in Women Undergoing Hysterosalpingography in South-south Nigeria

&#x0D; Background: Infertility is the inability of a couple to conceive after one year of regular, unprotected sexual intercourse. Hysterosalpingography plays a very crucial role the evaluation of the women with infertility.&#x0D; Objective: To determine the relationship between pre-procedure anxiety and procedure-associated pain among infertile women undergoing hysterosalpingography.&#x0D; Materials and Methods: This prospective survey was conducted at the Obstetrics and Gynaecology, and Radiology Departments of the two tertiary health institutions in Bayelsa State, Nigeria, from January to August, 2021. Hysterosalpingography was done for 380 infertile women, after obtaining written informed consent. Beck's Anxiety Inventory (BAI) and Numerical Rating Scale (NRS) were used to grade levels of anxiety and pain, respectively. Data were entered into a pre-designed proforma, and analysed using Statistical Product and Service Solutions (SPSS) version 25.0. Results were presented in frequencies and percentages for categorical variables; mean and standard deviation for continuous variables.&#x0D; Results: The pre-procedure anxiety scores showed significant, positive, and strong relationship with post-procedure pain scores, reflected in a correlation coefficient of 0.50 (p – 0.001). For every unit change in anxiety score, there was an estimated 25.4% change in the pain perception documented by the participants. For participants who had an anxiety score of 0, there was an average pain score of 3.45.&#x0D; Conclusion: This study established a positive correlation between pre-hysterosalpingography anxiety scores and post-hysterosalpingography pain scores.&#x0D;

Effect of Bronchoscopist-Directed Sedation and Other Factors on Patient Comfort during Diagnostic Flexible Bronchoscopy.

Background The factors affecting patient comfort during flexible bronchoscopy are not sufficiently addressed in resource-limited countries, and a need to devise strategies to improve patient experience is felt. The present study was undertaken to assess the effect of sedation and other factors on patient comfort during flexible bronchoscopy. Methods A total of 374 patients, aged ≥18 years undergoing flexible bronchoscopy, were enrolled in this prospective, single-center, cross-sectional study. The baseline clinical data of sedation and nonsedation groups were recorded. Anxiety level was assessed using Visual Analog Scale (VAS). Postprocedure VAS score (primary outcome measure) assessed the discomfort related to flexible bronchoscopy. Patient-reported willingness for a repeat procedure and occurrence of adverse events were used as secondary outcome measures. Based on the median of VAS score, the study population was divided into low discomfort and high discomfort groups, and the factors affecting comfort levels in these two groups were noted. Results Postprocedural VAS score (median (Q1, Q3)) for sedation and nonsedation groups was 20 (15, 30) and 25 (20, 40), respectively (<0.001). Willingness for a repeat procedure was significantly more in the sedation group (p=0.002). In the low and high discomfort groups, the preprocedural anxiety level (median (Q1, Q3)) was 20 (10, 25) and 30 (20, 40), respectively (p < 0.001). Conclusion Bronchoscopist-directed sedation significantly reduces patient discomfort and increases their willingness for a repeat procedure. Midazolam-fentanyl combination and lower prebronchoscopy anxiety are associated with lower discomfort levels during flexible bronchoscopy. This study is registered with the Clinical Trial Registry of India (CTRI/2018/11/016328).

Pre-procedural virtual reality education reduces anxiety in patients undergoing atrial septal closure – Results from a randomized trial

BackgroundPatients undergoing invasive cardiothoracic procedures are prone for pre-procedural anxiety and depression. Patient education is known to reduce anxiety. This study was performed to assess the effect of Virtual Reality (VR) as a means to educate patients to reduce pre-procedural anxiety in adult patients undergoing percutaneous closure of a patent foramen ovale (PFO) or atrial septal defect (ASD). Methods and resultsWe randomly assigned 60 patients (48% male; age 44 ​± ​11 years) with an indication for percutaneous PFO or ASD closure to receive pre-procedural education by their cardiologist (control) or to receive additional education through a VR information film depicting the day of the procedure (intervention). The primary outcome was change in the pre-procedural anxiety as assessed using the State Trait Anxiety Inventory (STAI) and the Amsterdam Pre-operative Anxiety and Information Scale (APAIS) questionnaires, filled-in during the outpatient clinic visit (baseline) and one week prior to the procedure (follow-up). At baseline patients in both groups experienced equal levels of anxiety (STAI state anxiety: control 40 ​± ​10 vs. intervention 39 ​± ​9; p ​= ​0.70). During follow-up, anxiety increased in the control group, but remained unchanged in the intervention group (45 ​± ​11 vs. 38 ​± ​7, p ​= ​0.02). No differences were found for the APAIS anxiety scale. ConclusionPatient education using Virtual Reality is effective in reducing pre-procedural anxiety in patients undergoing percutaneous PFO or ASD closure. General introduction of VR for a large population of patients undergoing invasive cardiac procedures should be considered to reduce anxiety in this already fragile population.

Efficacy of Paediatric Preinduction Anxiety Distraction Techniques During Oncologic Procedures

Introduction: Children undergoing oncologic procedures as part of their treatment may suffer from anxiety. It could be related to parental separation, pain/ bodily harm or a previous bad experience of procedure. Pre-procedure anxiety may result in adverse clinical outcomes such as emergence delirium, pulmonary complications and behavioral issues. Preoperative anxiety must be assessed to deal with using appropriate preinduction distraction techniques.&#x0D; Aims &amp; Objectives: The objective of audit is to determine efficacy of preinduction distraction techniques used in our clinical set up (to meet RCoA standards) in reducing anxiety and need of restrain for children at time of induction.&#x0D; Place and duration of study: Shaukat Khanum Memorial Cancer Hospital &amp; Research Centre, Lahore Pakistan. 14th of January 2020 to 15th of March 2020 (8 Weeks).&#x0D; Material &amp; Methods: It is a prospective outcome-based audit study of 101 children (2-8 years) undergoing intrathecal chemotherapy and bone marrow biopsy at Shaukat Khanum Cancer Hospital, Lahore. All children had non- pharmacological preinduction distraction techniques (Parental/legal guardian presence and/or play car) to reduce anxiety, cry and need for restraint. Anxiety levels as assessed by modified Yale Preoperative Anxiety Scale (mYPAS), cry and restrain were benchmarked with Royal College of Anesthetists (RCoA) standards.&#x0D; Results: A total of 101 children with a median age of 4 years (2-8 years), had 100% parental/legal guardian presence at induction. In our audit, 52% of children cried and 43% were found to be anxious. However, only 21% children required use of restraint (holding still in laps) by accompanying parent/legal guardian. This is acceptable for restraint but not for cry/ anxiety as per RCoA benchmark.&#x0D; Conclusion: Preinduction distraction technique of parental presence and/or toy car, showed only limited benefit in terms of cry, restraint and anxiety levels. Our audited results met benchmark set by RCoA only in terms of restraint but not for anxiety/cry.

Impact of Virtual Reality Technology on Pain and Anxiety in Pediatric Burn Patients: A Systematic Review and Meta-Analysis.

Introduction:Virtual reality (VR) has the potential to lessen pain and anxiety experienced by pediatric patients undergoing burn wound care procedures. Population-specific variables require novel technological application and thus, a systematic review among studies on its impact is warranted.Objective:The objective of this review was to evaluate the effectiveness of VR on pain in children with burn injuries undergoing wound care procedures.Methods:A systematic literature review was performed using PubMed and CINAHL databases from January 2010 to July 2021 with the keywords “pediatric,” “burn,” “virtual reality,” and “pain.” We included experimental studies of between- and within-subjects designs in which pediatric patients’ exposure to virtual reality technology during burn wound care functioned as the intervention of interest. Two researchers independently performed the literature search, made judgements of inclusion/exclusion based on agreed-upon criteria, abstracted data, and assessed quality of evidence using a standardized appraisal tool. A meta-analysis was conducted to evaluate the effectiveness of the VR on burning procedural pain in pediatric population. Standardized mean difference (SMD) was used as an index of combined effect size, and a random effect model was used for meta-analysis.Results:Ten articles published between January 2010 and July 2021 passed the selection criteria: six randomized controlled trials and four randomized repeated-measures studies. Consistent results among the studies provided support for VR as effective in reducing pain and potentially pain related anxiety in children undergoing burn wound care through preprocedural preparation (n = 2) and procedural intervention (n = 8). VR effects on pain intensity ratings were moderate to large (SMD=0.60, 95%CI=0.28–0.93, p=0.0037 with no significant heterogeneity of VR intervention effects between studies. Only one study reported direct influence of VR intervention on pre-procedural situational anxiety with a moderate effect size (Cohen’s d = 0.575, 95%CI = 0.11–1.04).Conclusion:Children’s exposure to VR during burn care procedures was associated with lower levels of pain and pain related anxiety. Moderate to large effect sizes support the integration of VR into traditional pediatric burn pain protocols irrespective of innovative delivery methods and content required for use in burned pediatric patients.

Effectiveness of Virtual Reality for Pediatric Pain and Anxiety Management during Skin Prick Testing

This study investigated the effectiveness of virtual reality (VR) distraction, compared to comic book distraction and no distraction, in reducing pain and anxiety during a medical procedure in a pediatric population: the skin prick test. Although this test has many advantages and is considered to be minimally invasive, it causes anxiety and painful discomfort in children. Ninety-two children aged 7 to 17 years consulting for an allergic test received VR distraction, comic book distraction, or no distraction. Outcome measures included pain score, level of anxiety, and VR measures. The results showed that there were no significant differences between the three groups regarding sex, age, and preprocedural anxiety level. In the distraction groups (VR and comic book), children reported significantly lower pain and procedural anxiety scores than children with no distraction; VR distraction had a more significant effect than comic book distraction. A decrease in anxiety before and during the skin prick test is significantly more significant in VR distraction. This study suggested the effectiveness and feasibility of VR to reduce pain and anxiety during the pediatric skin prick test.

Educating Outpatients for Bowel Preparation Before Colonoscopy Using Conventional Methods vs Virtual Reality Videos Plus Conventional Methods

Adequate bowel preparation is essential for diagnostic, screening, and surveillance colonoscopy. Virtual reality (VR) has the characteristics of immersion, interaction, and imagination and has been widely used in medicine for training and teaching, indicating that it could be used in the education of outpatients for bowel preparation before colonoscopy. To investigate whether using VR videos for patient education before colonoscopy could improve bowel preparation. A prospective, single-blinded, randomized clinical trial of 346 patients undergoing colonoscopy with local anesthesia in a tertiary care hospital was conducted between October 1, 2018, and November 1, 2020. Outpatients who had indications for colonoscopy and had not received one before were enrolled. Statistical analysis was performed from November 1 to December 31, 2020. All data were analyzed according to the intention-to-treat approach. Conventional bowel preparation education (oral instructions and written materials that had the same contents) or conventional education plus VR videos. The primary outcome was the quality of bowel preparation measured by the Boston Bowel Preparation Scale score (range, 0-9, where 0 indicates extremely unsatisfactory bowel preparation and 9 indicates complete bowel preparation). Secondary outcomes included polyp and adenoma detection rates, compliance with complete bowel cleansing, preprocedure anxiety, overall satisfaction, and willingness to undergo a follow-up colonoscopy. A total of 346 outpatients were enrolled in the trial, with 173 patients randomly assigned to each group (control group: 87 women [50.3%]; mean [SD] age, 50.5 [12.5] years; VR video group: 84 women [48.6%]; mean [SD] age, 52.6 [11.4] years). Baseline characteristics, including demographic information, medical history, lifestyle, and the characteristics of stool, were comparable between the VR video group and the control group. The mean (SD) Boston Bowel Preparation Scale score was significantly higher in the VR video group than in the control group (7.61 [1.65] vs 7.04 [1.70]; P = .002). The detection rate of polyps (72 of 172 [41.9%] vs 46 of 172 [26.7%]; P = .003) and the detection rate of adenomas (56 of 172 [32.6%] vs 38 of 172 [22.1%]; P = .03) were also higher in the VR video group. Patients who received VR education had better compliance (119 [68.8%] vs 87 [50.3%]; P < .001) and higher mean (SD) overall satisfaction (8.68 [1.70] vs 8.16 [2.15]; P = .01) with bowel preparation. Patients who received VR video education before colonoscopy had better bowel preparation, higher polyp and adenoma detection rates, and improved compliance and satisfaction. ClinicalTrials.gov Identifier: NCT03667911.

Impact of Anxiety Levels and Sleep Patterns on Perceived Pain During Intravitreal Bevacizumab Injections.

To evaluate the impact of anxiety and sleep patterns on intravitreal injection pain. This prospective, noninterventional study surveyed patients scheduled for intravitreal injection by two retinal surgeons. A standard intravitreal injection technique was used. Patients filled out pre-procedure General Anxiety Disorder-7 (GAD-7) and Pittsburgh Sleep Quality Index (PSQI) questionnaires. Post-procedural pain was assessed with a visual analogue scale. Quality and hours of sleep and anxiety levels were correlated with perceived intravitreal injection pain. A total of 140 patients met inclusion criteria. Mean ± standard deviation scores were 4.9 ± 5.6 for the GAD-7, 6.3 ± 4.1 for the PSQI, and 3.69 ± 2.64 for intravitreal injection pain. Anxiety correlated with intravitreal injection pain (rho = 0.25; P = .003). Previous night's sleep (rho = -0.16; P = .057) and poor sleep quality (rho = 0.14; P = .11) were weakly correlated. Regression analysis revealed anxiety was the only significant predictor of intravitreal injection pain. A 1-point increase in anxiety predicted a 0.10-point increase in intravitreal injection pain (B = 0.10, P = .032). Anxiety level was the best predictor of perceived pain. This has implications for pre-procedural anxiety screening. [Ophthalmic Surgery Lasers Imaging Retina. 2021;52:498-504.].

An Interactive Video Educational Tool Does Not Improve the Quality of Bowel Preparation for Colonoscopy: A Randomized Controlled Study.

Inadequate bowel preparation leads to poor outcomes in colonoscopy. Prior investigations have demonstrated improved bowel preparation with pre-procedural educational videos. We aimed to determine whether an interactive, online educational video could improve bowel preparation scores in an outpatient population. We performed a prospective, endoscopist-blinded, randomized controlled trial at our hospital-based outpatient endoscopy center. Eligible patients were randomized to two groups. Both groups received standard verbal and written instructions, while the intervention group also received access to an interactive, online video. The primary outcome was improvement in the bowel preparation scores graded using the Boston bowel prep score (BBPS). Secondary outcomes included adenoma detection rate, total number of polyps detected, patient satisfaction, pre-procedure anxiety, and complication rates. The difference in BBPS in the intervention group (8) compared to the control group (7.6) did not meet statistical significance in our primary outcome of improvement in BBPS (p = 0.076). However, on subgroup analysis, there was a statistically significant improvement in BBPS in the intervention group among African Americans (p = 0.007) and patients older than 65 (p = 0.026). Those in the intervention arm rated pre-procedural materials "very easy" to understand significantly more often than in the control arm (p = 0.018). Use of an interactive, online educational video for bowel preparation did not lead to improvement in overall BBPS. However, among patients at higher risk for inadequate bowel preparation, such as African Americans and elderly patients, there may be a benefit.

Pre-Procedural Patient Anxiety in Dermatologic Procedures: A Cross-Sectional Study of Dermatologists

As many as 73% of patients scheduled to undergo surgery have substantial preoperative anxiety [1]. Significant preoperative anxiety has also been reported in fast track and day-care patients [2]. Dermatologists perform a number of procedures ranging from skin biopsies to Mohs micrographic surgery. Patients may experience anxiety prior to such procedures, termed pre-procedural or preoperative anxiety. Patient anxiety prior to dermatologic surgery may be influenced by factors such as the sight of blood, perception of pain during the surgery, and potential complications of surgery. Given the role of preoperative anxiety in affecting tolerance of the procedure, intra- and postoperative complications, and overall satisfaction, further research is warranted to determine how best to reduce preprocedural anxiety in dermatologic procedures.

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.

Combined Oral Administration of Analgesia and Anxiolysis for Pain Associated with Bone Marrow Aspiration and Biopsy

▪BackgroundBone 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.AimsOur 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.MethodsPatients were randomly assigned into two arms for receiving either placebo plus LIA (standard group, 48,6%) or oral fentanyl citrate 200 mcg plus 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 telephone interview was performed 24 hours later. A total number of one-hundred-sixteen (n =116) were enrolled in the study. Nine (n = 9) patients did not meet inclusion criteria and were excluded. Fifty-two (n = 52) patients were randomized and assigned to standard group and fifty-five (n = 55) to combo group (Figure 1).ResultsAt T2b and T3 (corresponding to the biopsy time and time after the biopsy, respectively) there was a significantly lower (p < 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, thus confirming the effectiveness of this combination also in relieving anticipatory anxiety. Finally, the histological specimen was found to be high in quality, as defined by standards.ConclusionsAdministration 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. [Display omitted] DisclosuresPane:Novartis: Honoraria, Speakers Bureau.