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ISUP Grade Group 1 prostate cancer is the lowest histologic grade of prostate cancer with a clinically indolent course. Removal of the term ‘cancer’ has been proposed and has historical precedent both in urothelial and thyroid carcinoma. Evidence-based review identifying arguments for and against Grade Group 1 being referred to as cancer. Grade Group 1 has histologic evidence of tissue microinvasion and 0.3–3% rate of extraprostatic extension. Genomic evaluation suggests overlap of a minority of Grade Group 1 cancers with those of Grade Group 2. Conversely, Grade Group 1 tumors appear to have distinct genetic and genomic profiles from Grade Group 3 or higher tumors. Grade Group 1 has no documented ability for regional or distant metastasis and long-term follow up after treatment or active surveillance is safe with excellent oncologic outcomes. Grade Group 1 prostate cancer, while showing evidence of neoplasia on histology has a remarkably indolent natural history more akin to non-neoplastic precursor lesions. Consideration should be given to renaming Grade Group 1 prostate cancer, which has the potential to minimize overtreatment, treatment-related side effects, patient anxiety, and financial burden on the healthcare system.

We built a virtual reality (VR) application that runs on a commercially available standalone VR headset that allows patients to view a virtual simulation of themselves receiving radiotherapy. The purpose of this study was to determine if this experience can improve patient understanding of radiotherapy and/or reduce patient anxiety. We created software that reads data from our clinical treatment planning system and renders the plan on a life-size “virtual linear accelerator.” The patient’s CT simulation data is converted into a 3D translucent virtual human shown lying on the treatment table while visible yellow radiation beams are delivered to the target volumes in the patient. We conducted a prospective study to determine if showing patients their radiotherapy plan in VR improves patient education and/or reduces anxiety about treatment. A total of 43 patients were enrolled. The most common plans were 3D breast tangents and intensity-modulated radiotherapy prostate plans. Patients were administered pre- and post-experience questionnaires. Thirty-two patients (74%) indicated that they “strongly agree” that the VR session gave them a better understanding of how radiotherapy will be used to treat their cancer. Of the 21 patients who expressed any anxiety about radiotherapy beforehand, 12 (57%) said that the VR session helped decrease their anxiety about undergoing radiotherapy. In our single-institution, single-arm prospective patient study, we found that the majority of patients reported that the personalized VR experience was educational and can reduce anxiety. VR technology has potential to be a powerful adjunctive educational tool for cancer patients about to undergo radiotherapy. Electronic supplementary material The online version of this article (10.1007/s13187-020-01870-7) contains supplementary material, which is available to authorized users.

Purpose The ERAS protocol recommends fast mobilization of a patient along with providing psychological comfort; however, early verticalization can generate mental discomfort. In the post-operative period after Caesarean section (CC), a patient may experience pain, anxiety and negative affect. The main aim of the study was to investigate levels of patient anxiety concerning verticalization on day 0 after CC using. Also, the dependence between anxiety of verticalization and the following: pain, anxiety as a permanent disposition, resistance to pain, negative and positive emotions, and positive orientation was described. Methods The study included 150 women on day 0 after their CC. The measurement of anxiety concerning verticalization, pain, and also negative and positive emotions was conducted twice. During the first measurement, variables such as anxiety levels as a constant disposition, level of pain resistance and positive orientation were also monitored. Results Patients upon arrival at the post-operative room declared a higher level of anxiety of verticalization (p r = 0.264; p Conclusions Low levels of pain experienced by a patient after CC do not explain the variance in anxiety of verticalization. The use of the Numerical Rating Scale (NRS) of anxiety allows care givers to gain patients' psychological perspective in different moments after CC.

BACKGROUND: Preoperative anxiety is a common phenomenon in plastic surgery that has been associated with numerous negative patient outcomes. Little is known about the preferences of plastic surgeons regarding management of patient preoperative anxiety OBJECTIVE: To determine the preferences of plastic surgeons regarding the assessment and reduction of adult preoperative patient anxiety in their primary practice setting. METHODS: The membership of the American Council of Academic Plastic Surgeons (ACAPS) was surveyed using an anonymous, online questionnaire from April to June of 2020. RESULTS: A total of 100 participants from a membership of 532 responded (19%). The majority of respondents (63%) did not formally assess patient anxiety but supported the use of standardized scales to measure anxiety (57%). Most plastic surgeons preferred patient education (81%), family member presence (69%), and visit from the anesthesiologist (54%) to reduce patient anxiety. Plastic surgeons also allocated the most responsibility to anesthesiologists (63%) and plastic surgeons (62%) to reduce preoperative anxiety. DISCUSSION: Most plastic surgeon members of ACAPS did not assess their patients’ anxieties preoperatively but appeared willing to use anxiety scales. Plastic surgeons also supported several measures to reduce anxiety, especially patient education, family member preferences, and anesthesiologist visits. Although plastic surgeons appeared to hold multiple parties responsible to manage preoperative anxiety, they held themselves and anesthesiologists most responsible. Future studies are needed to determine whether these views cohere with those of other healthcare providers and whether these preferences change for pediatric patients. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these evidence-based medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Background There is little information available regarding the decision-making process of clinicians, especially in the choice of therapy for a severely atrophic tooth gap. The aim of this research was to use case vignettes to determine the influence of possible factors on the decision making of maxillofacial and oral surgeons. Methods A total of 250 maxillofacial (MFS) and oral (OS) surgeons in southern Germany were surveyed for atrophic single- or multiple-tooth gap with the help of case vignettes. The influence of different determinants on the therapy decision was investigated. Two case vignettes were designed for this purpose: vignette 1 with determinants “patient age” and “endocarditis prophylaxis” and vignette 2 with determinants “anxiety” and “bisphosphonate therapy”. Furthermore, the specialist designation was assessed for both. The options available to achieve a sufficient implant site were "bone split", "bone block", "augmentation with bone substitute material" and "bone resection". Therapy was either recommended or rejected based on principle. Results A total of 117 participants returned the questionnaire: 68 (58%) were OS and 49 (42%) MFS. “Patient age” and “patient anxiety” were not significantly associated with any therapy decision. However, required “endocarditis prophylaxis” led to significantly higher refusal rates for "bone split", "bone block" and "bone replacement material" and to higher rates of general refusal of a therapy. “Bisphosphonate therapy” was significantly associated with general refusal of therapy, but with no significant correlation with different therapy options. In vignette 1, OS refused therapy significantly more often than MFS, though there was no association with the specialist designation for other therapy modalities. In vignette 2, specialty was not significantly associated with the therapy decision. Conclusion “Patient age” as well as “patient anxiety” appear to have no or little influence on the treatment decision for severely atrophic single- or multiple-tooth gap by specialist surgeons. Surgeons more often refuse treatment for patients with endocarditis prophylaxis and bisphosphonate therapy.

Benefits of overnight attending radiologist final reports are debated, often stating low resident discrepancy rates, usually assessed retrospectively. The objective of this study was to assess the impact of overnight final reporting on the recall rates for patients in the emergency department (ED) receiving overnight imaging. Retrospective matched cohorts of two separate years prior (prior-16 and prior-17) and 1 year after (post-18) introduction of overnight attending radiologist final reporting. Patients receiving imaging between 22:00 and 07:00 h and returned to ED within 48 h of initial visit discharge were electronically identified. String matching identified return visits possibly related to imaging completed on first visit. Identified return visit notes were scored by three observers individually. Unclear and discrepant cases were resolved by consensus meeting, using full patient charts where needed. Incidences were provided and logistic regression analysis defined if coverage model was a predictor for recall. Odds ratios were calculated. ED patient count with imaging completed overnight in prior-16 was 9200, in prior-17 was 9543, and in post-18 was 9992. The number of overnight imaging studies performed was respectively 13,883, 14,463, and 15,112. Imaging-related ED recalls were respectively 54, 61, and 7, a decrease with the new coverage model of 89% to true and at least 90% of expected recalls.Logistic regression demonstrated that coverage model was a significant predictor of ED recalls with chi-square of 59.86 and p

Low health literacy leads to poor knowledge and understanding of health information, delayed diagnosis, lower use of preventative medicines/health services, increased likelihood of hospitalisation, and increased patient anxiety. Effective communication facilitates patient understanding and helps patients to manage the adverse side-effects associated with treatment. It is not yet known whether radiation therapists in Ireland tailor their communication to match a patient’s health literacy level. The purpose of this research was to investigate radiation therapists’ knowledge and awareness of health literacy and perceptions of their role in supporting patients with low health literacy. Semi-structured interviews were conducted with sixteen radiation therapists working in four radiotherapy departments in Ireland. Data were analysed using the framework approach. Through discussions with participants, it was apparent that radiation therapists had limited knowledge of the concept of health literacy. Common themes arose from the interviews with four key themes identified: Currently, radiation therapists show some knowledge and awareness of health literacy, but an increased awareness of the prevalence of low health literacy and a structured approach to supporting patients would allow radiation therapists to more effectively communicate with patients, thus improving their treatment experience and reducing the risk of adverse outcomes.

Ovarian cancer is one of the prime causes of mortality in women. Diagnosis of ovarian cancer using ultrasonography is tedious as ovarian tumors exhibit minute clinical and structural differences between the suspicious and non-suspicious classes. Early prediction of ovarian cancer will reduce its growth rate and may save many lives. Computer-aided diagnosis (CAD) is a noninvasive method for finding ovarian cancer in its early stage which can avoid patient anxiety and unnecessary biopsy. This study investigates the efficacy of a novel CAD tool to characterize suspicious ovarian cancer using Radon-transformed nonlinear features. The obtained dimension of the extracted features is reduced using Relief-F feature selection method. In this study, we have employed the fuzzy forest-based ensemble classifier in contrast to the known crisp rule-based classifiers. The proposed method is evaluated using 469 (non-suspicious: 238, suspicious: 231) subjects and achieved a maximum 80.60 ± 0.5% accuracy, 81.40% sensitivity, 76.30% specificity with fuzzy forest, an ensemble fuzzy classifier using thirty-nine features. The proposed method is robust and reproducible as it uses maximum number subjects (469) as compared to state-of-the-art techniques. Hence, it can be used as an assisting tool by gynecologists during their routine screening.

This paper is a practice reflection by two medical social workers. It describes insights from interviews with older adults recovering from illness. The clients were 32 survivors of hospitalization for critical illness and 50 home health patients. Our practice discussions explored a counterintuitive concept: patients with more sources of support reported more anxiety during their illness recovery. Patient anxiety was measured using the DSM-5 and HADS-A criteria. A brief literature review describes the difficulties of quantifying and defining support. Case vignettes are presented to describe three categories of patients who experienced anxiety connected to their support systems. The importance of a social work approach to understanding and individualizing client supports is highlighted. Practical practice suggestions and interventions are provided.

This article is the second part of a BDJ series of Practice papers on the subject of clinical examination and related record keeping. The series is taken from the Faculty of General Dental Practice UK (FGDP[UK]) 2016 Good Practice Guidelines book on this topic, edited by A. M. Hadden. This particular article discusses history taking, where information may be gathered prior to the patient seeing the clinician or, in some cases, this may be carried out chairside by the individual. The information gathered can include a medical history, socio-behavioural history, and patient anxiety levels. It is important to note that throughout this article (and the BDJ series and associated FGDP[UK] book), the specific guidelines will be marked as follows: A: Aspirational, B: Basic, C: Conditional. Further information about this guideline notation system is provided in Part 1 of this series ( 2017; 223: 765-768).

BackgroundPreoperative anxiety is one of the most important problems for the patients, because it causes emotional and psychiatric problems as well as physical problems. It is crucial to detect the patient’s existing anxiety to assist patients. Our primary aim in this study is to investigate how the patient’s age, gender, the operation, surgical briefing, type of anesthesia recommended for the operation ahead, and patient’s prior anesthesia experience affect the patient’s anxieties. Our secondary aim is to reveal the causes of the patient’s anxieties regarding anesthesia.MethodsOur study was conducted as a prospective cohort study between May 2016–2017. Interviews with the patients were performed in the anesthesia clinic for preoperative examination. For the study, The Amsterdam Preoperative Anxiety and Information Scale (APAIS) has been used. The answers were evaluated in two scales: the anxiety score and the desire for information score. Answers to the statements were evaluated with Likert Scale. In addition, our patients were asked whether they had received prior anesthesia, if so, the type of anesthesia, whether they received surgical briefing and anesthetic method we recommended. We also asked our patients about the cause of their anxiety regarding the anesthesia.ResultsA total of 637 patients were recruited to the study, after excluding the patients who do not meet the criteria for inclusion, and 499 patients were included. Between the age and desire for information sub-scores, a negative significant correlation was detected (r: − 0.241;p = 0.001). We found that the scores of graduates of university and higher were statistically significant than the primary school graduates (p = 0.003) and secondary school graduates (p = 0.034). Anxiety sub-scores of the patients who underwent general anesthesia were found to be significantly higher than the patients who underwent regional anesthesia (p = 0.029). Anxiety sub-scores of females were found to be significantly higher than the males (p = 0.001).ConclusionsWe think that being aware of the patients’ anxiety and finding appropriate approaches for their anxieties can be valuable. APAIS is an effective method to measure patient anxiety and it might be beneficial to use during preoperative visits. Patient satisfaction and superior outcomes can be achieved in this way.Trial registrationISRCTN43960422. Registered 19/02/2018—Retrospectively registered.http://www.isrctn.com/ISRCTN43960422

Background This study investigated the expectations and experiences of a sample of new patients visiting an Australian regional university Student Dental Clinic with regard to anxiety provoking and alleviating stimuli in the clinical environment. Differences in anxiety levels were examined by age, gender and the type of procedure undergone. Methods The number of dental patients who participated in the study was 102 (56 males, 43 females). The study used a pre-treatment/post-treatment design to assess the effect of the dental procedure on anxiety levels of patients. The Modified Dental Anxiety Scale (MDAS) was used to measure anxiety levels in patients at pre-treatment. Questions were also asked about factors which may increase (length of the appointment, invasiveness of procedure) or decrease (perceived student interpersonal skills and clinical ability) dental fear. Results Females reported higher total MDAS scores (M = 11.93) compared to males (M = 9.94). Younger patients (M = 12.15) had higher dental anxiety than older patients (M = 9.34). There was a reduction in dental anxiety from pre-treatment (M = 1.92) to post-treatment (M = 1.23) on the single item anxiety measure though most of the treatment being undergone by patients was for less complex procedures. Conclusions Patients’ anticipatory experience of anxiety was higher than the anxiety experience after having undergone treatment at the student dental clinic. Student interpersonal skills and clinical ability as perceived by the patient can lessen dental anxiety in patients. Clinical Supervisor-student ratios need to be more equivalent in order to reduce the time length of appointments which currently are associated with increased patient anxiety levels in student dental clinics.

Focal lesions of the spleen are being detected at an ever-increasing rate given the constant improvement in temporal and spatial resolution of computed tomography (CT) and magnetic resonance (MR) imaging. Many commonly encountered benign “incidentalomas” of the spleen present as non-specific lesions that are hypoattenuating relative to the background normal splenic parenchyma on CT. Incidentally detected lesions can lead to increased patient anxiety, while posing challenges in patient management for practicing radiologists and clinicians. While the literature regarding incidentally detected splenic lesions has previously been relatively scarce, recent consensus criteria have emerged in recent years that greatly aid in the characterization and management of such lesions. This article discusses the diagnosis and management of incidentally detected splenic lesions based on recently consensus criteria. This review is intended to aid clinical radiologists in the characterization, differentiation and management of incidentally detected splenic lesions.

This article reviews the imaging findings of hepatic steatosis (fatty liver disease) on cross-sectional imaging with an emphasis on various patterns of focal fat. Hepatic steatosis can herald pathology or mimic metastatic disease, the latter generating confusion and creating undue patient anxiety. Hepatic steatosis is often first detected at computed tomography imaging, which serves as the primary imaging modality for evaluating a wide variety of diseases within the abdomen and pelvis. However, magnetic resonance imaging (MRI) has evolved as a more precise method of evaluating for the presence, severity, and distribution of hepatic steatosis. In particular, chemical shift MRI is a robust technique that is invaluable in differentiating between focal fat and its mimics, allowing the radiologist to establish a confident diagnosis while preventing unnecessary biopsies.

Revision hip and knee arthroplasty surgery may cause great physiological stress to what is commonly an aged, infirm patient population. In some orthopaedic units, it is routine practice to book high-dependency unit (HDU) beds for postoperative revision arthroplasty surgery patients. If this facility is not available on the day of surgery, the operation may be postponed, leading to increased patient anxiety, wasted theatre time and loss of potential income for the hospital. If the likelihood of a patient needing HDU care could be accurately predicted from their comorbid conditions and type of surgery, it may be possible to safely proceed with surgery, avoiding the above scenario. To ascertain whether comorbidities and type of revision arthroplasty may be used to predict the need for postoperative high-dependency care. A total of 196 patients undergoing lower limb revision arthroplasty surgery at the Norfolk and Norwich University Hospital were identified from June 2007 to June 2010. For each patient, age, ASA grade and type of revision arthroplasty were correlated against length of stay in the HDU. The results showed that there was no clear-cut correlation between age, ASA grade or the type of revision operation and the patient’s length of stay in HDU. Age, ASA grade and type of revision arthroplasty are not useful tools in predicting the need for postoperative HDU admission with patients undergoing lower limb revision arthroplasty surgery.

Patients anticipating surgical procedures experience significant anxiety, resulting in adverse outcomes and increased expenditures. Research has investigated the impact of anxiety-reducing interventions, frequently the provision of surgical information, with inconsistent results. The present study (N = 98) examined preference for information, or “monitor-blunter” coping style, and the impact of a pre-surgical phone call from an anesthesiologist on anxiety in which treatment group participants (n = 51) dictated the amount of information received. Monitors were hypothesized to desire more information than blunters, and changes in anxiety for monitors/blunters were hypothesized to be moderated by length of call. Monitors and blunters demonstrated equal call durations and anxiety levels remained equivalent across groups. Findings and implications for future research are discussed.

Boker A, Brownell L, Donen N. Department of Anesthesia University of Manitoba Winnipeg Manitoba Canada. bokera@hotmail.com PURPOSE: To compare three anxiety scales; the anxiety visual analogue scale (VAS), the anxiety component of the Amsterdam preoperative anxiety and information scale (APAIS), and the state portion of the Spielburger state-trait anxiety inventory (STAI), for assessment of preoperative anxiety levels in same day admission patients. METHODS: Patients completed the three anxiety assessment scales both before and after seeing the anesthesiologist preoperatively. The scales used were the STAI, the six-question APAIS, and the VAS. APAIS was further subdivided to assess anxiety about anesthesia (sum A), anxiety about surgery (sum S) and a combined anxiety total (i.e., sum C = sum A + sum S). These scales were compared to one another. Pearson's correlation (pair-wise deletion) was used for validity testing. Cronbach's alpha analysis was used to test internal validity of the various components of the APAIS scale. A correlation co-efficient (r) > or = 0.6 and P < 0.05 were considered significant. RESULTS: Four hundred and sixty three scale sets were completed by 197 patients. There was significant and positive correlation between VAS and STAI r = 0.64, P < 0.001), VAS and APAIS r = 0.6, P < 0.001), sum C and STAI r = 0.63, P < 0.001) and between VAS and sum C r = 0.61, P < 0.001). Sum C and STAI r value were consistent with repeated administration. Cronbach's alpha-levels for the anxiety components of the APAIS (sum C) and desire for information were 0.84 and 0.77 respectively. CONCLUSION: In addition to VAS, the anxiety component of APAIS (sum C) is a promising new practical tool to assess preoperative patient anxiety levels.

Sedation is often required for a number of procedures to reduce patient anxiety, improve cooperation and ensure immobilisation when necessary. This article provides a concise summary of the recent developments and current techniques of sedation during surgical and investigational procedures.

This presentation will illustrate how the combination of established mammographic techniques and the alternative use of a biopsy attachment helped us to develop a technique that allows differential radiological diagnosis between dermal calcification and other calcification within breast tissue. The accurate radiological diagnosis of dermal calcification has many advantages: the possible prevention of unnecessary biopsy procedures; results can be given on the first visit; reduction of patient time in department; and reduction of patient anxiety induced by both biopsy and the wait for results. Dermal calcifications typically have lucent centres and maintain their positional relationships regardless of radiographic view (the tattoo sign). It is the maintenance of these positional relationships that enables a possible diagnosis of dermal calcification. Confirmation of this diagnosis can be made using the Siemens Mammomat 3000 and biopsy attachment with shadow cross. It is possible to accurately locate and subsequently skin mark the calcification. Tangential views are taken following the skin marking. If the calcifications are found to be within 3 mm of the skin marker the diagnosis of dermal calcifications can be made.

Objective To identify controlled clinical trials done in dental primary care and to classify the research according to design. Details of any procedures used to recruit general dental practitioners and any special organisational arrangements were also collected. Design A scoping literature review. Setting Dental primary care defined as general dental practice, community and school dental settings. Participants Published randomised controlled trials using randomised or quasi randomised approaches and controlled clinical trials were considered for inclusion in the review. Reports were excluded if they did not describe either a randomised controlled trial or a controlled trial. Studies were excluded if the setting was not primary dental care or the intervention was for non-dental conditions. Conference abstracts without a full report and trials published in a language other than English were also excluded. Main outcomes Experimental and quasi-experimental designs, clinical areas and different kinds of strategies used to recruit dentists, any organisational arrangements made to support research in dental primary care. Results The search of the Cochrane Oral Health Group Controlled Trials Register found 174 articles. 43 randomised controlled trials met the inclusion criteria. Trials to evaluate the effects of interventions for types of anaesthesia, periodontal diseases, smoking cessation techniques, dental materials, organisational aspects of dental care, patient anxiety, post extraction healing rates, antibiotics were identified. All were done in general dental practice. Trials in school and community settings were also included. Conclusions Practice-based research needs to be encouraged to provide dental primary care with relevant evidence upon which effective treatment can be based. This review shows there are few trials done in dental primary care to inform clinical practice, most of which have been reported since 1997. The range of trial designs shows that this method of evaluation can evaluate dental primary care interventions and this is promising for those with an interest in improving dental patient outcomes. More research on how to recruit dentists into clinical trial research must be done.