Search

The introduction of tyrosine kinase inhibitors (TKI) has revolutionised the management of patients with chronic myeloid leukemia (CML) over the last twenty years, but despite significant improvements in survival, patients exhibit long-term side effects that impact on quality of life. A major advance in CML management has been the ability to discontinue TKI therapy achieving a treatment-free remission (TFR), yet this option is only available to eligible patients who present with low-risk disease and who subsequently attain deep and sustained molecular responses. A case is described of a patient with CML who self-initiated stopping of TKI therapy when in a less than optimal molecular remission. Despite this action, the patient continues to experience a TFR with prospective close molecular monitoring performed. It is emphasized that this approach may lead to ineffective treatment discontinuation, molecular relapse, and increased patient anxiety. As TFR for patients with CML moves from clinical trials into routine clinical practice, emphasis is placed on adherence to (evolving) guidelines critical to ensure optimal counselling, selection, monitoring, and continued management of patients whether TFR is successful or not.

Aim: A variety of consumer-facing wearables, devices and apps are marketed directly to consumers to detect atrial fibrillation (AF). However, their management is not defined. Our aim was to explore their role for AF screening via a survey.Methods and Results: An anonymous web-based survey was undertaken by 588 health care professionals (HCPs) (response rate 23.7%). Overall, 57% HCPs currently advise wearables/apps for AF detection in their patients: this was much higher for electrophysiologists and nurses/allied health professionals (74-75%) than cardiologists (57%) or other physicians (34-38%). Approximately 46% recommended handheld (portable) single-lead dedicated ECG devices, or, less frequently, wristband ECG monitors with similar differentials between HCPs . Only 10-15% HCPs advised photoplethysmographic wristband monitors or smartphone apps. In over half of the HCP consultations for AF detected by wearables/apps, the decision to screen was entirely the patients. About 45% of HCPs perceive a potential role for AF screening in people aged > 65 years or in those with risk factors. Almost 70% of HCPs believed we are not yet ready for mass consumer-initiated screening for AF using wearable devices/ apps, with patient anxiety, risk of false positives and negatives, and risk of anticoagulant-related bleeding perceived as potential disadvantages, and perceived need for appropriate management pathways.Conclusions: There is a great potential for appropriate use of consumer-facing wearables/apps for AF screening. However, it appears that there is a need to better define suitable individuals for screening and an appropriate mechanism for managing positive results before they can be recommended by HCPs.

Purpose: This study aimed to determine the effectiveness of hand massage on patient anxiety and comfort before cataract surgery. Design: A randomized controlled trial. Methods: The 140 patients in this study were assigned to the intervention group (n = 70), which received a 10-minute hand massage before cataract surgery, and to the control group (n = 70), which received routine nursing care. The visual analog scale (VAS) and Spielberger State-Trait Anxiety Inventory (STAI) were used to collect data. Findings: The median STAI state scores of the intervention and control groups were found to be 46.0 (44.7 to 48.0) and 57.0 (55.75 to 59.00), respectively. The VAS comfort score of the intervention group after hand massage (4.0 [1.7-5.0]) was lower than that of the control group immediately before surgery (8.0 [6.0-10.0]) (P < .05). In addition, except oxygen saturation, the remaining vital signs were lower in the intervention group. Conclusions: Hand massage reduced the anxiety of patients, positively affected their vital signs, and increased their comfort. © 2019 American Society of PeriAnesthesia Nurses

Plasma free metanephrines or urinary fractionated metanephrines are the biochemical tests of choice for the diagnosis of pheochromocytoma as they have greater sensitivity and specificity than catecholamines for pheochromocytoma detection. This case highlights the preanalytical factors which can influence metanephrine measurement and cause a false positive result. It describes a patient with a high pre-test probability of pheochromocytoma due to hypertension and a past medical history of adrenalectomy for a purported pheochromocytoma in her home country. When biochemical screening revealed grossly elevated urine normetanephrine in the presence of a previously identified right adrenal lesion, there was high clinical suspicion of a pheochromocytoma. However, functional imaging did not support this view which prompted additional testing with plasma metanephrines. Results for plasma and urine metanephrines were discordant and preanalytical drug interference was suspected. Patient medications were reviewed and sulfasalazine, an anti-inflammatory drug was identified as the most likely analytical interferent. Urinary fractionated metanephrines were re-analysed using liquid chromatography tandem mass spectrometry (LC-MS/MS) and all metanephrines were within their reference intervals. This case illustrates how method-specific analytical drug interference prompted unnecessary expensive imaging, heightened patient anxiety and resulted in lengthy investigations for what turned out to be a phantom pheochromocytoma.

Aim: Preoperative education is one of the methods used to reduce anxiety levels. This study was planned to investigate the effect of preoperative education on the anxiety levels of patients undergoing planned colorectal surgery with creation of an intestinal stoma. Method: the study population consisted of patients admitted to the general surgery department of a university hospital between 9 June 2013 and 15 August 2014 for planned colorectal surgery with stoma creation. the study sample consisted of 30 patients in the experimental group (received preoperative education) and 30 patients in the control group who met the inclusion criteria. Scheduled trainings were given to the experimental group during the preoperative period using a training booklet on stoma care. the Spielberger State-Trait Anxiety Inventory (STAI form TX-1/2) was administered to all patients preoperatively and six months after surgery. Results: Mean age of the patients was 53.5±12.83 years in the experimental group, and 58.00±14.22 years in the control group. Mean preoperative STAI form TX-1 scores of the experimental and control groups were 37.10±3.57 and 42.70±2.02, respectively. Mean preoperative STAI form TX-2 scores in the experimental and control groups were 37.00±2.00 and 47.83±3.37, respectively. Six months after surgery, the experimental and control groups had mean STAI form TX-1 scores of 37.17±5.38 and 41.93±3.02 and mean STAI form TX-2 scores of 39.73±5.02 and 48.00±2.33, respectively. Preoperative STAI form TX-1 and 6-month postoperative STAI form TX-1/2 scores were significantly higher in the control group than in the experimental group (p, Amaç: Ameliyat öncesi dönemde verilen eğitim anksiyete seviyesini düşürmek için uygulanan yöntemlerden biridir. Bu araştırma planlı kolorektal cerrahi sonrası stoma açılacak olan hastalara ameliyat öncesi verilen eğitimin hastaların anksiyete düzeyine etkisini incelemek amacıyla planlanmıştır. Yöntem: Araştırmanın evrenini 9 Haziran 2013-15 Ağustos 2014 tarihleri arasında bir üniversite hastanesinin genel cerrahi anabilim dalında planlı kolorektal cerrahi ameliyatı için yatışı yapılan stoma açılacak olan hastalar, örneklemi araştırmanın sınırlılıklarına uyan 30’u deney (ameliyat öncesi eğitim alan), 30’u kontrol grubunda yer alan hastalar oluşturdu. Deney grubundaki hastalara ameliyat öncesi dönemde stoma bakımına yönelik eğitim kitapçığı kullanılarak planlı eğitim verildi. Tüm hastalara ameliyat öncesi ve ameliyattan 6 ay sonra Spielberger Durumluk-Sürekli Kaygı Ölçeği (STAI form TX-1/2) uygulandı. Bulgular: Deney grubundaki hastaların yaş ortalaması 53,5±12,83; kontrol grubundaki hastaların yaş ortalaması 58,00±14,22 yıldır. Deney grubundaki hastaların ameliyat öncesi STAI form TX-1 puan ortalaması 37,10±3,57, kontrol grubunun 42,70±2,02, deney grubunda STAI form TX-2 puan ortalaması 37,00±2,00, kontrol grubunun 47,83±3,37 olduğu saptandı. Ameliyattan 6 ay sonra deney grubundaki hastaların STAI form TX-1 puan ortalaması 37,17±5,38, kontrol grubunun 41,93±3,02, deney grubunda STAI form TX-2 puan ortalaması 39,73±5,02, kontrol grubunun 48,00±2,33 olduğu saptandı. Ameliyat öncesi STAI form TX-1 ve ameliyattan 6 ay sonraki STAI form TX-1/2 puanları kontrol grubundaki hastalarda deney grubundaki hastalara göre anlamlı derecede yüksek olduğu saptandı (p

The used of Hyperbaric therapy at Port Health Center of West Nusa Tenggara keeps increasing.There were fifteen patients with thirty-six times of visit during 2011. Meanwhile, there were twelve type of cases in which forty-two pateints came eighty-one times in 2012. However, this therapy also meets an annulment due to psychological condition such patients’ anxiety. There were three cases found in 2011 whereas five patients could not perform this therapy in 2012. The annulment of therapy caused by a fear and anxiety factors. This information was obtained from patients. Moreover, according to Port Health Center of West Nusa Tenggara in 2012 reported “physical assessment that is conducted indicated the incresing of blood pressure, pulse rate frequency, and excessive of sweat. The objective was to find out the influence of supportive psychotherapy toward patients’ anxiety against pre-hyperbaric therapy at Port Health Center. The research was done at Hyperbaric therapy chamber in July to November 2012. The research design employed pre and post test.

To investigate a new clinical role for medical physicists in direct patient care with a prospective phase 2 clinical trial.Medical physicists participated in the Physics Direct Patient Care (PDPC) protocol, establishing independent professional relationships with radiation oncology patients. After attending a dedicated patient communication training program, medical physicists routinely met with patients for 2 physicist-patient consults to explain the treatment planning and delivery process, review the patient's treatment plan, and answer all technical questions. The first physicist-patient consult took place immediately before the computed tomography simulation, and the second took place immediately before the first treatment. Questionnaires were administered to each patient on the PDPC protocol at 3 time points to assess both anxiety and satisfaction. The first questionnaire was given shortly after the first physicist-patient consult, the second questionnaire was given shortly after the second physicist-patient consult, and the third questionnaire was given after the last treatment appointment, with no associated physicist-patient consult.The mean patient anxiety score was considered to be low at all questionnaire time points. There was a statistically significant decrease (P .0001) in anxiety from the simulation time point to the first treatment time point. The mean patient technical satisfaction score was considered to be high at all measurement time points. There was a statistically significant increase (P = .0012) in technical satisfaction from the simulation time point to the first treatment time point. There was a statistically significant decrease (P .023) in technical satisfaction from the first treatment time point to the last treatment time point.Establishing a new clinical role for medical physicists and investigating its effects on patient anxiety and satisfaction have created the foundation for future studies. Based on the results of this trial, the PDPC protocol will be expanded to a larger group of medical physicists, radiation oncologists, and patient disease sites and investigated with a randomized phase 3 clinical trial.

The dental surgery induces some degree of anxiety in many patients: 12% of the UK adult population who had visited a dentist were extremely dentally anxious. Such patients can be unco-operative and difficult to manage as they avoid dental visits and suffer a greater amount of dental disease. Furthermore, patients believe that their oral health has an impact on their quality of life. Sedation is an option to relieve anxiety, however this is associated with risks, including respiratory depression and over sedation. Erdal et al found that music was as effective as midazolam in terms of its sedative and anxiolytic properties during surgery. CPD/Clinical Relevance: Music has demonstrated its usefulness in terms of calming anxious patients.

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.

Background: In performing an MRI examination the patient may feel anxious due to the nature of the MRI scan as the patient would be inserted into the narrow bore of the MRI scanner and would be asked to be immobile during the examination period for approximately 20 to 90 minutes depending on the scan type. Patient feeling anxious may also be evoked by several causes and consequently may develop into anxiety reactions by the patient either before, during, or after the scan. Aim: This paper aim to study the issues surrounding the anxiety in patients undergoing MRI examinations by identifying the prominent causes, outlining the possible effects of anxiety, discussing the main potential methods for alleviating patient's anxiety. Materials and methods: This review is conducted by using a comprehensive search of PubMed, Google Scholar, and Elsevier, August 1993, through March 2018. The following search terms were used: causes of anxiety in MRI, claustrophobia and MRI, effects of anxiety in MRI, alleviation of anxiety in MRI patient. Conclusion: Patient's anxiety can pose problems that may impede the process of the MRI examination. Patient's anxiety may have adverse effects on both patient and the healthcare institution as it can cause financial losses for the healthcare institutions. However, sedation techniques, acoustic noise reduction, and adequate patient preparation for the MRI scan are possible methods that can alleviate patient's anxiety.

An objective method to recognize patient psychology using heart rate variability (HRV) has recently been developed and is increasingly being used in medical practice. This study compared the potential of this new method with the use of conventional surveys measuring anxiety levels in patients undergoing impacted third molar (ITM) surgery. Patient anxiety was examined before treatment in 64 adults who required ITM surgery, using two methods: measurement of HRV and conventional questionnaire surveys (state section of the State-Trait Anxiety Inventory (STAI-S) and Dental Fear Survey (DFS)). Both methods were assessed for their respective abilities to determine the impact of personal background, the amount of information provided, and the surgical procedure on patient psychology. Questionnaires and HRV yielded the same finding: dental experience was the single background factor that correlated with patient anxiety; the other factors remain unclear. The STAI-S showed a significant relationship between the information provided to the patient and their anxiety level, while the DFS and HRV did not. In addition, HRV demonstrated its ability to assess the effects of the surgical procedure on patient psychology. HRV demonstrated great potential as an objective method for evaluating patient stress, especially for providing real-time information on the patient's status.

Study Design: Observational study. Objectives: Perioperative patient anxiety is a major concern in orthopedic surgery. Mobile messaging applications have been used in a number of healthcare settings. The goal of this project is to develop a novel mobile messaging application aimed at decreasing perioperative patient anxiety in spine surgery patients. Methods: Postoperative recovery journals were collected from patients undergoing spine surgery. Journals were used as a framework to develop a software-messaging library. A subsequent cohort of patients received daily text messages with educational material regarding their recovery for 14 days after discharge from their operative admission. Patients ranked the usefulness of the survey on day 14; further feedback was obtained via interviews. Results: Nineteen postoperative recovery journals were collected and analyzed. Content regarding postoperative recovery was compiled. The pilot group consisted of 21 patients. Average rating of the application on a 1 to 5 scale with 5 being “very useful” was 4.57. Of the 12 patients available for postoperative interviews, 11 felt the content of the messages was relevant. Nine of 12 patients felt the application made it less likely for them to call clinic. Conclusions: The study presents a unique mobile phone messaging tool to offer patients support in the 2 weeks following spine surgery. The tool was felt to be useful by nearly all patients, had a high degree of patient engagement, and made the majority of patients less likely to call clinic.

Owing to the wide-ranging role nurses have in supporting patients undergoing fertility treatment, we recorded the learning/teaching expectations and experiences of nurses using a redesigned fertility pen injector.This was a multicentre, simulated-use study, using unbranded placebo-filled pens. Before teaching patients, nurses were given free choice to rank the importance of the device attributes and predict the level of patient anxiety. Nurses taught 2-5 patients how to prepare the device, inject the dose and complete an incomplete dose. They rated the teaching experience on a 5-point scale during a questionnaire interview.Thirty nurses were enrolled across four countries. All nurses found the redesigned fertility pen injector easy to use and teach. 90% found the overall administration process easy to learn and teach. More than 80% (range 83%-100%) found each of the steps easy (score 4 or 5), and most found the steps easier to teach than expected (score 4 or 5; range 57%-90%). 97% would recommend the redesigned fertility pen injector to a colleague.Nurses rated the redesigned fertility pen injector easy to learn and use and easier to teach than expected. Most would recommend the device to a colleague.

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.

Background Patients with cancer experience stress surrounding diagnosis and treatment. Many cancer centers employ a nurse-led education session to alleviate patient anxiety and confusion. . Objectives The goal was to evaluate the effect of a nurse-led chemotherapy teaching session on patients' knowledge, anxiety, and preparedness for cancer-directed therapy. . Methods After discussing treatment with their oncologist, participants completed a survey assessing their perceived understanding of various treatment topics. After, they underwent a teaching session with an oncology nurse. The survey was readministered when patients returned for their first and second treatment cycles. . Findings Significant increases were observed in patients' understanding of their treatment schedule, potential adverse effects, and antiemetic medication regimen by the first cycle of therapy and a reduction in treatment-related anxiety by the second cycle of therapy.

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.

Introduction. Neuraxial labor analgesia has become an integral part of modern obstetric anesthetic practice. Presence of a familiar person during its placement may be beneficial to the patient. A survey was sent to anesthesiologists practicing obstetric anesthesia in the USA to determine their views. Methods. The survey queried the following: existence of a written policy; would they allow a visitor; visitor’s view, sitting or standing; reasons to allow or not allow a visitor; and influence by other staff on the decision. The responses were analyzed using multiple chi-square analyses. Results. Most practitioners supported allowing a visitor during placement. Reduction of patient anxiety and fulfillment of patient request were the major reasons for allowing a visitor. Sitting position and no view of the workspace were preferred. Visitor interference and safety were cited as the major reasons for precluding a visitor. Nonanesthesia providers rarely influenced the decision. Epidural analgesia was the preferred technique. Essentially no bias was found in the responses; there was statistical uniformity regardless of procedures done per week, years in practice, professional certification, geographic region (rural, urban, or suburban), or academic, private, or government responders. Conclusion. The practice of visitor presence during the placement of neuraxial labor analgesia is gaining acceptance.

Objective: The effect on patient anxiety of lidocaine infiltration into nasal packing following septoplasty was investigated by this prospective, case- control study. Methods: 60 patients, who underwent septoplasty operation with bilateral merocele nasal packing were included in this study. Nasal packs were infiltrated with 0.9% saline (5 mL in each nostril) for 30 patients and remaining 30 were infiltrated with 2% xylocaine (5 mL in each nostril), 15 minutes before nasal pack removal. Patient anxiety levels were measured at various time points i.e. 24 hours pre-operatively, 48 hours post operatively, 30 minutes after pack removal. Patients marked their level of pain on a visual analogue scale during pack removal. Results: Hamilton Anxiety Scale scores for saline infiltration patients were found to be (Mean ± SD) 12.3 ± 5.35, 16.23 ± 5.12 and 14.23 ± 4.55 for 24 hours pre-operatively, 48 hours post operatively, 30 minutes after pack removal respectively. The respective scores for lidocaine infiltration patients were: 13.83 ± 4.46, 17.07 ± 3.98 and 11.7 ± 3.52. at 24 hours before surgery, 48 hours after surgery and 30 minutes after pack removal. The visual analogue scale pain score was 5.6 ± 0.89 for Saline study group and 7.13 ± 0.73 in the lidocaine study group. Conclusion: Patient pain was significantly reduced following infiltration of lidocaine into nasal packing. Patients developed mild to moderate anxiety before nasal packing removal. Use of techniques without nasal packing like soluble packs or quilting methods after septoplasty for patient comfort can be recommended after septoplasty to ease patient post-operative discomfort.

Antiresorptives such as bisphosphonates (BP) and denosumab are commonly used osteoporosis treatments that are effective in preventing osteoporotic fractures by suppressing bone turnover. Although these treatments reduce fracture risk, their long-term use has been associated with atypical femoral fracture (AFF), a rare potential side effect. Despite its rare occurrence, AFF has had a disproportionately significant adverse impact on society due to its severe outcomes such as loss of function and delayed healing. These severe outcomes have led to the decrease in the use and prescription of osteoporosis treatment drugs due to patient anxiety and clinician reluctance. This creates the risk for increasing osteoporotic fracture rates in the population. The existing information on the pathogenesis of AFF primarily relies on retrospective observational studies. However, these studies do not explain the underlying mechanisms that contribute to AFF, and therefore the mechanistic origins of AFF are still poorly understood. The purpose of this review is to outline the current state of knowledge of the mechanical mechanisms of AFF. The review focuses on three major potential mechanical mechanisms of AFF based on the current literature which are (1) macroscale femoral geometry which influences the stress/strain distribution in the femur under loading; (2) bone matrix composition, potentially altered by long-term remodeling suppression by BPs, which directly influences the material properties of bone and its mechanical behavior; and (3) microstructure, potentially altered by long-term remodeling suppression by BPs, which impacts fracture resistance through interaction with crack propagation. In addition, this review presents the critical knowledge gaps in understanding AFF and also discusses approaches to closing the knowledge gap in understanding the underlying mechanisms of AFF.

Post-examination interpretation of contrast-enhanced ultrasound (CEUS) cineloops of focal liver lesions (FLLs) requires offline manual assessment by experienced radiologists, which is time-consuming and generates subjective results. Such assessment usually starts by manually identifying a reference frame, where FLL and healthy parenchyma are well-distinguished. This study proposes an automatic computational method to objectively identify the optimal reference frame for distinguishing and hence delineating an FLL, by statistically analyzing the temporal intensity variation across the spatially discretized ultrasonographic image. Level of confidence and clinical value of the proposed method were quantitatively evaluated on retrospective multi-institutional data (n = 64) and compared with expert interpretations. Results support the proposed method for facilitating easier, quicker and reproducible assessment of FLLs, further increasing the radiologists' confidence in diagnostic decisions. Finally, our method yields a useful training tool for radiologists, widening CEUS use in non-specialist centers, potentially leading to reduced turnaround times and lower patient anxiety and healthcare costs.

Objective To assess the association between the frequency of empathic physician responses with patient anxiety, ratings of communication, and encounter length during hospital admission encounters. Design Analysis of coded audio-recorded hospital admission encounters and pre- and postencounter patient survey data. Setting Two academic hospitals. Patients Seventy-six patients admitted by 27 attending hospitalist physicians. Measurements Recordings were transcribed and analyzed by trained coders, who counted the number of empathic, neutral, and nonempathic verbal responses by hospitalists to their patients' expressions of negative emotion. We developed multivariable linear regression models to test the association between the number of these responses and the change in patients' State Anxiety Scale (STAI-S) score pre- and postencounter and encounter length. We used Poisson regression models to examine the association between empathic response frequency and patient ratings of the encounter. Results Each additional empathic response from a physician was associated with a 1.65-point decline in the STAI-S anxiety scale (95% confidence interval [CI], 0.48-2.82). Frequency of empathic responses was associated with improved patient ratings for covering points of interest, feeling listened to and cared about, and trusting the doctor. The number of empathic responses was not associated with encounter length (percent change in encounter length per response 1%; 95% CI, -8%-10%). Conclusions Responding empathically when patients express negative emotion was associated with less patient anxiety and higher ratings of communication but not longer encounter length.

Objective Urodynamic studies (UDS) include assessments of the physics and physiology of the lower urinary tract (LUT). It is an invasive test and patients can feel fear and anxiety, especially at the beginning of the test. The aim of this study was to determine whether listening to music during urodynamic study decreases patient anxiety and pain. Methods Sixty-two patients who underwent urodynamic study were randomized into the following groups: no music (group 1, n = 30) or classical music (group 2, n = 32) during the procedure. Patient anxiety levels were quantified using the State-Trait Anxiety Inventory (STAI) and Beck's Anxiety Inventory (BAI). A visual analog scale (VAS) was used for self-assessment of discomfort and willingness among patients to have a repeat urodynamic study. Results Demographic characteristics, mean age, duration of procedure, systolic and diastolic blood pressure (SBP and DBP) and heart rate before procedure were statistically significantly similar between the two groups. Statistically significant differences were detected between the two groups in the mean pain score on VAS (4.1 ± 1.4 vs 2.6 ± 1.8), mean post-procedural STAI score (46 ± 5.8 vs 37.3 ± 5) and mean BAI score (14.2 ± 1.7 vs 3.5 ± 0.7). SBP and DBP and heart rate were similar between the groups. Conclusion Music is a cheap, safe and effective intervention that has gained increasing recognition as an effective tool to reduce pain and anxiety. Listening to music during urodynamic study reduced patient pain and anxiety.

A lack of well-defined postoperative imaging guidelines for bariatric patients may lead to false-positive findings, radiation exposure, additional cost, and patient anxiety. We investigated our institutional usage and utility of nonroutine postoperative abdominal imaging.Laparoscopic gastric bypass and sleeve gastrectomy patients over a 5-year period were retrospectively identified. All bariatric-related nonroutine initial and all subsequent prompted abdominal and pelvic imaging was included.A total of 578 patients were included (399 gastric bypass, 179 sleeve gastrectomy); 907 nonroutine studies in 69% of patients were performed, and 36% patients underwent computed tomography (CT). Only 20.3% of findings were symptom-related, 26% had benign incidental findings, and 50% were negative. Incidental findings prompted 71 additional studies. Bypass procedure (sleeve versus bypass, odds ratio [OR] .3), older age (median 43 versus 48 years), and lower initial body mass index (BMI) (median 43 versus 45) increased the likelihood of imaging. History of prior abdominal surgery and dyspepsia increased the probability of undergoing CT by an odds ratio of 1.8 and 2.0, respectively (P.05). History of ulcer (OR .6) or reflux on routine upper gastrointestinal imaging (OR .3) decreased probability (P.05). Patients who underwent CT were more likely to undergo other abdominal imaging (3 versus 1 study per patient, P.01).Postoperative abdominal imaging in the bariatric population is common, with almost 70% of patients undergoing imaging and 70% of findings not related to patient symptoms. Bypass procedure, older age, and lower initial BMI were associated with a higher likelihood of patients undergoing imaging. Heightened understanding of this important subject is necessary to help streamline cost-effective imaging protocols for these patients.

The surgical procedure for most patients triggers anxiety and fear. Approximately 60-80% of patients who will undergo surgery experience anxiety that needs to be intervened in the category of moderate to severe anxiety (Efendy, 2005 in Faradisi, 2012). This study aims to determine the effect of psycho-religious therapy and classical music therapy on pre operative patient anxiety in RSUDAM Lampung Province in 2016. This research type is quasi-experiment research with non-equivalent control group design. This research was conducted at RSUDAM Lampung Province in September- November 2016 in three surgical wards: the gelatik room (orthopedic surgery), the kutilang room (male general surgery) and the rose room (female general surgery). The population taken were all pre operative patients within the study period. The sampling technique uses a purposive method and the sample size is 80 people divided into 2 groups ie the group which is given the classical music intervention and the group that is given psycho-religious therapy with religious music and murrotal Al Quran surah Arrahman. The data were collected using a survey of Zung Self Anxiety Rating Scale (ZSARS) instruments before and after treatment. Bivariate analysis was performed using independent t-test statistic test by setting Alpha value 0,05 and 95% CI. The results of this study conclude that there are differences of psycho-religious therapy and classical music therapy on pre operative patient's anxiety at RSUDAM Lampung Province 2016 (p-value 0,030) with a decrease of ZSARS score in patients treated with psycho-religious therapy 2,250. Researchers suggested that psycho-religious therapy performed on pre operative patients at RSUDAM Lampung Province and entered into one form of intervention to decrease preoperative anxiety.

The aim of treatment in acute traumatic spinal cord injury is to preserve residual neurologic function, avoid secondary injury, and restore spinal alignment and stability. In this second part of the review, we describe the management of spinal cord injury focusing on issues related to short-term respiratory management, where the preservation of diaphragmatic function is a priority, with prediction of the duration of mechanical ventilation and the need for tracheostomy. Surgical assessment of spinal injuries based on updated criteria is discussed, taking into account that although the type of intervention depends on the surgical team, nowadays treatment should afford early spinal decompression and stabilization. Within a comprehensive strategy in spinal cord injury, it is essential to identify and properly treat patient anxiety and pain associated to spinal cord injury, as well as to prevent and ensure the early diagnosis of complications secondary to spinal cord injury (thromboembolic disease, gastrointestinal and urinary disorders, pressure ulcers).

INTRODUCTION[|]The purpose of this study was to evaluate the success rate of shock wave lithotripsy (SWL) and possible effects on the anxiety status of patients.[¤]METHODS[|]Anxiety status of 128 patients was evaluated using State and Trait Anxiety Inventory (STAI) scale. Three groups were created depending on stone condition: Group 1, completely stone-free; Group 2, asymptomatic residual fragments; and Group 3, fragments requiring additional procedures. Anxiety was evaluated comparatively according to analgesic need and emergency department referrals.[¤]RESULTS[|]Mean score in all 3 groups 1 month after treatment showed significant decrease; however, this decrease was smaller in Group 3 than the other 2 groups. Pairwise evaluation of mean STAI scores revealed significant difference between Group 3 and other groups. Similarly, analgesic need and emergency department referral rate were higher in Group 3.[¤]DISCUSSION AND CONCLUSION[|]Residual fragments after SWL procedure may affect the anxiety status of the treated patients due to both symptoms they experience and need for additional procedures. We believe that detailed information should be provided to patients with respect to procedure, possible complications, and potential need for additional treatment.[¤]

Neste estudo, objetivou-se tratar, por meio da terapia cognitivo-comportamental, o transtorno de ansiedade de pacientes que se encontram em tratamento médico, cujo diagnóstico é de púrpura idiopática. Para tanto, participaram, três pacientes, do sexo feminino, com idade entre 27 a 70 anos. O método aplicado durante a realização deste estudo teve por base 10 sessões de psicoterapia e a utilização de uma escala para medir a intensidade dos sintomas de ansiedade, o inventário de ansiedade Beck (BAI), juntamente com a coleta de exames de sangue. Após o acompanhamento psicoterapêutico, independentemente do uso de medicação para controle das quedas de plaquetas, observou-se a redução da ansiedade e aumento de plaquetas nas três participantes. De acordo com os resultados deste estudo, pode-se sugerir a continuidade do mesmo, com um número maior de pacientes, de diferentes idades e gênero.

Background Many factors influence anxiety and satisfaction of patients undergoing Mohs micrographic surgery (MMS). Objective We sought to determine the effect of a preoperative educational telephone call on anxiety and satisfaction for patients undergoing same-day office consultation and MMS. Methods Patients with skin cancer (N = 104) scheduled for same-day office consultation and MMS were randomly assigned to receive or not to receive an educational telephone call during the week before surgery. All patients rated their anxiety levels immediately before and after the same-day office consultation and MMS by completing the State-Trait Anxiety Inventory and an anxiety visual analog scale. Patients also rated satisfaction immediately after MMS by completing the Visit-Specific Patient Satisfaction Questionnaire. Results Patients undergoing same-day office consultation and MMS reported similar levels of increased anxiety and high satisfaction, regardless of whether they received a preoperative educational telephone call. Limitations Lack of control for patients' prior surgery or self-education is a limitation. Conclusion Preoperative educational telephone calls did not relieve anxiety or improve satisfaction for patients undergoing same-day office consultation and MMS. Preoperative education and counseling has uncertain benefits to anxiety and satisfaction of patients undergoing MMS.

A simple 3-min educational video viewed before cardiac catheterization significantly improved patient knowledge and alleviated patient anxiety. The key characteristics of a good educational video are: clarity, simplicity, brevity, and humanity. Educational videos may benefit both patients and operators but require continuous evaluation and improvement.

As a Patient Editor for CJASN , I have been extended several important privileges. First, of course, is continuous exposure to the rich and diverse range of research and scholarly writing from experts across the entire continuum of kidney diseases and kidney research. Second is the ability to

Background This study compared a needle-free anesthesia method with traditional local anesthesia for insertion and removal of Nexplanon® long-acting removable contraceptive device. In our clinic, patients often avoid this highly effective form of contraception due to fear of needles. We sought to determine if patients perceived a difference in pain with the injection, anxiety level or pain with the procedure when local anesthesia was given with a needle v/s a needle-free jet injector device. Methods Patients were randomly assigned to one of two groups: jet injector or needle lidocaine delivery. Outcomes were ease of use, patient anxiety level, painfulness, and efficacy of anesthesia method. Results Patient pain perception with administration of jet injector lidocaine was statistically lower than traditional needle with no difference in anxiety or ease of use, or efficacy of the anesthesia. Conclusion The jet injector device is a reasonable alternative to needle injection delivery of anesthesia prior to insertion/removal of Nexplanon® device. Further studies may determine whether this needle-free alternative for administration of local anesthetic would result in more women choosing Nexplanon® as a contraceptive method.

One barrier to the use of intrauterine devices (IUDs) as a contraceptive method is the experience of anxiety and pain during the insertion procedure. Previous reviews have focused on pharmacological methods used to relieve pain during IUD insertion; however, few similar reviews have examined non-pharmacological methods to relieve pain or strategies to reduce anxiety. The objectives of this study were to identify and categorize strategies for reducing anxiety and pain with respect to IUD insertion and the ways in which anxiety and pain were assessed. In particular, the study aimed to identify non-pharmacological interventions and studies that included anxiety as a research outcome. A literature search was conducted of all English-language studies between inception and the week of July 29, 2018 from the following online databases: Medline, Embase, Cochrane Library, and PubMed. The search revealed 426 studies after removal of duplicates, 35 of which fulfilled the inclusion criteria. A total of 29 studies were identified as assessing pharmacological interventions for the management of pain, and six studies assessed non-pharmacological interventions. Only one study included a measurement of patient anxiety during the procedure as an outcome measure. Research on non-pharmacological interventions for the management of anxiety and pain during IUD insertion is lacking. This review found that evidence for the studied pharmacological interventions is conflicting, and there is very little evidence on understanding the effectiveness of strategies to manage anxiety during the IUD insertion procedure. Further high-quality research on non-pharmacological pain and anxiety management strategies is warranted.

This brief report explores the adjunctive use of therapeutic essential oils in clinical practice to reduce overall patient anxiety and stress. The use of therapeutic essential oils is becoming increasingly popular among the general population. Studies have validated that these oils have the potential to affect patient health and wellness positively, if used properly in the clinical setting. This report discusses how to incorporate essential aromatic oils safely and efficiently in clinical practice and advocates for more research on the efficacy of aromatic oils to reduce patient anxiety in human populations.