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There are multiple developmental variations of soft-tissue neck structures that can be detected on computed tomography (CT), magnetic resonance imaging (MRI), and 18 fluro-deoxy-glucose position emission tomography (FDG-PET). These need to be recognized and differentiated from actual pathologies. There can also be benign lesions involving the soft tissue neck that are caught incidentally while the study is obtained to evaluate other pathologies. Being aware of these variations and certain common benign lesions is quite important. If such variants or “don’t touch lesions” are diagnosed correctly, this can prevent unnecessary patient anxiety, possible invasive procedures, and potential complications. For example, being knowledgeable about the common FDG-PET findings of brown fat activation-related FDG uptake in certain parts of the body prevents misdiagnosis of disease progression and possibly unnecessary biopsies.

Lipomas are benign tumors consisting primarily of mature adipocytes. Imaging is important in distinguishing benign ossifying lipoma from more aggressive tumors such as well-differentiated liposarcomas. Early diagnosis of ossifying lipoma and understanding of its benign etiology prevent unwarranted medical intervention such as biopsies and surgical resection, as well as decrease patient anxiety.

The fear of painful procedures is at an increased incidence within the pediatric population. This can be an extremely challenging obstacle in dermatology where injections, blood draws, and cryotherapy are often required during the care of patients. Psychologic techniques based on cognitive behavioral therapy (CBT) can be implemented leading up to and while performing these procedures to help reduce patient anxiety.

The purpose of this study was to examine the effect of waiting room time on patient stress. The wait for patients undergoing diagnostic imaging tests, such as magnetic resonance imaging (MRI), can vary significantly. However, the impact of MRI waiting room time on patient stress has not been determined. The study had a prospective nonrandomized design. One hundred ninety-two of 200 enrolled subjects completed self-report State-Trait Anxiety Inventory assessments to measure levels of anxiety on arrival to the waiting room and entering the MRI suite. Scores from the Trait and State anxiety tests were compared to understand how waiting times impacted patient anxiety. Data were analyzed using a multivariate model, which demonstrated that sex (female), baseline anxiety, and the length of waiting time were predictive of increased anxiety. These results support the correlation between high levels of anxiety with longer waiting times, particularly in females who arrive to the waiting room feeling anxious. Longer waiting room times had no effect on patients who were not anxious when they arrived.

Objective:This prospective, controlled study investigated the effect on patient anxiety of lidocaine infiltration into nasal packing following septoplasty.Methods:The study included 50 patients who underwent septoplasty operation. Patient anxiety levels were measured 24 hours pre-operatively; 48 hours post-operatively, before saline or lidocaine infiltration; and 15 minutes after lidocaine or saline infiltration into the packing. The patients were asked to mark their level of pain during pack removal on a visual analogue scale.Results:Hamilton Anxiety Scale scores for lidocaine infiltration patients were: 15.1 ± 7.4 pre-operatively; 16 ±7.6 post-operatively, before infiltration; and 13.7 ± 6.6 at 15 minutes after infiltration. The scores for saline infiltration patients were: 16.3 ± 6.8 pre-operatively, 16.4 ± 5.5 before infiltration and 16.1 ± 6.1 after infiltration. The visual analogue scale pain score was 5.3 ± 2.0 in the lidocaine study group and 7.5 ± 1.8 in the control saline group.Conclusion:Infiltration of lidocaine into nasal packing significantly reduced patient pain. Patients developed mild to moderate anxiety before nasal packing removal. Use of techniques without nasal packing can be recommended after septoplasty to ease patient post-operative discomfort.

6th Annual Scientific Meeting of the Australian and New Zealand Urogenital and Prostate Cancer Trials Group, Redefining Personalised Medicine.

Nipple discharge is commonly encountered by health care providers, accounting for 2%-5% of medical visits by women. Because nipple discharge is the presenting symptom in 5% to 12% of breast cancers, it causes considerable anxiety for both patient and providers. Furthermore, the work-up and management of nipple discharge can be confusing. Fortunately, the cause of nipple discharge is usually benign, so the primary goal of evaluation and management is separation of patients with pathologic causes of discharge from those with benign or physiologic causes. The evaluation of nipple discharge requires a thorough history, careful physical examination, and an informed approach that selects the most suitable diagnostic modality. Primary care providers, working with their radiologists and surgeons, are well positioned to design appropriate diagnostic and management protocols to assess and treat nipple discharge. A thoughtful and prudent approach to nipple discharge should alleviate patient anxiety by efficiently and effectively defining the underlying etiology.

Aims and Background This study is aimed at evaluating the effectiveness of a physician-centered communication skills training program on cancer patient anxiety levels. Methods and Study design In this quasi-experimental study, physicians from 9 units of 5 general hospitals and 1 cancer research institute were recruited. The unit heads chose which physicians would attend the training program (treatment group) and which would not (control group). The effectiveness of the course was evaluated by assessing the evolution of state anxiety in a sample of cancer patients before and after clinical consultations. Results Thirty-eight physicians and 339 outpatients were assessed. Patients from the treatment and control groups did not differ in pre-examination anxiety or psychological distress levels. Patients examined by physicians from the treatment group displayed a higher decrease in state-anxiety levels compared with those examined by physicians from the control group. A higher proportion of high anxiety levels was found in women, in less educated patients, and in those with a high distress level. Conclusions Our findings suggest the effectiveness of the communication skills training program with reference to patient anxiety levels. Given the potential gap between training and clinical impact, further studies investigating the effect of communication training on patient outcomes are needed.

Telephone consultations are well suited to epilepsy review, particularly for those ineligible to drive. Careful patient selection and a courtesy call beforehand, by an administrator, increases efficiency and saves patient anxiety and clinician time. This paper gives advice based upon the author's experience of telephone review of patients with epilepsy.

David A Ramirez,1,2 Frank L Brodie,2 Jennifer Rose-Nussbaumer,2,3 Saraswathy Ramanathan2 1School of Medicine, University of California, San Francisco, 2Department of Ophthalmology, University of California, San Francisco, 3Francis I. Proctor Foundation, San Francisco, CA, USA Purpose: Reducing surgery-related patient anxiety without under-emphasizing surgical risk is challenging for even the most experienced surgeon. The purpose of this study is to identify specific anxieties faced by patients in hopes of better informing the preoperative surgeon-patient dialogue.Setting: Comprehensive and specialty ophthalmology clinics at the University of California, San Francisco.Design: A prospective, survey-based study in which a pre- and postoperative questionnaire was administered to patients undergoing routine phacoemulsification. The surgeon was masked to patient enrollment and questionnaire responses.Materials and methods:A 36-item questionnaire on patient anxiety was developed from existing literature, building on the validated Surgical Fear Questionnaire. Patients were eligible if they were aged >18 years and willing to participate. Patients were excluded if having more than phacoemulsification alone or if unable to respond in English, and were retroactively excluded if there were complications during surgery. The primary outcome was self-reported anxiety on an 11-point Likert scale.Results: Sixty-one patients were included for analysis. Preoperatively, patients reported greatest anxiety around the operation itself and becoming blind. Reflecting postoperatively, patients reported the greatest anxiety for the operation itself. Statistically significant decreases were greatest for anxiety about the operation failing (p

Enhanced recovery after surgery (ERAS®) is an enhanced postoperative recovery program based on evidence-based medicine introduced by the European Society for Clinical Nutrition and Metabolism in 2005. Many reports have been shown that this program is useful not only in general surgery but also in cardiac and vascular surgery. The goals of this management are reducing operative stress, early restarting of meal consumption, early starting of postoperative rehabilitation, shortening the length of postoperative hospital stay, reducing medical costs, reducing patient anxiety perioperatively and encouraging the patient’s volition to recover, and securing safety and satisfactory results. Although only minimally invasive surgery has been continuously developing in Japan, this management is not yet widely used and conventional management remains standard in many institutions. In this chapter, we introduce the many elements of ERAS® management for cardiac and vascular surgery divided into the preoperative, intraoperative, and postoperative periods, according to our experiences and past reports.

Objective Positive communication is advocated for physicians during consultations with patients presenting medically unexplained symptoms (MUS), but studies generally focus on what is said rather than how it is said. This study quantified language use differences of general practitioners (GPs), and assessed their relation to patient anxiety. Methods Language use of 18 Dutch GPs during 82 consultations was compared for patients with MUS versus medically explained symptoms (MES). Message content (positive or negative) was differentiated from its directness (direct or indirect), and related to changes in patient’s state anxiety (abbreviated State Trait Anxiety Inventory; STAI). Results In total, 2590 clauses were identified. GPs approached patients with MES with relatively more direct (vs. indirect) positive and indirect (vs. direct) negative messages (OR 1.91, 95% CI 1.42–2.59). Anxiety of both patient groups increased when GPs used more direct (vs. indirect) negative messages ( b = 0.67, 95% CI 0.07–1.27) Conclusions GPs use different language depending on the content of messages for patients with MES, but not MUS. Direct negative messages relate to an increase in patient anxiety. Practice implications GPs could manage patient’s state anxiety by expressing negative messages in an indirect rather than direct manner.

Introduction: In lung function testing, a directive form of coaching is used to achieve a correct result. If patients are not at ease they will accept this with difficulty, according to the Coaching Manual (Julie Starr, 2003). And if the patient is anxious, will this influence the results? Questions: · Are patients anxious for lung function testing? · Does the lung function technician recognize patient anxiety and adapt? · Do anxious patients need more attempts for correct spirometry? (min. 3 attempts following ERS/ATS 2005 standards.) Methods: We invited adult patients to fill in the validated Spielberger State-Trait Anxiety Inventory (Pearson©)(Dutch Version) before and after their first ever lung function test (Spirometry, in some followed by Box and/or DLCO), and also a general questionnaire. The technician also filled in a list. We received 61 sets, 28 M (M Age 61.7 SD 12.9) and 33 F (M Age 61.2 SD 11.7). Results: · Anxiety decreased significantly after lung function testing. In M from 34.9 to 30.9 (P= 0.018) in F from 38.1 to 34.7 (p= 0.016). · The correlation between self-reported anxiety and anxiety reported by the technician was significant but not high, (correlation M:0.39, F: 0.36 P=0.04 for groups apart, the entire group p=0.002). Adaptation was usual and consisted mostly of small talk and complimenting on efforts. · We did not find a correlation between the level of anxiety and attempts needed for a successful spirometry. Conclusion: Most of the patients are more anxious before than after lung function. The technician appears sensitive to the anxiety and conducts the test adapting to the anxiety. The more anxious patient doesn9t need more attempts for a correct spirometry.

Improved access to technology in the radiation therapy (RT) workforce education has resulted in opportunities for innovative patient education methods. This study investigated the impact of a newly developed education tool using the Virtual Environment for Radiotherapy Training (VERT) system on patients’ RT knowledge and anxiety. Breast cancer patients were recruited into a control group (CG) (n = 18) who underwent the standard pre-RT education package at a targeted cancer therapy centre, followed by a VERT group (VG) (n = 19). VG patients attended a VERT-based education session detailing RT immobilisation, planning and treatment. All patients completed questionnaires at four time points throughout their treatment, with survey sub-sections on RT knowledge, experience and anxiety. For both groups, anxiety levels were highest at time point 1(T1 after initial radiation oncologist consultation) (CG, 41.2; VG, 43.1), with a gradual decrease observed thereafter at time points before simulation, at the beginning of treatment and at the end of treatment (p > 0.05). The VG’s RT knowledge scores were statistically significantly higher than those of the CG scores at all time points following VERT education (p

Background Noise reduction headphones decrease the sound during cast removal. Their effectiveness in decreasing anxiety has not been studied. Purpose Compare pediatric patients' anxiety levels during cast removal with and without utilization of noise reduction headphones combined with use of a personal electronic device. Methods Quality improvement project. Patients randomly assigned to noise reduction headphone group or standard care group during cast removal. Faces, Legs, Activity, Cry, and Consolability Scale and heart rate were evaluated prior to, during, and after cast removal. Data were compared across groups. Results Fifty patients were included; 25 per group. No difference detected between the 2 groups in Faces, Legs, Activity, Cry, and Consolability Scale score prior to (p = .05) or after cast removal (p = .30). During cast removal, the headphone group had lower FLACC Scale scores (p = .03). Baseline heart rate was lower in the headphone group prior to (p = .02) and after (p = .005) cast removal with no difference during cast removal (p = .24). Conclusion Utilizing noise reduction headphones and a personal electronic device during the cast removal process decreases patient anxiety.

Introduction Up to one third of radiation therapy patients are reported to have unmet psychosocial needs. Radiation therapists (RTs) have daily contact with patients and can provide daily psychosocial support to reduce patient anxiety, fear and loneliness. However, RTs vary in their values, skills, training, knowledge and involvement in providing psychosocial support. The aims of this study were to: (1) develop an online survey instrument to explore RT values, skills, training and knowledge regarding patient anxiety and psychosocial support, and (2) pilot the instrument with RT professionals to assess content validity, functionality and length. Method An online cross‐sectional survey, titled ‘Radiation therapists and psychosocial support’ was developed. Items included patient vignettes, embedded items from RT research, and the Professional Quality of Life Scale (ProQOL5). Four radiation oncology departments volunteered to pilot the survey; each nominated four RT staff to participate. Survey data were analysed descriptively and qualitative feedback grouped and coded to determine whether the survey needed to be refined. Results Thirteen of sixteen RTs completed the pilot survey and feedback form. Median time to completion was 35 mins, with 54% of respondents stating this was too long. Respondents reported content, questions and response options were relevant and appropriate. Feedback was used to: refine the survey instrument, minimise responder burden and drop out and improve functionality and quality of data collection. Conclusion This pilot of the ‘Radiation therapists and psychosocial support’ survey instrument demonstrated content validity and usability. The main survey will be circulated to a representative sample of RTs for completion.

Critical care unit is a treatment unit with high risk of death of patient. Patients of ICU Husada Hospital approximately 4-5 patients who have full awareness (compos mentis) and ICCU patients about 5-6 patients compos mentis or compos mentis have a high risk of anxiety. This study was conducted to determine the factors that affect the level of anxiety of patients treated in ICU / ICCU Husada Hospital. This research use cross sectional design. The sample of the study was 25 people, taken with saturated sampling method, because the population number is relatively small. The results of statistical analysis show that 60% of ICU and ICCU patients experience anxiety. There was a significant relationship between sexes on anxiety level (p = 0.031), there was a significant correlation between length of care to anxiety level (p = 0.007), there was significant correlation between patient experience treated to anxiety level (p = 0.014) There is a significant relationship between ICU and ICCU tools on the level of anxiety, there is a significant relationship between ICU and ICCU tools on anxiety level (p = 0.002). There is a significant correlation between knowledge level and patient's anxiety level (p = 0.014). Conclusion: patient anxiety in ICU / ICCU influenced by many factors so that clear information from health officer is needed. Advanced research is required with larger and more focused sample quantities. Keywords: intensive care unit, intensive critical care unit, anxiety, patients

Medicines reconciliation is integral to patient safety, symptom control and reducing patient anxiety. During a 3-month period on the respiratory ward at St. Peter9s Hospital, 54% of drug charts were not reconciled with pre-admission medicines at the point of discharge for admissions up to 17 days. Only 18% were reconciled within 24 hours of admission. 50% of drug charts were missing 0-2 pre-admission medicines and 50% were missing 3-5 pre-admission medicines. The most common medicines that were not reconciled included topical applications which included eye, ear, nasal and skin applications (14%); vitamins i.e. vitamin B12 and thiamine, analgesia, PRN inhalers (11% individually); antidepressants and lipid regulators (6% individually); amongst a range of other medications including antiplatelets, calcium channel blockers, ACE inhibitors and diuretics. Two interventions were carried out to improve the rate of medicines reconciliation onto hospital drug charts with pre-admission medicines. These were: 1) a green sticker placed in the medical notes by the pharmacist when drug charts were incomplete, which required a date and signature from the doctor when the drug chart had been reconciled 2) the placing of the loose medicines reconciliation record (a list of pre-admission medicines retrieved from a reliable source usually by the pharmacist) to the front of the drug chart. These measures were designed to alert the doctors that the drug chart was incomplete. After 2 PDSA cycles, the results showed positive outcomes. In 75% of the cases where the interventions were used, medicines reconciliation was complete at the point of discharge with 34% of drug charts reconciled within 24 hours of admission. Of the 25% of drug charts that were not reconciled despite the use of the interventions, 100% of them were missing 0-2 medicines however 0% were missing 3-5 medicines. This highlights that the interventions were effective in improving the rates of medicines reconciliation.

Patients undergoing Mohs micrographic surgery frequently experience anxiety as a result of multiple potential factors. There is currently no data regarding how this anxiety compares to other common procedures performed in dermatology offices, such as shave biopsy and excision, relative to a general dermatology visit. Herein, we conducted a survey of 471 dermatology patients at an academic medical center, using a validated tool (Visual Analogue Scale from 1 "no anxiety at all" to 10 "extremely anxious").

The most important clues to narrow differential diagnosis of benign bone tumors in the pediatric population include patient age, location of the lesion, number of lesions, type of matrix, margin features, and presence of periosteal reaction and extraosseous extension; a systemic imaging approach helps guide clinical management and prevent unnecessary patient anxiety and medical intervention.

Background: We measured postoperative anxiety in patients who underwent transseptal suturing or nasal packing after septoplasty. Materials and Methods: Transseptal suturing was performed on Group 1 patients and nasal splints with airway were placed after septoplasty in Group 2 patients. Postoperative 48-h anxiety levels of both groups were measured using the State-Trait Anxiety Inventory (STAI) clinical assessment scale, prior to removal of nasal packing in Group 2. Results: Transseptal suturing was performed after septoplasty in 28 patients and nasal packing in 34 patients. The State-Trait Anxiety Inventory clinical assessment state (STAI-S) and trait (STAI-T) instruments were used to measure postoperative anxiety. The STAI-S scores were found 35.00 in the transseptal suturing group and 43.8 in the nasal packing group; the difference was found significant (p < 0.05). The STAI-T scores were found 42.6 in the transseptal suturing group and 45.7 in the nasal packing group; the difference was not found significant (p > 0.05). The rate of minor hemorrhage was found 10.7% in Group 1 patients. Conclusions: Transseptal suturing is simple and reliable when performed after septoplasty. The technique is painless and comfortable, and reduces patient anxiety (compared to that associated with nasal packing) with only a minor increase in operating time and hemorrhage.

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.

Objective Up to 20% of patients seen in public emergency departments (EDs) have already been seen for the same complaint at another ED, but little is known about the origin or impact of these duplicate ED visits. The goals of this investigation were to explore 1) whether patients making a repeat ED visit are self-referred or indirectly referred from the other ED and 2) gather the perspective of affected patients on the health, social, and financial consequences of these duplicate ED visits. Methods This mixed-methods study conducted over a 10-week period during 2016 in a large public hospital ED in Texas prospectively surveyed patients seen in another ED for the same chief complaint. Selected patients presenting with fractures were then enrolled for semistructured qualitative interviews, which were audiotaped, transcribed, and independently coded by two team members until thematic saturation was reached. Results A total of 143 patients were identified as being recently seen at another local ED for the same chief complaint prior to presenting to the public hospital; 94% were uninsured and 61% presented with fractures. A total of 27% required admission at the public ED and 95% of those discharged required further outpatient follow-up. Fifty-one percent of patients completed a survey and qualitative interviews were conducted with 23 fracture patients. Fifty-three percent of patients reported that staff at the first hospital told them to go the public hospital ED, and 23% reported referral from a follow-up physician associated with the first hospital. Seventy-three percent reported receiving the same tests at both EDs. Interview themes identified multiple health care visits for the same injury, concern about complications, disrespectful treatment at the first ED, delayed care, problems accessing needed follow-up care without insurance, loss of work, and financial strain. Conclusions The majority of patients presenting to a public hospital ED after treatment for the same complaint in another local ED were indirectly referred to the public ED without transferring paperwork or records, incurring duplicate testing and patient anxiety.

Nuclear medicine imaging in children is best accomplished when a child-friendly environment is provided for patients and parents. An approach that minimizes patient anxiety and fear is described. International guidelines for administered activity should be used to minimize absorbed radiation doses from radiopharmaceuticals. CT exposure parameters may be reduced to pediatric best practice for diagnostic CT and further reduced when CT images are needed only for localization purposes.

We aimed to evaluate the overall impressions of learning and subsequent use of the redesigned GONAL-f® (follitropin alfa) pen injector by women with recent or current infertility requiring assisted reproductive technologies (ART) or in vitro fertilization (IVF).This was a simulated-use study including 86 women with infertility and 30 fertility nurses. Nurses trained the women on the use of the redesigned pen. The opinions of the women on the pen injector were collected during a questionnaire interview. Fertility nurse opinions on patient anxiety were collected before training.The pen injector was considered easy to learn to use and easy to use, particularly setting the dose and reading the number on the dial. After training, most women felt confident they could self-administer medication without further training. Most women would recommend the redesigned pen injector to friends and family requiring IVF treatment. Overall, fertility nurses overestimated how anxious the women would be when using the pen injector.This study demonstrated that both IVF/ART-experienced and -naïve women with infertility found the redesigned pen injector easy to learn to use and to use.

Purpose This study was done to determine day surgery patients' presurgery anxiety levels related to information received. Design A descriptive and cross-sectional model was used. Methods The study was conducted with 151 patients who underwent day surgery at surgical clinics of a university hospital in Turkey. The data were gathered with the Patient Information Form and the State-Trait Anxiety Inventory. Findings The findings were that most of the patients received information about their day surgery, but the rate of receiving information about some issues was very low. Most of the patients reported that although they did not have any anxiety about surgery and anesthesia, observations revealed that their average state and trait anxiety scores were high. Conclusions Study results can be used as a basis to provide patients with clarifications about surgeries during the presurgery period and as a means of decreasing their anxiety about surgery and anesthesia.

Purpose : We investigated whether the order in which patients learned about complication risks affected their anxiety about and willingness to undergo the removal of their third molar. Materials and Methods : In total, 171 patients (65 males, 106 females) were included in the study. The distributions of gender and the position of mandibular third molars were recorded. The Amsterdam Preoperative Anxiety and Information Scale and Spielberger’s State–Trait Anxiety Inventory were used to evaluate anxiety. Associations of anxiety with timing (pre/post), gender, and the order in which the information was presented in the consent form were analyzed. Results : The most common angulations were horizontal (26.3%) and mesioangular (60.2%), and these were more common in women. All patients obtained significantly higher anxiety scores after reading the consent form. There was no significant difference in anxiety scores, according to the order of information. In total, 88 patients underwent surgery, whereas 83 postponed the extraction after reading the consent form. Women were significantly more anxious than men before the procedure. Patients showed lower anxiety levels after the procedure (P < 0.05). Conclusion : Increased anxiety was not associated with the order in which information was presented in the informed consent form. However, the informed consent form itself was a major contributor to increased patient anxiety. Further studies regarding the contents of consent forms and their effects on patient anxiety and decisions regarding third molar removal are needed. Key words : Anxiety, informed consent, third molar extraction

Environmental health crises can appear anywhere and without warning. After research revealed a significant incidence of elevated pediatric blood lead levels following a water source change, Genesee County declared a public health emergency in Flint, Michigan. Hospital patients and family members began approaching Hurley Medical Center's physicians with questions regarding the health implications of the lead contamination. Many of the physicians voiced concerns about responding appropriately to patient needs and increasing demands for information. As a result, a Hurley research team decided to conduct an informal survey across training programs to determine the need for added education.Because of heightened patient anxiety, it was necessary for the timeline to progress quickly. In creating the survey, the team's objective was to assess resident and faculty physician knowledge, attitudes, and experiences concerning lead contamination. The results revealed a critical need for supplementary training. Therefore, Hurley embarked on an education campaign for its graduate medical education programs, benefiting physicians and patients alike.Patient and physician needs may change drastically following an environmental health emergency. It is the duty of medical centers to ensure their clinicians are well equipped to confront such threats. As prompt treatment is often a key to positive health outcomes, the authors stress the importance of acting quickly and suggest conducting informal surveys to identify gaps in physician knowledge. Likewise, the authors encourage medical educators nationwide to examine their environmental health curricula. It appears lead-contaminated water is not just a Flint problem but may have far-reaching implications for many cities.

Ultrasound-guided puncture and alcoholization are the gold standard technique for the treatment of simple renal cysts. The main indications for the treatment of simple cysts are pain due to the mass compression effect, obstruction of the excretory tract, arterial hypertension, and patient anxiety. In addition, it is preferable to treat all renal cysts with a longitudinal diameter of 9 cm or more. The treatment method consists of the insertion of a sclerosing substance inside the cyst cavity, after having emptied it under US guidance. The aim is to sclerose the cyst walls so as to reduce the risk of recurrence. The treatment can be repeated two or three times, but in many experiences, a single treatment was sufficient to guarantee comparable results to multiple sclerosing sessions. The success of the treatment seems to depend on how long the ethyl alcohol remains in contact with the cyst walls. There is a negligible incidence of complications, so the method can be considered safe and reliable.

Large-bore positron emission tomography and computed tomography (PET/CT) combo scanners have recently been developed and released for use. The large bore not only provides a spacious and comfortable environment for the patient, but it also allows the operator to observe and interact with the patient more easily during the examination, thus maximizing safety and minimizing patient anxiety. However, the increased size of the bore may affect image quality and the sensitivity of the PET scanner. To compensate for the diminished image quality, it is necessary to develop different technologies, including a time-of-flight (TOF) function. In this chapter, we introduce recent developments in the field of large-bore PET/CT, using the Celesteion as an example.

Background: The preanesthetic visit influences patient satisfaction and medical outcome. Providing relevant information may reduce anxiety. This study aimed to evaluate whether training for a structured interview technique improves communication skills, resulting in increased patient satisfaction and reduced patient’s anxiety and fear of anesthesia. Methods: Randomized controlled observational study, comparing patients (n=47) interviewed by anesthesiologists having obtained training to optimize structured communication (TA) or by anesthesiologists without such training (CA). Patient anxiety and fear was recorded before and after the preoperative interview. Interview duration and satisfaction with the anesthesiologist were also recorded. Data were analysed to test for superiority of the structured interview approach. Results: Mean preoperative anxiety was 1.2 VAS points lower in TA vs. CA group (95% CI-2.39; -0.03, P=0.082). Structured interviews significantly reduced preoperative anxiety in younger (

Modern clinical trials have demonstrated that implantable cardioverter defibrillators (ICDs) have been broadly successful in terminating potentially life-threatening arrhythmias in at-risk patients. This success fostered greater attention to the potential negative aspects of the therapy, with particular focus on ICD shocks. Substantial research examining the psychological and quality-of-life effects of shock has followed and been debated,1–3 and have generally shown that the effects of shock are equivocal in relation to generic quality-of-life outcomes, but more detectable when examined in the acute setting (short-term, 30-day window) and using disease-specific measures (e.g., shock anxiety vs general anxiety). Current clinical practice has generally taken a “one size fits all” approach for communicating a patient’s risk for ICD shock. Going beyond reassurance to a more empirically based conversation about individual patients’ risk for shock is now possible with recent clinical trial data. This conceptualization prompts a more clinically meaningful effort to address patient anxiety routinely encountered in cardiology clinics. The purpose of this paper is to integrate recent clinical trial data with psychological and behavioral research to provide a discussion base for a clinical forecast to patients about the nature and probability of ICD shock.

Patient leaflets can provide an invaluable tool for guiding a patient through their procedure. Studies have shown that when properly constructed, leaflets can help to reduce patient anxiety, improve the patient experience, and reduce both postoperative pain and hospitalisation. They can also aid the process of informed consent. This article aims to review current research on both the design and content of patient leaflets with particular reference to patients undergoing cataract surgery. It then goes on to propose a design for a leaflet for this patient group, using current thinking. This is presented as a copyright-free template which could be used for this patient group or adapted for other procedures.

GI endoscopy is often performed by using proceduralsedation to reduce patient anxiety, discomfort, and mem-ory of what is at best an unpleasant experience. Whenthe patient is comfortable, nurses can focus on patientsafety while the endoscopist focuses on the technical de-tails of the procedure, which together likely improve theoverall outcome. With sedation, the procedure also is asso-ciated with greater patient and doctor satisfaction and withgreater patient compliance with endoscopic screening pro-grams. However, sedation is not without costs for theendoscopy unit and for society. Societal costs in part relateto the psychomotor effects of sedation, which includeimpaired physical and mental abilities (eg, to drive a caror make important decisions). These impairments oftenrequire that the patient be accompanied and also taketime offfrom workuntil the results of sedation have abated.The duration of impairment is a function of the agents usedfor sedation as well as the underlying condition of the pa-tient. The choice of agent for procedural sedation involvestrade-offs in terms of effectiveness, safety, and monitoringduring the procedure and during recovery time. An idealagent would provide good sedation, have a good marginof safety, and be followed by rapid psychomotor recovery.Here, we review current knowledge concerning psychomo-tor recovery after sedated GI endoscopy and make recom-mendations for modern sedation. Among the currentlyavailable agents, propofol comes closest to being ideal.The increased use of GI endoscopy in the diagnosis andtreatment of benign and malignant GI diseases has resultedin an ever-increasing number of endoscopic proceduresbeing performed. The majority of procedures are donewith moderate sedation. Moderate sedation is associatedwith an increased willingness of patients to undergo GIendoscopic procedures and with patient satisfaction withthe procedure. However, sedation carries costs and risks,and the current requirements that the patient be accompa-nied and be prohibited from driving or returning to workafter the procedure likely represent a barrier to endoscopy,especially in relation to colonoscopic screening for colo-rectal caner prevention.

Objectives We conducted a systematic review to determine the effect of providing patients access to their medical records (electronic or paper-based) on healthcare quality, as defined by measures of safety, effectiveness, patient-centeredness, timeliness, efficiency, and equity. Methods Articles indexed in PubMed from January 1970 to January 2012 were reviewed. Twenty-seven English-language controlled studies were included. Outcomes were categorized as measures of effectiveness (n=19), patient-centeredness (n=16), and efficiency (n=2); no study addressed safety, timeliness, or equity. Results Outcomes were equivocal with respect to several aspects of effectiveness and patient-centeredness. Efficiency outcomes in terms of frequency of in-person and telephone encounters were mixed. Access to health records appeared to enhance patients’ perceptions of control and reduced or had no effect on patient anxiety. Conclusion Although few positive findings generally favored patient access, the literature is unclear on whether providing patients access to their medical records improves quality.

The purpose of this study is to determine whether it is possible to make breast cancer screening more efficient in those with dense breasts. Over 12 states require that patients with dense breasts receive notification about their breast density in lay letters that are sent after the screening mammogram. Some of these letters advise patients to speak with their primary care providers about the possibility of supplemental breast cancer screening. We sought to determine whether primary care providers can discuss breast density and recommend supplemental breast cancer screening using the density of the previous mammography. This would reduce the burden of additional appointments and might increase the number of patients choosing to have supplemental screening. The mammographic breast density of 250 consecutive patients from May 2011 to September 2011 was compared with the immediate prior mammogram. Patients whose prior mammograms were more than 36 months prior or less than 8 months prior to the current exam were excluded, leaving 217 patients. The proportion of patients with breast density change was analyzed. The concordance of breast density between the two exams was assessed and the effects of patient age and the length of time between mammograms were examined. The breast density of the current and most recent prior mammogram was stable for 86.6% of patients. Neither age nor length of time between mammograms affected concordance. Primary care providers can decrease the need for multiple appointments and decrease patient anxiety by discussing breast density and screening choices prior to the patient's screening mammography. The great majority of patients will receive the correct information about their breast density by using a prior report.

Colonoscopy is commonly used to investigate gastrointestinal symptoms such as pain or changes in bowel habits and may either induce patient anxiety or assist in patient reassurance. Currently, 2 studies investigating negative colonoscopy, reassurance, and anxiety came to conflicting conclusions on this issue. Furthermore, it is possible that differences in coping styles may influence patient anxiety. A mixed-methods study was conducted with 26 precolonoscopy and 24 post colonoscopy patients to address the conflicting, limited literature regarding colonoscopy, coping, and anxiety. Participants completed postal surveys and interviews were conducted with16 participants. There was no significant difference between pre- and postcolonoscopy groups on any anxiety measures; however, this was possibly because of individual differences. Significant positive correlations were found between maladaptive coping and state anxiety indicating that healthcare professionals should consider screening formaladaptive coping in patients needing invasive procedures. Neither problem- nor emotion-focused coping showed any significant relationship with state anxiety. Interviews revealed that clinicians and endoscopy nurses should be aware that some patients are not absorbing correct information about colonoscopy, specifically that they may be conscious or experience pain during the procedure. Because of this, clinicians should ensure that patients understand standard practice at their hospital. In addition, interview data suggested that more attention should be given to pain management as it currently may not be adequate during conscious sedation. Refereed/Peer-reviewed

Focal lesions in bone are very common and many of these lesions are not bone tumors. These bone tumor mimickers can include numerous normal anatomic variants and non-neoplastic processes. Many of these tumor mimickers can be left alone, while others can be due to a significant disease process. It is important for the radiologist and clinician to be aware of these bone tumor mimickers and understand the characteristic features which allow discrimination between them and true neoplasms in order to avoid unnecessary additional workup. Knowing which lesions to leave alone or which ones require workup can prevent misdiagnosis and reduce patient anxiety.

Background Music therapy has been used greatly in various medical procedures to reduce associated anxiety and pain. Objective to evaluate the evidence from published randomized clinical trials (RCTs) about the effect of music intervention in reducing patient's anxiety during the colposcopy. Search strategy Electronic databases included PubMed, Cochrane Library, Scopus and Web of Science were searched using the relevant MeSH terms. Selection criteria All RCTs assessing the effect of music therapy versus no music in reducing anxiety during colposcopy were considered. Eighty-five studies were identified of which five studies deemed eligible for this review. Data extraction The extracted outcomes were; anxiety, pain during and after the procedure, and satisfaction levels. They were pooled as mean difference in a fixed-effects model, using Review Manager 5.3 software for windows. Main results We found no effect of music therapy in reducing the anxiety levels when compared with the control group (SMD= -0.11, 95% CI [-0.36, 0.14], p = 0.4). No difference between music and control groups regarding pain during and after the procedure respectively (SMD= -0.20, 95% CI [-0.58, -0.18], p = 0.31) and (SMD=-0.10, 95% CI [-0.30, -0.10], p = 0.33). Conclusions Music therapy had no positive effect in reducing anxiety, pain and satisfaction levels during colposcopy.

e23164 Background: Patient education (PE), the use of educational interventions to improve patient knowledge of healthcare, has been shown to reduce patient anxiety and facilitate shared decision making. In contrast to many other medical specialties, the state of radiation oncology (RO) PE is unclear. This scoping review aims to characterize the state of ROPE peer-review scholarship to describe strengths, identify gaps and guide future ROPE research. Methods: Predetermined medical subject headings and search terms were used to search PubMed for ROPE articles. Additional terms were identified from these articles and the search was repeated until no further articles were found. In-press articles in major RO and medical education (ME) journals were searched. English language articles published after 1/1/1990 that had a primary ROPE focus were included. Two independent reviewers performed the search and determined eligibility. Articles were categorized using the most predominant step of Kern’s six-step conceptual framework for ME curriculum development and the country and year of publication. Results: Of 11,756 identified articles, 182 met inclusion criteria. Articles per year increased over time (p < 0.01): 1990-1994 (5.5%); 1995-1999 (11.0%); 2000-2004 (13.7%); 2005-2009 (10.4%); 2010-2014 (25.8%); 2015-2019 (33.5%). Conceptual framework categorization was as follows: problem identification (22.0%); needs assessment (23.6%); goals and objectives (4.9%); education strategies (9.9%); implementation (7.7%); evaluation and feedback (31.9%). Regional breakdown was as follows with some articles spanning regions: Africa (1.1%); South America (2.2%); Asia (6.0%); Australia (15.4%); Europe (30.2%); North America (45.6%). Conclusions: Nearly half of articles are primarily problem identification or needs assessment (45.6%) which are descriptive in nature and only identify or clarify ROPE needs. Additionally while these results are limited to English language scholarship, there are significant regional maldistributions. Although there is an encouraging trend of increasing ROPE publications over time, this study identifies opportunities to further develop, implement and evaluate ROPE scholarship.

697 Background: Delays in treatment for colorectal cancer (CRC) may worsen prognosis and increase patient anxiety. This study aims to understand population-based trends and variations in wait times (WTs) for CRC in a universal healthcare system over a decade. Methods: Patients diagnosed with stage I-IV CRC in Manitoba, Canada between 2004 and 2014 were included. Data were obtained through province-wide administrative claims and cancer registry. WTs were defined as time from index contact to pathological diagnosis (diagnosis WT), time from pathological diagnosis to first treatment (treatment WT) and total (diagnosis + treatment WT). Index contact was the consult preceding the first gastrointestinal investigation in the year preceding the date of diagnosis. First treatment was radiation, chemotherapy or surgery. The association between WTs and year of diagnosis was estimated using Negative Binomial regression and reported as incidence rate ratio (IRR). Variability in WTs by year were estimated using the Coefficient of Variation (CV) and average annual percent change (AAPC). A CV > 100 indicates high-variability and < 100 indicates low-variaability. Results: A total of 5359 patients were diagnosed with CRC (1802 rectal vs 3557 colon). WTs increased overall. Total WTs for rectal cancer increased by 6% (IRR 1.06, 95% CI 1.04-1.07, p < 0.01) per year from a median of 90 days in 2004 to 147 days in 2014. This was due increases in time to diagnosis (IRR 1.07, 95% CI 1.06-1.09, p < 0.01) and treatment (IRR 1.04, 95% CI 1.03-1.06, p < 0.01). Total colon cancer WTs increased an estimated 5% (IRR 1.05, 95% CI 1.04-1.06, p < 0.01) per year from a median of 89 days in 2004 to 110 days in 2014. This was due to both time to diagnosis (IRR 1.05, 95% CI 1.04-1.07, p < 0.01) and treatment (IRR 1.03, 95% CI 1.02-1.04, p < 0.01). There was increasing variability in total WTs. The CV increased from 87 in 2004 to 102 in 2014 in rectal cancer (AAPC +3.85%) and from 86 in 2004 to 128 in 2014 in colon cancer (AAPC + 5.04%). Conclusions: Total WTs for CRC in Manitoba have increased from 2004 and 2014. This may reflect the growing challenges in providing increasingly complex cancer care to geographically dispersed populations in a universal healthcare system.