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Boyce L, Jordan C, Egan T, Sivaprakasam R. Can virtual reality enhance the patient experience during awake invasive procedures? A systematic review of randomized controlled trials. Pain 2024; 165:741-752. [PMID: 37870233 DOI: 10.1097/j.pain.0000000000003086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 08/16/2023] [Indexed: 10/24/2023]
Abstract
ABSTRACT Procedural anxiety and pain negatively affect surgical outcomes and the patient experience during awake, invasive procedures (AIPs). This systematic review aims to evaluate the effect of using virtual reality (VR) to enhance the intraprocedural patient experience during AIPs. PRISMA, Cochrane, and SWiM Reporting Items guidelines were followed. PubMed, EMBASE, CENTRAL, and medRxiv databases were systematically searched for randomised controlled trials (RCTs) investigating the use of immersive VR headsets to enhance the patient experience in adults undergoing AIPs. Sixteen studies were included. The VR and control groups comprised 685 and 677 patients, respectively. Patients underwent endoscopic procedures in 9 studies ("endoscopic") and interventions that involved a skin incision in 7 studies ("incision"). Eleven (of 13) studies demonstrated a favourable effect on procedural anxiety with VR use compared with standard intraprocedural care (85% [95% CI: 46%-100%], P = 0.011). Ten (of 13) studies demonstrated a favourable effect on pain with VR use (77% [95% CI: 38%-100%], P = 0.046). Seven (of 9) studies demonstrated a favourable VR effect on patient satisfaction (78% (95% CI: 44%-100%), P = 0.070). The effect of VR on physiological markers of anxiety and pain and requirements for additional pro re nata (PRN) analgesia and sedation were not clear. No significant differences in patient experience were identified between the "incision" and "endoscopic" subgroups. This review demonstrates that VR can feasibly be used to enhance the patient experience during AIPs by attenuating subjective perceptions of procedural anxiety and pain. However, further RCTs are required to elucidate the effect of VR on more objective measures of the patient experience.
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Affiliation(s)
| | | | | | - Rajesh Sivaprakasam
- Nephrology and Renal Transplant, the Royal London Hospital, Barts Health NHS Trust, London, United Kingdom
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Dibabu AM, Ketema TG, Beyene MM, Belachew DZ, Abocherugn HG, Mohammed AS. Preoperative anxiety and associated factors among women admitted for elective obstetric and gynecologic surgery in public hospitals, Southern Ethiopia: a cross-sectional study. BMC Psychiatry 2023; 23:728. [PMID: 37807071 PMCID: PMC10561508 DOI: 10.1186/s12888-023-05005-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 07/05/2023] [Indexed: 10/10/2023] Open
Abstract
BACKGROUND Preoperative anxiety is a major mental health problem during the preoperative period. Admission of women to surgery is stressful, and a high level of anxiety was associated with increased perioperative morbidity and mortality, poor treatment satisfaction, and bad obstetric outcomes, including long-term cognitive impairment in children. Despite its negative consequences, little is known on this area, particularly in the study area. OBJECTIVE To assess preoperative anxiety and associated factors among women admitted for elective obstetrics and gynecologic surgeries in public hospitals in Southern Ethiopia, 2022. METHODS AND MATERIALS An institution-based cross-sectional study design was conducted among 389 women using structured interviewer-administered samples who were selected by systematic random sampling from May 20th to June 20th, 2022. The Amsterdam preoperative anxiety and information scale (APAIS) was used to assess the level of anxiety. Data were collected electronically using the Open Data Kit version 2022.2.3 and analyzed with the Statistical Package for Social Sciences version 26.0. Bivariate and multivariable logistic regression analyses were done. The strength of the association was declared by using an adjusted odds ratio (AOR) with a 95% confidence interval, and a statistical significance of P < 0.05. RESULTS The magnitude of preoperative anxiety was 57.1% (95% CI = 51.4-61.5), and 48.1% of women required an average amount of information. Being a gynecologic patient (AOR = 2.0, 95% CI = 1.21, 3.32), having previous anesthesia and surgery (AOR = 2.09, 95% CI = 1.10, 3.96), having fear of postoperative pain (AOR = 1.96, 95% CI = 1.08, 3.53), having concern for family (AOR = 2.56, 95% CI = 1.49, 4.37), having poor social support (AOR = 3.75, 95% CI = 1.99, 7.09), and moderate social supports (AOR = 3.27, 95% CI = 1.74, 6.17), and having a high information requirement about anesthesia and surgery (AOR = 4.68, 95%CI = 2.16, 10.13) were statistically associated with preoperative anxiety. CONCLUSION Preoperative anxiety was often high in the region. Associated factors were the type of surgery, previous anesthesia and surgery, fear of postoperative pain, fear for family, social support, and a high information need. So the national and regional health bureau should develop guidelines and implement strategies to reduce women preoperative anxiety as part of midwifery care. The women should be assessed regularly during the preoperative visits; and appropriate anxiety reduction and information regarding surgery, and anesthesia should be provided.
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Affiliation(s)
- Abera Mamo Dibabu
- Department of Midwifery, College of Medicine and Health Sciences, Mizan Tepi University, Mizan Teferi, Ethiopia.
| | - Teklemariam Gultie Ketema
- Department of Midwifery, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Maechel Maile Beyene
- Department of Midwifery, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Dereje Zeleke Belachew
- Department of Midwifery, College of Medicine and Health Sciences, Mizan Tepi University, Mizan Teferi, Ethiopia
| | | | - Abdu Seid Mohammed
- Department of Midwifery, College of Medicine and Health Sciences, Mizan Tepi University, Mizan Teferi, Ethiopia
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Zhang C, Liu X, Hu T, Zhang F, Pan L, Luo Y, Wang Z. Development and psychometric validity of the perioperative anxiety scale-7 (PAS-7). BMC Psychiatry 2021; 21:358. [PMID: 34271896 PMCID: PMC8284006 DOI: 10.1186/s12888-021-03365-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 07/07/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Preoperative anxiety is a common psychological reaction in perioperative patients. The absence of a valid measurement tool hinders the evaluation of interventions to treat preoperative anxiety in China. This study aims to develop the Perioperative Anxiety Scale-7 (PAS-7) and test its reliability, validity, and cut-off value. METHODS A total of 280 patients over 16 years old (M = 55.1, SD = 14.3) who were undergoing elective surgery were recruited to complete the PAS-7 and the Generalized Anxiety Disorder-7 scale (GAD-7) one day before surgery. RESULTS The PAS-7 included seven items divided into two dimensions: mental anxiety and somatic anxiety. These two dimensions could explain 74.294% of the population variance. The internal consistency of each dimension ranged from 0.761-0.933. The confirmatory factor analysis showed that the model fit of the scale was good (χ2= 34.798, df = 13, χ2/df = 2.677, CFI = 0.949, TLI = 0.918, SRMR = 0.057, RMSEA = 0.115). The correlations between the GAD-7 and each dimension and the scale's total score were significant (0.711-0.789). A cut-off score of 8, maximizing the Youden Index, yielded a sensitivity of 75% and a specificity of 84.6% (95% CI: 0.88 ~ 0.97). CONCLUSIONS The PAS-7 had good reliability and validity and could be used as an effective tool to evaluate preoperative anxiety.
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Affiliation(s)
- Chengjiao Zhang
- grid.16821.3c0000 0004 0368 8293Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xitong Liu
- grid.16821.3c0000 0004 0368 8293Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Tianran Hu
- grid.412277.50000 0004 1760 6738Department of Anesthesia and Pain Management, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Fei Zhang
- grid.16821.3c0000 0004 0368 8293Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lingyi Pan
- grid.16821.3c0000 0004 0368 8293Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yan Luo
- grid.412277.50000 0004 1760 6738Department of Anesthesia and Pain Management, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhen Wang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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Kayabasi S, Cayir S, Hizli O. The effects of intraday operation time on pain and anxiety of patients undergoing septoplasty. Braz J Otorhinolaryngol 2019; 87:310-314. [PMID: 31771818 PMCID: PMC9422450 DOI: 10.1016/j.bjorl.2019.09.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 08/19/2019] [Accepted: 09/17/2019] [Indexed: 11/17/2022] Open
Abstract
Introduction Anxiety and pain levels of septoplasty patients may vary according to intraday operation time. Objective To investigate the effects of septoplasty operation and intraday operation time on anxiety and postoperative pain. Methods Ninety-eight voluntary patients filled out the hospital anxiety and depression scale to measure the anxiety level three weeks before, one hour before and one week after surgery. Forty-nine patients were operated at 8:00 am (morning group); other 49 were operated at 03:00 pm (afternoon group). We used a visual analogue scale to measure postoperative pain. Preoperative and postoperative scores were compared, as were the scores of the groups. Results Median hospital anxiety and depression scale scores one hour before the operation [6 (2–10)] were significantly higher compared to the median scores three weeks before the operation [3 (1–6)] (p < 0.001), and one week after the operation [2 (1–6)] were significantly lower compared to the median scores three weeks before the operation [3 (1–6)] (p < 0.001). Hospital anxiety and depression scale scores one hour before the operation were significantly greater in the afternoon group [8 (7–10)], compared to the morning group [4 (2–6)] (p < 0.001). Postoperative first, sixth, twelfth and twenty-fourth-hour pain visual analogue scale scores were significantly higher in the afternoon group compared to the morning group (p < 0.001). Conclusion Septoplasty might have an increasing effect on short-term anxiety and postoperative pain. Performing this operation at a late hour in the day might further increase anxiety and pain. However, the latter has no long-term effect on anxiety.
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Affiliation(s)
- Serkan Kayabasi
- Aksaray University, Faculty of Medicine, Department of ENT, Aksaray, Turkey
| | - Serkan Cayir
- Aksaray University, Aksaray Education and Research Hospital, Department of ENT, Aksaray, Turkey
| | - Omer Hizli
- Giresun University, Prof Dr. A. Ilhan Ozdemir Education and Research Hospital, Department of ENT, Giresun, Turkey.
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Y.B. W, G.L. F, H.T. Y, A.G. H. Prevalence and factors associated with preoperative anxiety among elective surgical patients at University of Gondar Hospital. Gondar, Northwest Ethiopia, 2017. A cross-sectional study. International Journal of Surgery Open 2018. [DOI: 10.1016/j.ijso.2017.11.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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van Asten F, van Middendorp H, Verkerk S, Breukink MB, Lomme RM, Hoyng CB, Evers AW, Klevering BJ. ARE INTRAVITREAL INJECTIONS WITH ULTRATHIN 33-G NEEDLES LESS PAINFUL THAN THE COMMONLY USED 30-G NEEDLES? Retina 2015; 35:1778-85. [PMID: 25901838 DOI: 10.1097/IAE.0000000000000550] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
PURPOSE This study investigated whether pain from intravitreal injections (IVIs) can be reduced by injecting with a 33-G needle instead of the commonly used 30-G needle. Additionally, several pain-related psychological factors were explored as predictors of outcome. METHODS This randomized crossover trial included 36 patients who received injections with both needles in randomized order. After the injection, patients rated IVI pain on a 0 to 10 scale. Before injection, distress and pain expectations were assessed. Afterward, patients rated the IVI procedure and anticipated consequences. In addition, we assessed the force necessary to penetrate the sclera for both needles in porcine eyes. RESULTS The 33-G needle did not result in lower IVI pain (2.8 vs. 3.1, P = 0.758) but tended to cause less vitreal reflux (0 vs. 5 times, P = 0.054). Factors related to more pain were distress, expecting IVI pain and discomfort, dissatisfaction with the preparation procedure, anticipating negative consequences, and female gender. Patients regarded povidone-iodine disinfection as particularly unpleasant. Exploration of the needles' mechanical properties showed that 33-G needles penetrate the sclera more easily. CONCLUSION The thinner 33-G needle does not reduce IVI pain but may limit scleral damage. Future efforts could be aimed at optimizing patient information, reducing distress, and the use of better tolerable disinfectants.
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Watkins LL, Koch GG, Sherwood A, Blumenthal JA, Davidson JRT, O'Connor C, Sketch MH. Association of anxiety and depression with all-cause mortality in individuals with coronary heart disease. J Am Heart Assoc 2013; 2:e000068. [PMID: 23537805 PMCID: PMC3647264 DOI: 10.1161/jaha.112.000068] [Citation(s) in RCA: 170] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Background Depression has been related to mortality in coronary heart disease (CHD) patients, but few studies have evaluated the role of anxiety or the role of the co‐occurrence of depression and anxiety. We examined whether anxiety is associated with increased risk of mortality after accounting for depression in individuals with established CHD. Methods and Results The cohort was composed of 934 men and women with confirmed CHD (mean age, 62±11 years) who completed the Hospital Anxiety and Depression scale (HADS) during hospitalization for coronary angiography. Over the 3‐year follow‐up period, there were 133 deaths. Elevated scores on the HADS anxiety subscale (HADS‐A≥8) were associated with increased risk of mortality after accounting for established risk factors including age, congestive heart failure, left ventricular ejection fraction, 3‐vessel disease, and renal disease (hazard ratio [HR], 2.27; 95% CI, 1.55 to 3.33; P<0.001). Elevated scores on the HADS depression subscale (HADS‐D≥8) were also associated with increased risk of mortality (HR, 2.18; 95% CI, 1.47 to 3.22; P<0.001). When both psychosocial factors were included in the model, each maintained an association with mortality (anxiety, HR, 1.83; 95% CI, 1.18 to 2.83; P=0.006; depression, HR, 1.66; 95% CI, 1.06 to 2.58; P=0.025). Estimation of the HR for patients with both anxiety and depression versus those with neither revealed a larger HR than for patients with either factor alone (HR, 3.10; 95% CI, 1.95 to 4.94; P<0.001). Conclusions Anxiety is associated with increased risk of mortality in CHD patients, particularly when comorbid with depression. Future studies should focus on the co‐occurrence of these psychosocial factors as markers of increased mortality risk.
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Affiliation(s)
- Lana L Watkins
- Departments of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27710, USA.
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Matthias AT, Samarasekera DN. Preoperative anxiety in surgical patients - experience of a single unit. ACTA ACUST UNITED AC 2012; 50:3-6. [PMID: 22500906 DOI: 10.1016/j.aat.2012.02.004] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2011] [Revised: 11/04/2011] [Accepted: 11/09/2011] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Preoperative anxiety has a significant effect on the outcome of anesthesia and surgery. At present, there is no published data on the preoperative anxiety levels in Sri Lankan patients. In the West, several validated questionnaires such as The Amsterdam Preoperative Anxiety and Information Scale (APAIS) and State Trait Anxiety Inventory (STAI) are used. To measure the preoperative anxiety levels in patients using APAIS and to analyze the factors affecting anxiety and the role played by the anesthetist in allaying anxiety. METHODS One hundred patients scheduled for elective surgery were prospectively studied using the APAIS. The internal consistency was checked using Cronbach's alpha. RESULTS The ages varied 25 to 72 years (mean=48.7 years, SD=13.6). Reliability of the APAIS was high; Cronbach's alpha=0.864 in the overall component and 0.84, 0.73 and 0.97 in the anxiety related to surgery, anesthesia and in the information desire components, respectively. Females were more anxious than males (p=0.02) and those who had never sustained surgery were more anxious than those who previously had surgery (p=0.05). An anesthetist's visit and premedication reduced total anxiety scores (Z=-3.07, p=0.002) and anesthesia related anxiety scores (Z=-3.45, p=0.001). CONCLUSIONS The prevalence of anxiety is high among Sri Lankan patients. Females are more anxious than males and those who have never had surgery are more anxious than those who have had surgery. The anesthetist's visit could reduce anxiety. Sinhala version of the APAIS is highly reliable in assessing the preoperative anxiety levels.
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Schandl AR, Brattström OR, Svensson-Raskh A, Hellgren EM, Falkenhav MD, Sackey PV. Screening and treatment of problems after intensive care: a descriptive study of multidisciplinary follow-up. Intensive Crit Care Nurs 2011; 27:94-101. [PMID: 21334207 DOI: 10.1016/j.iccn.2011.01.006] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2010] [Revised: 11/23/2010] [Accepted: 01/19/2011] [Indexed: 10/18/2022]
Abstract
OBJECTIVES To describe a multidisciplinary intensive care follow-up and the methods used for identifying and managing physical and psychological problems in ICU survivors. METHODS Patients treated>four days in an intensive care unit (ICU) were invited three, six and 12 months after intensive care for screening of physical problems with function tests and psychological problems with the Impact of Event Scale (IES) and the Hospital Anxiety and Depression Scale (HADS). RESULTS 40 of 61 patients had clinically impaired physical function, with no ongoing physical rehabilitation at three months. Twenty-two patients received specific training instructions and 18 patients were referred for physiotherapy. 34 of 61 patients had symptoms of moderate to severe posttraumatic stress and/or symptoms of clinically significant anxiety or depression. Twelve patients accepted referral for psychiatric evaluation and treatment. CONCLUSION Multidisciplinary follow-up after intensive care can be of value in identifying untreated physical and psychological problems in ICU survivors. Liaison with specialists enables referral for identified problems. Patients screened and treated in the first six months appear to have little need for further follow-up after intensive care.
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Affiliation(s)
- Anna R Schandl
- General ICU, Karolinska University Hospital Solna, Sweden.
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Fekrat F, Sahin A, Yazici KM, Aypar U. Anaesthetists' and surgeons' estimation of preoperative anxiety by patients submitted for elective surgery in a university hospital. Eur J Anaesthesiol 2006; 23:227-33. [PMID: 16441974 DOI: 10.1017/s0265021505002231] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/01/2003] [Indexed: 11/06/2022]
Abstract
BACKGROUND AND OBJECTIVE Preoperative anxiety is a challenging concept in the preoperative care of patients. The hypothesis of this study was that the doctors are able to estimate their patients' preoperative anxiety. METHODS A prospective clinical trial was performed on 67 adult patients and 26 paired anaesthetists and surgeons. The patients filled out two separate visual analogue scales for anxiety for the planned anaesthesia and surgery. After that the 'anxiety subscale' of the Hospital Anxiety and Depression's Scale was completed and a list of fearsome items was presented as the patients were asked to choose two conditions they considered the most frightening. Finally the patients were asked to select one or more items from a list of things, which they considered likely to relieve their preoperative anxiety. Similarly, the participating doctors were asked to estimate their patients' anxiety, guess their fearful conditions and their anxiety-relieving requests. RESULTS Median scores for anxiety as estimated with visual analogue scales by anaesthetists, surgeons and patients for anaesthesia were 34, 36 and 6, respectively; and for surgery 53, 47 and 9, respectively. The anxiety subscale of the Hospital Anxiety and Depression's Scale 8.9 +/- 4.2, 8.6 +/- 4.6 and 6.5 +/- 4.5 (mean +/- SD), respectively. Doctors' scores were significantly higher than the patients' scores (P < 0.05). Thus, the anaesthetists and the surgeons were unable to estimate their patients anxiety on any of the scales used (Kendall's tau < 0.25; P < 0.05). The proportion of correct estimation of the fearsome items was 20% for both the anaesthetists and the surgeons. CONCLUSIONS Both anaesthetists and surgeons overestimated their patients' preoperative anxiety by a wide margin and poorly predicted their patients' feared conditions and their desire for relief of anxiety.
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Affiliation(s)
- F Fekrat
- Department of Anaesthesiology, Hacettepe University Hospital, Ankara, Turkey
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12
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Abstract
PURPOSE Preoperative anxiety in relation to anesthesia remains for many patients a major subject of concern. The aim of the present study was to compare the level of preoperative anxiety in patients assessed in an outpatient consultation clinic with the anxiety level of those having been assessed by the anesthesiologist after entering the hospital. METHOD We studied two groups of 20 patients who underwent elective transurethral prostate or bladder resection: group A having the anesthetic assessment between one-two weeks before hospitalisation, group B having this assessment the evening before surgery, after entering the hospital. Two different methods to assess anxiety were used: the Multiple-Affect-Adjective-Check-List (MAACL) and the visual analogue scale of anxiety (VAS). RESULTS Both anxiety provided scores, assessed by two different methods, were lower in group A, than in group B(P<0.01). CONCLUSION The results of this study confirm that an anesthetic assessment in an outpatient consultation clinic reduces preoperative anxiety, when compared with an assessment on the evening before surgery.
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Affiliation(s)
- C E Klopfenstein
- Department of Anaesthesiology, Clinical Pharmacology and Surgical Intensive Care, University Hospitals, Geneva, Switzerland.
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Kindler CH, Harms C, Amsler F, Ihde-Scholl T, Scheidegger D. The visual analog scale allows effective measurement of preoperative anxiety and detection of patients' anesthetic concerns. Anesth Analg 2000; 90:706-12. [PMID: 10702461 DOI: 10.1097/00000539-200003000-00036] [Citation(s) in RCA: 369] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
UNLABELLED The advent of managed care, reduction of costs, and advances in medical technology place increasing demands on anesthesiologists. Preoperative anxiety may go unnoticed in an environment that stresses increased productivity. The present study compares different methods for measuring preoperative anxiety, identifies certain patient characteristics that predispose to high anxiety, and describes the quantity and quality of anxiety that patients experience preoperatively. Seven hundred thirty-four patients participated in the study. We assessed aspects of anxiety by means of visual analog scales (VAS) and the State Anxiety Score of the Spielberger State-Trait Anxiety Inventory (STAI). The mean STAI anxiety score was 39 +/- 1 (n = 486) and the mean VAS for fear of anesthesia was 29 +/- 1 (n = 539). Patients feared surgery significantly more than anesthesia (P < 0.001). The VAS measuring fear of anesthesia correlated well with the STAI score (r = 0.55; P < 0.01). Young patients, female patients, and patients with no previous anesthetic experience or a previous negative anesthetic experience had higher anxiety scores. Patients worried most about the waiting period preceding surgery and were least concerned about possible awareness intraoperatively. Factor analysis of various anxiety items showed three distinct dimensions of fear: 1) the fear of the unknown 2) the fear of feeling ill, and 3) the fear for one's life. Among these dimensions, fear of the unknown correlated highest with the anxiety measuring techniques STAI and VAS. The simple VAS proved to be a useful and valid measure of preoperative anxiety. IMPLICATIONS The study of qualitative aspects of anxiety reveals three distinct dimensions of preoperative fear: fear of the unknown, fear of feeling ill, and fear for one's life. Groups of patients with a higher degree of preoperative anxiety and their specific anesthetic concerns can be identified using the visual analog scale.
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Affiliation(s)
- C H Kindler
- Department of Anesthesia, University of Basel, Kantonsspital, Basel, Switzerland
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Lilja Y, Rydén S, Fridlund B. Effects of extended preoperative information on perioperative stress: an anaesthetic nurse intervention for patients with breast cancer and total hip replacement. Intensive Crit Care Nurs 1998; 14:276-82. [PMID: 10196910 DOI: 10.1016/s0964-3397(98)80688-5] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
An anaesthetic nurse intervention was performed in order to evaluate the effects of extended preoperative information, given by anaesthetic nurses, on perioperative stress in patients operated on for breast cancer or total hip replacement (THR). Forty-six consecutive patients scheduled for surgery for breast cancer, and 55 for THR, were randomized into two groups which were given different modes of preoperative information. Patients in the control group were informed about pre- and postoperative routines by a ward nurse. Patients in the intervention group were given extended formalized information by an anaesthetic nurse. Wilcoxon rank sum test was used to show relations between variables. There were no significant differences between the intervention group and control group for patients with breast cancer or for patients with THR. Breast cancer patients in the intervention group were significantly more anxious than THR patients in the intervention group (P < 0.01). Breast cancer patients in the intervention group showed the highest anxiety scores on the Hospital Anxiety and Depression Scale (HADS) scale on the day of surgery. This information may reflect an increased level of anxiety due to the extended information given preoperatively. The information may thus have had a negative effect on breast cancer patients, resulting in an increased state of anxiety. The result indicates a need for individualized modes of information to provide a proper balance between enough and too much information.
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MESH Headings
- Aged
- Arthroplasty, Replacement, Hip/adverse effects
- Arthroplasty, Replacement, Hip/nursing
- Arthroplasty, Replacement, Hip/psychology
- Female
- Humans
- Hydrocortisone/blood
- Male
- Mastectomy/adverse effects
- Mastectomy/nursing
- Mastectomy/psychology
- Middle Aged
- Nurse Anesthetists
- Nursing Evaluation Research
- Pain, Postoperative/etiology
- Patient Education as Topic/methods
- Preoperative Care/methods
- Preoperative Care/psychology
- Stress, Psychological/blood
- Stress, Psychological/etiology
- Stress, Psychological/nursing
- Stress, Psychological/prevention & control
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Affiliation(s)
- Y Lilja
- Dept of Health Sciences, Kristianstad University, Angelholm Hospital, Sweden
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Boezaart AP, Berry RA, Laubscher JJ, Nell ML. Evaluation of anxiolysis and pain associated with combined peri- and retrobulbar eye block for cataract surgery. J Clin Anesth 1998; 10:204-10. [PMID: 9603590 DOI: 10.1016/s0952-8180(98)00008-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
STUDY OBJECTIVES To evaluate five different preoperative anxiolytic regimens in cataract surgery performed under regional anesthesia; to quantify the pain associated with combined peri- and retrobulbar injection (PRBI) of local anesthetic drugs; and to describe a technique of painless eye block. DESIGN Randomized, double blind, placebo-controlled study. SETTING Private clinic. PATIENTS 376 ASA I and II patients presenting for cataract surgery. INTERVENTIONS Patients were extensively briefed by the nursing staff on the various procedures. Of the 376 study patients, 136 preferred to have no anxiolytic drug. The remaining 240 patients were randomly allocated to one of six groups to receive either 3 mg of bromazepam, 6 mg of bromazepam, 0.5 mg of alprazolam, 1 mg of alprazolam, 5 mg of diazepam, or a placebo on a double-blind protocol. All patients received a standard combined peri- and retrobulbar eye block (PRBB) before surgery. MEASUREMENTS AND MAIN RESULTS Anxiety at various stages of the procedure and PRBB were measured on visual analog scale (0-10). PRBB pain was compared with pain of intravenous (i.v.) cannula placement. On admission, anxiety of the 136 patients who preferred no anxiolytic premedication was significantly less than that of the 240 patients assigned to one of the six treatment groups (p < 0.05). There was no difference between the six treatment groups in reported anxiety before surgery (p > 0.05) except for Group 1 (3 mg bromazepam), where anxiety increased before and during PRBB administration (p < 0.05). In all six treatment groups, anxiety decreased significantly 30 minutes after medication was administered (p < 0.05). For the total group, 61.18% of patients reported more or equal pain associated with the placement of the 20-gauge i.v. cannula than by the PRBB. Of the patients who received medication, 94% stated that, should they require another eye operation, they would like the same anxiolytic treatment. No patient requested general anesthesia for their next operation or to be rendered unconscious for PRBB. CONCLUSIONS 1. There was interpersonal variation in the level of preoperative anxiety. 2. In patients who were anxious, the anxiolytic drugs and placebo decreasedanxiety although the level of anxiety did not differ between the anxiolytic drugs or between placebo and the anxiolytic drugs. The only difference was in Group 1 patients (3 mg promazepam), who reported slightly increased anxiety before and during PRBB administration (p < 0.05). 3. Placement of the PRBB is less painful than the insertion of a 20 g i.v. cannula.
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Affiliation(s)
- A P Boezaart
- Department of Anesthesiology, University of Stellenbosch, Tygerberg, Cape Town, Western Cape, South Africa
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16
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Abstract
OBJECTIVE To determine if a self-administered previsit questionnaire designed to increase awareness of patients' concerns alters the visit duration, content of the discussion, and patient and physician satisfaction. DESIGN A balanced, two-arm trial in which physicians were randomized. SETTING Two primary-care clinics affiliated with a university hospital. PATIENTS/PARTICIPANTS Ten physicians and 201 continuity-care patients. INTERVENTIONS In intervention visits, patients completed a previsit questionnaire asking about the desire for medical information, psychosocial assistance, therapeutic listening, general health advice, and biomedical treatment. Physicians reviewed questionnaires with patients during the visit. MEASUREMENTS AND MAIN RESULTS We used audiotapes of encounters to quantify the duration of the encounter and measured the number and type of diagnoses discussed in the visit, and patient and physician satisfaction with the encounter. Intervention visits were 34% longer (increase of 6.8 minutes; 95% confidence interval [CI] 0.4, 13.2) than control visits with most of the additional time spent in discussion of biomedical diagnoses (3.35 minutes; 95% CI 0.00, 6.72) and in the performance of the physical examination (2.7 minutes; 95% CI 0.5, 4.9). The number of diagnoses discussed per visit was 30% higher in intervention visits (increase of 1.7 diagnoses per visit; 95% CI 0.3, 3.2), but patients' satisfaction with these visits tended to be lower. CONCLUSIONS Using a previsit questionnaire to increase awareness of the patients' concerns may entail a trade-off between conflicting goals: trying to respond to patient concerns while not significantly increasing the cost per visit. A future challenge is to develop and refine techniques with sufficient efficacy to justify the expense of implementing the intervention and the longer visit needed to respond adequately to patients' concerns.
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Affiliation(s)
- J Hornberger
- Department of Health Research & Policy, Stanford University School of Medicine, CA 94305-90521, USA
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17
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Abstract
More than 200 published studies from most medical settings worldwide have reported experiences with the Hospital Anxiety and Depression Scale (HADS) which was specifically developed by Zigmond and Snaith for use with physically ill patients. Although introduced in 1983, there is still no comprehensive documentation of its psychometric properties. The present review summarizes available data on reliability and validity and gives an overview of clinical studies conducted with this instrument and their most important findings. The HADS gives clinically meaningful results as a psychological screening tool, in clinical group comparisons and in correlational studies with several aspects of disease and quality of life. It is sensitive to changes both during the course of diseases and in response to psychotherapeutic and psychopharmacological intervention. Finally, HADS scores predict psychosocial and possibly also physical outcome.
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Affiliation(s)
- C Herrmann
- Department of Psychosomatics and Psychotherapy, University of Göttingen, Germany.
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18
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Abstract
The present study examined the prevalence and severity of anxiety and depression among people with migraine. To obtain a spectrum of migraine experience two potentially different samples were identified: over 600 patients attending migraine clinics and 87 migraine sufferers in the general population. International Headache Society criteria were used to establish the diagnosis of migraine. Anxiety and depression were measured using the Hospital Anxiety and Depression scale and studies using this scale in other patient groups were identified for comparison. Approximately 50% of subjects experienced anxiety and 20% experienced depression, rates which were consistent across the two study groups. This prevalence of psychological morbidity is unexpectedly high and comparable to that measured in patients with other diseases. There is no evidence that it is correlated with frequency of migraine attacks. Anxiety and depression are common among people with migraine and remain largely unrecognized. Future studies should identify contributory factors.
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Affiliation(s)
- Jennifer Devlen
- Centre for Primary Care Research, Department of General Practice, University of Manchester, Manchester, UK
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19
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Devlen J. Anxiety and depression in migraine. J R Soc Med 1994; 87:338-41. [PMID: 8046705 PMCID: PMC1294564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
The present study examined the prevalence and severity of anxiety and depression among people with migraine. To obtain a spectrum of migraine experience two potentially different samples were identified: over 600 patients attending migraine clinics and 87 migraine sufferers in the general population. International Headache Society criteria were used to establish the diagnosis of migraine. Anxiety and depression were measured using the Hospital Anxiety and Depression scale and studies using this scale in other patient groups were identified for comparison. Approximately 50% of subjects experienced anxiety and 20% experienced depression, rates which were consistent across the two study groups. This prevalence of psychological morbidity is unexpectedly high and comparable to that measured in patients with other diseases. There is no evidence that it is correlated with frequency of migraine attacks. Anxiety and depression are common among people with migraine and remain largely unrecognized. Future studies should identify contributory factors.
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Affiliation(s)
- J Devlen
- Department of General Practice, University of Manchester, UK
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20
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Polk-Walker GC. Counseling implications in a client's choice of anesthesia during a first or repeat abortion. Nurs Forum 1993; 28:22-8. [PMID: 8488111 DOI: 10.1111/j.1744-6198.1993.tb00923.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Deciding to have an abortion is a process that causes most women a great deal of distress. This study addresses the question of whether a difference exists in psychological distress between women having abortions under local and general anesthesia. A two-factor analysis of variance design was utilized. The level of psychological distress among four groups of women was measured: Those experiencing a first-time and a repeat abortion under local anesthesia and those experiencing a first-time and repeat abortion under general anesthesia. A main effect for anesthesia was found for the variables of somatization, depression, hostility, psychotocism, global severity index, and positive symptom total. Specifically, women experiencing abortions under general anesthesia experienced more psychological distress in the above variables. Data suggest an association between psychological distress concerning the procedure and choice of anesthetic method may provide clues to the women's counseling needs.
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Abstract
Patient anxiety is a common problem identified by nurses. However, the difficulty of assessing the level and significance of the anxiety is problematic. This paper discusses the issue of measuring patient anxiety, specifically in Coronary Care. As well as discussing physiological measures, three appropriate psychometric instruments are identified (the State-Trait Anxiety Inventory--STAI; the Hospital Anxiety and Depression Scale--HAD; a Linear Analogue Anxiety Scale--LAAS), along with a review of the relevant literature. Systematic anxiety measurement, and management of maladaptive anxiety would appear to be appropriate and meaningful nursing functions within the provision of holistic patient care in Coronary Care.
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22
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Abstract
The purpose of this study was to determine whether there is a correlation between anxiety the night before surgery and that existing immediately preoperatively, whether anaesthetists can detect preoperative anxiety and to establish the presence of any factors that might assist in the determination of preoperative anxiety. Anxiety was measured objectively using the Spielberger State-Trait Anxiety Inventory (STAI), and the Multiple Affect Adjective Check List (MAACL). Anxiety was found to be higher in females and those not having had a previous anaesthetic, and to remain constant from the afternoon before surgery to the immediate preoperative period. Anaesthetists were found to be poor assessors of anxiety unless they specifically questioned their patients about this.
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Affiliation(s)
- N H Badner
- Department of Anaesthesia, University Hospital, London, Ontario, Canada
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