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Digital Technology Distraction for Acute Pain in Children: A Meta-analysis. Pediatrics 2020; 145:peds.2019-1139. [PMID: 31969473 DOI: 10.1542/peds.2019-1139] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/04/2019] [Indexed: 12/14/2022] Open
Abstract
CONTEXT Digital distraction is being integrated into pediatric pain care, but its efficacy is currently unknown. OBJECTIVE To determine the effect of digital technology distraction on pain and distress in children experiencing acutely painful conditions or procedures. DATA SOURCES Medline, Embase, Cochrane Library, Cumulative Index to Nursing and Allied Health Literature, PsycINFO, Institute of Electrical and Electronics Engineers Xplore, Ei Compendex, Web of Science, and gray literature sources. STUDY SELECTION Quantitative studies of digital technology distraction for acutely painful conditions or procedures in children. DATA EXTRACTION Performed by 1 reviewer with verification. Outcomes were child pain and distress. RESULTS There were 106 studies (n = 7820) that reported on digital technology distractors (eg, virtual reality and video games) used during common procedures (eg, venipuncture, dental, and burn treatments). No studies reported on painful conditions. For painful procedures, digital distraction resulted in a modest but clinically important reduction in self-reported pain (standardized mean difference [SMD] -0.48; 95% confidence interval [CI] -0.66 to -0.29; 46 randomized controlled trials [RCTs]; n = 3200), observer-reported pain (SMD -0.68; 95% CI -0.91 to -0.45; 17 RCTs; n = 1199), behavioral pain (SMD -0.57; 95% CI -0.94 to -0.19; 19 RCTs; n = 1173), self-reported distress (SMD -0.49; 95% CI -0.70 to -0.27; 19 RCTs; n = 1818), observer-reported distress (SMD -0.47; 95% CI -0.77 to -0.17; 10 RCTs; n = 826), and behavioral distress (SMD -0.35; 95% CI -0.59 to -0.12; 17 RCTs; n = 1264) compared with usual care. LIMITATIONS Few studies directly compared different distractors or provided subgroup data to inform applicability. CONCLUSIONS Digital distraction provides modest pain and distress reduction for children undergoing painful procedures; its superiority over nondigital distractors is not established. Context, preferences, and availability should inform the choice of distractor.
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Music listening for children and adolescents in health care contexts: A systematic review. ARTS IN PSYCHOTHERAPY 2016. [DOI: 10.1016/j.aip.2016.08.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Correlates of psychological distress immediately following colposcopy. Psychooncology 2015; 24:819-24. [DOI: 10.1002/pon.3738] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Revised: 11/17/2014] [Accepted: 11/20/2014] [Indexed: 11/11/2022]
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Qualitative insights into the psychological stress before and during colposcopy: a focus group study. J Psychosom Obstet Gynaecol 2013; 34:150-6. [PMID: 24188786 DOI: 10.3109/0167482x.2013.849688] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To determine the reasons for women's anxiety and psychological stress before and during colposcopy, in order to define strategies to decrease their stress. METHODS Qualitative study with 15 women participating in four focus groups between April 2011 and April 2012. All participants were diagnosed with a cervical cytological abnormality and attended a gynecologist's clinic to undergo colposcopy. The focus group interview was audio-taped and transcribed verbatim. The data were analyzed using qualitative content analysis to identify themes. RESULTS Psychological stress before colposcopy was seen as being caused by unsatisfactory explanation of abnormal cervical smears and the colposcopy procedure itself. Additionally, a fear of cancer, pain and discomfort, embarrassment, waiting time in the hospital, and a longer interval between referral and the actual colposcopy appointment increased psychological stress and anxiety. Women indicated that more detailed and practical information about the cervical smear result and the colposcopy procedure may reduce stress and anxiety. CONCLUSION In order to minimize the adverse psychological consequences of an abnormal cervical smear and colposcopy, timely, practical and detailed information needs to be provided to the women, and waiting and access times need to be as short as possible. These measures may reduce the psychological stress and anxiety, however some stress and anxiety will always remain, and may even be desirable in order to ensure proper follow-up of abnormal cervical smears.
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Abstract
2011: this review is being updated by a new author team who are preparing a new protocol. This update is due to be published in 2011. The replacement protocol was published in September 2011 (Bradshaw DH, Brown CJ, Cepeda MS, Pace NL. Music for pain relief (Protocol). Cochrane Database of Systematic Reviews 2011, Issue 9. Art. No.: CD009284. DOI: 10.1002/14651858.CD009284). 2015: at July 2015, the PaPaS Review Group withdrew the 2011 protocol (Bradshaw 2011) as there were significant delays in preparing the full review, which did not meet the expectations of Cochrane and PaPaS editorial processes and timelines. For more information, please contact the PaPaS CRG office. The editorial group responsible for this previously published document have withdrawn it from publication.
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Effects of active distraction on pain of children undergoing venipuncture: Who benefits from it? ACTA ACUST UNITED AC 2013. [DOI: 10.1163/156856903767650781] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Matching intra-procedural information with coping style reduces psychophysiological arousal in women undergoing colposcopy. J Behav Med 2012; 36:401-12. [DOI: 10.1007/s10865-012-9435-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2011] [Accepted: 06/05/2012] [Indexed: 10/28/2022]
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Abstract
BACKGROUND Prior to the development of cervical cancer abnormal cervical cells can be detected on a cervical smear. The usual practice following an abnormal cervical smear is to perform colposcopy. Colposcopy is the visualisation of the cervix using a binocular microscope. Women experience high levels of anxiety and negative emotional responses at all stages of cervical screening. High levels of anxiety before and during colposcopy can have adverse consequences, including pain and discomfort during the procedure and high loss to follow-up rates. This review evaluates interventions designed to reduce anxiety levels during colposcopic examination. OBJECTIVES To compare the efficacy of various interventions aimed at reducing anxiety during colposcopic examination in women. SEARCH METHODS We searched the Cochrane Gynaecological Cancer Group Trials Register, Cochrane Central Register of Controlled Trials (CENTRAL), Issue 3, 2010, MEDLINE and EMBASE up to July 2010. We also searched registers of clinical trials, abstracts of scientific meetings, reference lists of included studies and contacted experts in the field. SELECTION CRITERIA Randomised controlled trials (RCTs) of interventions to reduce anxiety during colposcopic examination. DATA COLLECTION AND ANALYSIS Two review authors independently abstracted data and assessed risk of bias. Mean differences for anxiety levels, knowledge scores, pain, patient satisfaction and psychosexual dysfunction in women who underwent colposcopy were pooled in a random effects meta-analyses. MAIN RESULTS We found six trials that met our inclusion criteria. These trials assessed the effectiveness of different interventions for reducing anxiety in women undergoing colposcopy for the first time.All comparisons were restricted to single trial analyses or meta analysis of just two trials. There was evidence from a reasonably large trial (n = 220) that was at low risk of bias to suggest that music during colposcopy significantly reduced anxiety levels (MD = -4.80, 95% CI: -7.86 to -1.74) and pain experienced during the procedure (MD = -1.71, 95% CI: -2.37 to -1.05) compared to not listening to music. There was no statistically significant difference between anxiety levels prior to colposcopy in women receiving information leaflets versus no leaflets and information leaflets, video and counselling versus information leaflets and video with no counselling. However, knowledge scores were significantly higher and psychosexual dysfunction scores were significantly lower in women who received leaflets compared to those who did not so there was some sort of benefit to giving patients information leaflets. There is evidence for video colposcopy from a quasi randomised trial which assessed 81 women showing significant anxiety reduction. AUTHORS' CONCLUSIONS Anxiety appears to be reduced by playing music during colposcopy. Although information leaflets did not reduce anxiety levels, they did increase knowledge levels and are therefore useful in obtaining clinical consent to the colposcopic procedure. Leaflets also contributed to improved patient quality of life by reducing psychosexual dysfunction.
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Music Therapy to Reduce Pain and Anxiety in Children With Cancer Undergoing Lumbar Puncture: A Randomized Clinical Trial. J Pediatr Oncol Nurs 2010; 27:146-55. [DOI: 10.1177/1043454209355983] [Citation(s) in RCA: 133] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
A nonpharmacological method can be an alternative or complement to analgesics.The aim of this study was to evaluate if music medicine influences pain and anxiety in children undergoing lumbar punctures. A randomized clinical trial was used in 40 children (aged 7-12 years) with leukemia, followed by interviews in 20 of these participants. The participants were randomly assigned to a music group (n = 20) or control group (n = 20). The primary outcome was pain scores and the secondary was heart rate, blood pressure, respiratory rate, and oxygen saturation measured before, during, and after the procedure. Anxiety scores were measured before and after the procedure. Interviews with open-ended questions were conducted in conjunction with the completed procedures. The results showed lower pain scores and heart and respiratory rates in the music group during and after the lumbar puncture. The anxiety scores were lower in the music group both before and after the procedure. The findings from the interviews confirmed the quantity results through descriptions of a positive experience by the children, including less pain and fear.
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AIM To test whether postoperative music listening reduces morphine consumption and influence pain, distress, and anxiety after day surgery and to describe the experience of postoperative music listening in school-aged children who had undergone day surgery. BACKGROUND Music medicine has been proposed to reduce distress, anxiety, and pain. There has been no other study that evaluates effects of music medicine (MusiCure) in children after minor surgery. METHODS Numbers of participants who required analgesics, individual doses, objective pain scores (Face, Legs, Activity, Cry, Consolability [FLACC]), vital signs, and administration of anti-emetics were documented during postoperative recovery stay. Self-reported pain (Coloured Analogue Scale [CAS]), distress (Facial Affective Scale [FAS]), and anxiety (short State-Trait Anxiety Inventory [STAI]) were recorded before and after surgery. In conjunction with the completed intervention semi-structured qualitative interviews were conducted. RESULTS Data were recorded from 80 children aged 7-16. Forty participants were randomized to music medicine and another 40 participants to a control group. We found evidence that children in the music group received less morphine in the postoperative care unit, 1/40 compared to 9/40 in the control group. Children's individual FAS scores were reduced but no other significant differences between the two groups concerning FAS, CAS, FLACC, short STAI, and vital signs were shown. Children experienced the music as 'calming and relaxing.' CONCLUSIONS Music medicine reduced the requirement of morphine and decreased the distress after minor surgery but did not else influence the postoperative care.
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Women's experiences of having a colposcopic examination: self-reported satisfaction with care, perceived needs and consequences. J OBSTET GYNAECOL 2009; 18:462-70. [PMID: 15512145 DOI: 10.1080/01443619866804] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
This study was conducted in seven gynaecological clinics in New South Wales (NSW), Australia. The study aimed to assess the level of satisfaction with care, unmet needs and consequences following the procedure reported by women having a colposcopic examination. Of the 161 eligible women attending colposcopy clinics who were approached to take part, 156 (97%) gave written consent to participate and 138 (86%) completed interviews. Consenting women were telephoned within 1 week of their clinic visit to complete a computer-assisted telephone interview (CATI). The survey addressed a number of issues relating to the care they received during their colposcopic examination: satisfaction with care, satisfaction with the waiting time to have a colposcopy, preferences for provider gender, information and health care needs while waiting for the colposcopy, information and health care needs during the colposcopy, short-term physical consequences and shortterm psychosocial consequences of the procedure. Results indicate that satisfaction with care among women ranged from 69% to 96%. The highest expressed needs while waiting for the colposcopy were for information about risks of cancer (91%), reasons for needing a colposcopy (86%), and the colposcopy procedure (86%). Women reported that outcomes such as anxiety and disinterest in sex had further worsened or not been improved following the colposcopy. The results indicate that interventions to address specific concerns would need to be designed, implemented and evaluated.
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Music for Pain and Anxiety in Children Undergoing Medical Procedures: A Systematic Review of Randomized Controlled Trials. ACTA ACUST UNITED AC 2008; 8:117-28. [DOI: 10.1016/j.ambp.2007.12.005] [Citation(s) in RCA: 165] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2007] [Revised: 12/05/2007] [Accepted: 12/10/2007] [Indexed: 11/20/2022]
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Psychological distress associated with colposcopy: patients' perception. Eur J Obstet Gynecol Reprod Biol 2007; 139:90-4. [PMID: 17980478 DOI: 10.1016/j.ejogrb.2007.09.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2007] [Revised: 09/12/2007] [Accepted: 09/13/2007] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Cervical screening and colposcopy are associated with varying degrees of anxiety in women. Interventions are in place to reduce anxiety but the effectiveness of these needs examination. Our objective was to develop an understanding of factors associated with anxiety in relation to colposcopy and to seek women's opinion on interventions designed to reduce anxiety. STUDY DESIGN Prospective, anonymised survey. Determination of anxiety level and effectiveness of interventions within the colposcopy experience, i.e. information leaflet, video-screen display, nursing and medical intervention and exploration of medical terms, i.e. 'CIN'. RESULTS Prior to attendance 36% of patients felt they were very worried, 54% slightly worried and 10% not worried. All patients found the standardised NHS information leaflet helpful to a variable degree. During colposcopy 30% of patients found watching on a video-screen display very helpful, whilst a significant number (18%) found it increased their worry. Stratification of results showed that women with pre-existing high level of anxiety were least satisfied with indices examined. CONCLUSION Our results indicate that the higher the index level of anxiety regarding colposcopy, the less likely women were to find either the leaflet or the video-screen display helpful. Research should focus on the 'very anxious' women, as they are least satisfied with existing measures in place to reduce anxiety. However, evidence is presented to imply this may not be possible.
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Abstract
BACKGROUND Before cervical cancer develops the cells of the cervix become abnormal. Following an abnormal cervical smear colposcopy is performed. Colposcopy is the visualisation of the cervix using a binocular microscope. Women experience high levels of anxiety and negative emotional responses at all stages of cervical screening. High levels of anxiety before and during colposcopy can have adverse consequences, including pain and discomfort during the procedure and high loss to follow-up rates. This review evaluates interventions designed to reduce anxiety levels during colposcopic examination. OBJECTIVES To compare the efficacy of various interventions aimed at reducing anxiety during colposcopic examination in women. SEARCH STRATEGY The Cochrane Central Register of Controlled Trials (CENTRAL), (Cochrane Library, Issue 1, 2006) MEDLINE (1951-2006), EMBASE (1980-2006), CINAHL (1982-2006), Psych Lit and CancerLit, NHMRC Clinical Trials Register, UKCCCR Register of Cancer Trials, Meta-Register and Physician Data Query Protocols. SELECTION CRITERIA Randomised and quasi randomised controlled trials of interventions to reduce anxiety during colposcopic examination. DATA COLLECTION AND ANALYSIS One author searched the citations and reference lists. Studies that appeared to meet inclusion criteria were retrieved and assessed independently by the remaining three authors. The methodological quality of included studies was assessed using the Cochrane Collaboration Back Review Group's methodological quality criteria (van Tulder 2003). MAIN RESULTS Eleven trials were included, these trials used various interventions to reduce anxiety. These examined 1441 women's anxiety levels after different types of intervention. These included: Information leaflets - (proved not to be associated with anxiety reduction). Counselling: pre-colposcopic counselling was not associated with anxiety reduction. Information leaflets and information video and pre-colposcopy counselling was not associated with a reduction in anxiety levels. Listening to music during colposcopy: this intervention was associated with reduction in anxiety levels (p < 0.002). Video colposcopy was associated with reduction in anxiety levels, and the reduction in anxiety was significant (p < 0.0002). Information using graphs and verbal information and information video versus information only when sought: There was no significant reduction in the level of anxiety in the intervention group. Information leaflets and information video versus information leaflets only: There was a reduction in anxiety levels in the intervention group compared to the control group (p < 0.00001). AUTHORS' CONCLUSIONS Anxiety appears to be reduced by playing music during colposcopy, showing information videos prior to colposcopy and viewing video colposcopy during the procedure. Although information leaflets did not reduce anxiety levels, they did increase knowledge levels and so are useful in obtaining clinical consent to the colposcopic procedure.
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Abstract
Although the incidence rate of cervical cancer has decreased over the last several years, low-income ethnic minority women remain at increased risk for morbidity and mortality from cervical cancer. We conducted a pilot study to examine the feasibility and acceptability of mindfulness-based stress reduction (MBSR) program among multiethnic low-income women with abnormal Pap smears. Spanish- and English-speaking women recruited through convenience sampling participated in MBSR classes 2 hours each week over 6 consecutive weeks. State anxiety and self-compassion were measured before and after the MBSR program. Focus groups and surveys were used to evaluate the program. Although 51 women were initially recruited, pre- and post-MBSR data were available only for 8 women. There was a significant reduction in anxiety and a trend toward increased self-compassion in this group of women. The participants evaluated the MBSR program very positively. The high attrition rate highlights the challenges of conducting MBSR research with this demographic of women. Potential strategies for improving recruitment and retention of low-income multiethnic women are discussed.
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Abstract
BACKGROUND The efficacy of music for the treatment of pain has not been established. OBJECTIVES To evaluate the effect of music on acute, chronic or cancer pain intensity, pain relief, and analgesic requirements. SEARCH STRATEGY We searched The Cochrane Library, MEDLINE, EMBASE, PsycINFO, LILACS and the references in retrieved manuscripts. There was no language restriction. SELECTION CRITERIA We included randomized controlled trials that evaluated the effect of music on any type of pain in children or adults. We excluded trials that reported results of concurrent non-pharmacological therapies. DATA COLLECTION AND ANALYSIS Data was extracted by two independent review authors. We calculated the mean difference in pain intensity levels, percentage of patients with at least 50% pain relief, and opioid requirements. We converted opioid consumption to morphine equivalents. To explore heterogeneity, studies that evaluated adults, children, acute, chronic, malignant, labor, procedural, or experimental pain were evaluated separately, as well as those studies in which patients chose the type of music. MAIN RESULTS Fifty-one studies involving 1867 subjects exposed to music and 1796 controls met inclusion criteria. In the 31 studies evaluating mean pain intensity there was a considerable variation in the effect of music, indicating statistical heterogeneity ( I(2) = 85.3%). After grouping the studies according to the pain model, this heterogeneity remained, with the exception of the studies that evaluated acute postoperative pain. In this last group, patients exposed to music had pain intensity that was 0.5 units lower on a zero to ten scale than unexposed subjects (95% CI: -0.9 to -0.2). Studies that permitted patients to select the music did not reveal a benefit from music; the decline in pain intensity was 0.2 units, 95% CI (-0.7 to 0.2). Four studies reported the proportion of subjects with at least 50% pain relief; subjects exposed to music had a 70% higher likelihood of having pain relief than unexposed subjects (95% CI: 1.21 to 2.37). NNT = 5 (95% CI: 4 to 13). Three studies evaluated opioid requirements two hours after surgery: subjects exposed to music required 1.0 mg (18.4%) less morphine (95% CI: -2.0 to -0.2) than unexposed subjects. Five studies assessed requirements 24 hours after surgery: the music group required 5.7 mg (15.4%) less morphine than the unexposed group (95% CI: -8.8 to -2.6). Five studies evaluated requirements during painful procedures: the difference in requirements showed a trend towards favoring the music group (-0.7 mg, 95% CI: -1.8 to 0.4). AUTHORS' CONCLUSIONS Listening to music reduces pain intensity levels and opioid requirements, but the magnitude of these benefits is small and, therefore, its clinical importance unclear.
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Anxiety levels in women attending a colposcopy clinic: a randomised trial of an educational intervention using video colposcopy. PATIENT EDUCATION AND COUNSELING 2004; 55:247-251. [PMID: 15530762 DOI: 10.1016/j.pec.2003.09.012] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2003] [Revised: 09/24/2003] [Accepted: 09/30/2003] [Indexed: 05/24/2023]
Abstract
A video colposcopy allows the real-time images viewed by the doctor performing the examination to be viewed by patients on a television monitor during the consultation. Eighty-one women (requiring either laser treatment or a normal recheck) were randomly assigned to either the video intervention group or the control group. A significant decrease in state anxiety was observed from one visit to the next in all patients (P = 0.000). This decrease in anxiety was significantly greater in the laser patients in the video colposcopy condition than patients in the control group for both groups of patients. Patients in the experimental groups also reported less pain than patients in the control conditions (P < 0.05). This benefit associated with video colposcopy was not observed on the second (treatment) visit. In conclusion, video colposcopy is a useful and time-efficient method that reduces patient anxiety and pain during examination visits, but not necessarily during visits where laser treatment is required.
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Abstract
OBJECTIVE The goal of this work was to investigate the impact of music on women's anxiety and perceived pain during colposcopy examination. METHODS This was a prospective randomized study. Two hundred and twenty women referred for colposcopy for the first time were recruited. They were randomized to either the music or no-music group. Before colposcopy examination, each subject completed a Chinese version of the state anxiety questionnaire (STAI) and assessed the anticipated pain for colposcopy with a visual analog scale (VAS). Slow-rhythm music was played during colposcopy examination in the music group. Subjects in the no-music group were examined in the same setting without music. After colposcopy, each subject completed the STAI form again and assessed their pain during examination by the VAS. RESULTS Women in the music group experienced significantly less pain (mean VAS 3.32 [95% CI 2.86-3.78] vs 5.03 [4.54-5.52], P<0.001) and lower anxiety (mean STAI 39.36 [95% CI 37.33-41.39] vs 44.16 [41.82-46.49], P = 0.002) during colposcopy examination than women in the no-music group. On linear regression analysis, the factors significantly affecting anxiety during colposcopy were anxiety score at enrollment, pain score during colposcopy, and whether or not the women had listened to music during the colposcopy examination. The factors significantly affecting the pain scores were whether the women had listened to music during the procedure and the final anxiety scores. CONCLUSIONS Music is a simple, inexpensive, and easily used strategy to minimize anxiety and pain during colposcopy examination.
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Abstract
OBJECTIVE The aim of this investigation was to evaluate the impact of optical spectroscopy, a new approach for the detection of cervical dysplasia, on patient well-being and satisfaction. STUDY DESIGN Patient distress and satisfaction with optical spectroscopy compared with the Papanicolaou test and colposcopically directed biopsy were measured in a volunteer sample of 314 women with no history of abnormal Papanicolaou test findings. RESULTS Participants reported significantly less pain and anxiety (P<.001) during optical spectroscopy than during the Papanicolaou test or colposcopically directed biopsy. Generally, participants found spectroscopy equal to the Papanicolaou test and to biopsy on a variety of questions that measured satisfaction. There were statistically significant differences between spectroscopy and the Papanicolaou test or biopsy on issues such as the discomfort and fear caused by the test, the amount of time taken, the room lighting, and perceptions of accuracy. CONCLUSION That patients reported less distress during spectroscopy than during a Papanicolaou test, colposcopy, or biopsy suggests the possibility of improved adherence to cervical cancer screening and follow-up in settings in which it is used.
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Abstract
PURPOSE To examine adolescents' responses to a medical examination, which included the use of video colposcopy, conducted during an investigation of possible child sexual abuse. METHODS Girls aged 11 to 18 years, referred for evaluation and treatment of sexual abuse at an academic medical center were eligible to participate. Demographic data and information regarding the alleged sexual abuse event(s) were obtained by medical record review. Prior to the medi- cal examination subjects were assessed regarding: anticipations of the medical examination; level of state anxiety using the State-Trait Anxiety Inventory (STAI); response to stressful situations along the dimensions of information-seeking or information-avoiding using the Miller Behavioral Style Scale (MBSS); and knowledge of reproduction and genital anatomy. Subsequently, a medical examination, which included the use of video colposcopy with a monitor for subject viewing, was completed. The examining physician provided a standardized educational intervention regarding genital anatomy and a discussion about abuse issues and sexually transmitted infections. An exit interview assessed perceptions of the medical examination and video colposcopy and reassessed anxiety using the state portion of the STAI. Follow-up interviews occurred 3 months later during which knowledge of reproduction and genital anatomy was reassessed. Measures were evaluated using paired Student's t-tests, McNemar tests for correlated proportions, correlations and independent Student's t-tests, as appropriate. RESULTS Seventy-seven eligible girls participated; 51 returned for follow-up. The mean age of the subjects was 13.5 years (SD 1.4 years). Fifty-one percent of the sample was Caucasian, 29% African-American, 18% Hispanic, and 2% other. Seventy-nine percent of the girls chose to watch the examination on the video monitor. The girls' post-examination perceptions were significantly more positive than their pre-examination anticipations (p <.001), even though some aspects continued to be embarrassing, painful, or "scary". Anxiety, as measured by the STAI, significantly decreased from pre- to post-examination (p <.001). Pre-examination and post-examination anxiety were negatively associated with pre-examination anticipation and post-examination perceptions, respectively. Information-avoiding coping styles on the MBSS were associated with positive anticipations of the examination, but exhibited a trend toward negative associations with perceptions of video colposcopy. Scores assessing knowledge of the reproductive functions of their bodies at 3 months revealed no significant differences during the period from pre-examination assessment to three month follow-up. CONCLUSIONS; Teens generally reported that the medical examination, which included the use of video colposcopy, was beneficial. There was a significant reduction in anxiety from pre-examination to post-examination and the girls' feelings about the medical examination were significantly more positive afterwards.
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Variables influencing anxiety of patients with abnormal cervical smears referred for colposcopy. J Psychosom Obstet Gynaecol 2002; 23:257-61. [PMID: 12520863 DOI: 10.3109/01674820209074680] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The state anxiety scores of women with abnormal cervical smears referred for colposcopy were investigated to identify causes of anxiety, factors influencing anxiety and emotions involved with anxiety, in order to define strategies to reduce this anxiety. Forty-seven women were interviewed and completed a questionnaire and the Spielberger State and Trait Anxiety Inventory (STAI): 22 women prior to their intake consultation at the colposcopy clinic of the University Medical Center St Radboud, Nijmegen, and 25 women during their second visit before the actual colposcopy. The mean State anxiety score was 48.2, without significant differences between the intake and colposcopy consultation. The majority experienced anxiety because of a fear of cancer and/or the colposcopy. The mean State anxiety score was significantly higher in women who considered the level of information provided by the gynecologist/family practitioner insufficient, who experienced a long waiting time, who did not have a partner, and who experienced additional emotions like anger and sadness. In conclusion, patients referred for colposcopy after an abnormal cervical smear result have high levels of anxiety. High levels of anxiety may be reduced by uniform and explicit information about cervical smear results and colposcopy, by reduction of clinic waiting times, by stimulating social support, and by attention to emotions like anger and sadness.
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Abstract
Tellington touch (ttouch) is an emerging natural healing modality used by nurses and other health care providers to communicate caring and connection to clients. This simple-to-learn and easy-to-implement form of mindful, gentle physical touch is said to help in diverse areas such as chronic pain management, labor discomfort, and postinjury pain and edema. Despite 15 years of anecdotal evidence outlining reported benefits for humans, no investigation of ttouch has yet been undertaken. This qualitative study initiates a body of knowledge about ttouch by exploring and describing the experience of ttouch when administered to healthy people awaiting a routine venipuncture. The study includes qualitative data from both the participants (n = 47) and the provider (n = 1) and provides essential foundational information regarding the experience of ttouch. Implications for practice and future research are provided.
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Distraction reduces self-reported physiological reactions to blood donation in novice donors with a blunting coping style. Psychosom Med 2001; 63:447-52. [PMID: 11382272 DOI: 10.1097/00006842-200105000-00014] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Vasovagal reactions experienced by some blood donors (eg, faintness, lightheadedness, and dizziness) have been shown to be related to a decreased likelihood of future blood donations. This study evaluated the efficacy of audiovisual distraction as a means of reducing self-reported physiological reactions in first-time blood donors. Because interventions that are consistent with an individual's preferred coping style have been shown to be more effective at reducing physiological and psychological responses to stressful medical procedures, coping style (monitoring vs. blunting) was assessed as a possible moderating variable. METHODS First-time blood donors were randomly assigned to one of two conditions: audiovisual distraction or no-treatment control. Participants in the distraction group donated blood at an American Red Cross blood drive while watching a three-dimensional video presentation on a personal visor and headset. The control group donated blood according to standard American Red Cross procedures. Score on a self-reported measure of physiological reactions completed immediately after donation served as the dependent variable. RESULTS Individuals who typically use blunting coping strategies to cope with stress reported an attenuation of vasovagal reactions to blood donation in the distraction vs. the control condition (t(49) = 2.29, p < .05), whereas donors who prefer a monitoring coping style did not benefit from distraction. CONCLUSIONS Among first-time blood donors, audiovisual distraction may be an effective means of reducing vasovagal reactions in donors who prefer to cope with stress using such strategies as distraction, denial, and reinterpretation.
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Abstract
Guided imagery, the use of focused concentration of formed mental images, provides the mechanism of an independent nursing intervention to facilitate mind and body healing. Nurse healers can channel clients to personal restorative potentials and independent health through this powerful and inexpensive tool. In a variety of outpatient, inpatient, chronic care, and home care settings, nurses can introduce this treatment modality early on and for lifelong use for any number of nursing diagnoses. Specific conceptualizations for women's health are presented here. By unleashing your own and your client's imagination, the endless possibilities of guided imagery applications and resulting self-empowerment become apparent.
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Abstract
OBJECTIVE Our purpose was to compare three techniques in their ability to decrease anxiety induced by the pelvic examination among children of different races. STUDY DESIGN Eighty-nine subjects between 3 and 8 years old of white, African-American, and Hispanic race or ethnicity were randomly assigned to one of three distraction techniques that was used during the genital examination: passive play (being read to), active play (singing, blowing bubbles), or viewing a movie through video eyeglasses. Levels of vocalized distress, as well as distress expressed by physical behavior and emotional support requested, were directly observed and recorded. Children also reported their level of satisfaction at the end of the examination. Multivariate analysis of covariance was used to evaluate the independent effects of each technique and race while we controlled for confounding variables. RESULTS Levels of physical distress were lowest among children who used video glasses and highest among those randomly assigned to passive play (p = 0.02). Children randomized to video glasses also expressed higher levels of satisfaction than those randomized to active (p = 0.001) or passive (p = 0.05) play. No differences associated with race or ethnicity were detected. CONCLUSION This study demonstrates that video glasses are more effective than active or passive play in reducing anxiety and improving satisfaction levels among children undergoing a genital examination.
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Abstract
STUDY OBJECTIVE To determine colposcopic findings among adolescents and to determine compliance with management recommendations. DESIGN Retrospective review of colposcopy logs and patient charts. SETTING Two urban resident colposcopy clinics. PARTICIPANTS Low-income, predominantly minority girls 16 years of age or younger referred for evaluation of abnormal cervical cytology. INTERVENTION Colposcopy with directed biopsy. MAIN OUTCOME MEASURES Histologic findings in colposcopic biopsies and compliance with management recommendations. RESULTS Of 62 adolescents evaluated, 17 (27%) had biopsies showing atypia or koilocytosis and 13 (21%) had dysplasia, with grade 2 cervical intraepithelial neoplasia (CIN 2) in 5 (8%). No biopsy showed CIN 3 or invasive cancer. None of 31 endocervical curettings contained dysplasia. Forty-one adolescents (66%) failed to comply with recommendations for surveillance or treatment. CONCLUSIONS The prevalence of dysplasia among adolescents referred for colposcopy is substantial, and better strategies are needed to ensure proper follow-up.
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