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Comparison of music medicine intervention and visual imagery techniques and conventional treatment alone on preoperative anxiety among children undergoing surgery – A Randomized Control Trial
... Previous literature found that music can help alleviate the adverse effects of medical procedures, such as pain. Listening to music can decrease and regulate the patient's respiration and heart rate, resulting in improved relaxation and mood (Mohanasundari et al., 2023). Overall, music can help create a positive and less stressful experience during painful procedures such as burn dressing changes. ...
... It distracts the patient from pain stimuli and induces relaxation through brain stimulation. Music intervention can also improve children's cooperation and quality of life (Mohanasundari et al., 2023). ...
... Previous studies involving advanced technologies have also reported how music can affect the brain when it is exposed to stimulation through listening to music. It has a positive influence on prick pain, postoperative pain, chronic pain, and procedural pain (Mohanasundari et al., 2023). Therefore, this supportive method can create a comfortable environment and friendly rapport and reduce the patient's pain (Li et al., 2017). ...
Daily dressing changes cause distress and pain for victims of burn injuries. The study aimed to determine the effect of music in reducing the pain and anxiety of thermally burned children during routine dressing changes. This quantitative study employed a randomized controlled trial design. The participants comprised 80 children at the Specialized Burns Hospital, in Baghdad, Iraq who were divided into two groups. The intervention group were exposed to three generic musical pieces (children’s music, nature sounds, and classical music) for 10-15 minutes. The researchers used the Objective Pain Scale, State-Trait Anxiety Inventory, and physiological parameters to measure the children’s responses immediately before the dressing change and five minutes after, over seven days. The paired t-test and independent t-test were used to compare the means between the control and intervention groups. The mean values for the pain, anxiety, and physiological parameters before the procedure in both groups showed no significant differences (p > 0.01). The intervention group revealed significant statistical differences after being played music in all study parameters for pre- and post-dressing (p < 0.01), except for the blood pressure parameter. The music intervention alleviated children’s pain, anxiety, respiration, and pulse measurements when undergoing dressing changes.
... Beberapa penelitian menguji efektivitas musik selama prosedur kateterisasi jantung anak terhadap rasa sakit, rasa takut, kecemasan, dan tanda-tanda vital anak.Tingkat nyeri, rasa takut, dan kecemasan diukur sebelum dan sesudah prosedur kateterisasi jantung anak.Tanda-tanda vital diukur sebelum, selama, dan setelah prosedur kateterisasi jantung anak.Hasil penelitian didapatkan bahwa intervensi musik yang diterapkan pada prosedur kateterisasi jantung pada anak berpengaruh terhadap penurunan rasa sakit, tingkat ketakutan, dan kecemasan serta stabilisasi tanda-tanda vital.Intervensi ini dapat menjadi metode non farmakologis yang efektif dalam menurunkan tingkat nyeri anak (Karakul, Akgül, Yalınız, & Meşe, 2022).Terapi musik dapat menurunkan nyeri dan kecemasan anak selama tindakan medis dan keperawatan berlangsung. Perawat dapat meningkatkan kenyamanan anak dengan menggunakan intervensi musik (Ortiz, O'Connor, Carey, Vella, Paul, Rode, & Weinberg, 2019;Bulut, Alemdar, Bulut, & Şalcı, 2020;Ferro, Pegueroles, Lorenzo, Roy, Forner, Jurado, & Alcaraz, 2023;Mohanasundari, Thanigainathan, & Padmaja, 2023). ...
Background: Handling or caring for children who are hospitalized requires special attention, especially the psychological burden of sick children in feeling pain due to injury or illness. The pain experienced by pediatric patients needs to be treated appropriately to help reduce discomfort and divert the focus of the pain they suffer. Music is a unique form of communication that can convey emotions and feelings deeply. This can have emotional and physical benefits, such as improving mood, reducing stress, reducing pain and anxiety levels.Purpose: To present and analyze the results of research on music therapy as a non-pharmacological intervention for pain management in children.Method: The form of a literatur review. database searches are carried out through Scopus, Science Direct, Pub med, and ProQuest and to obtain 10 suitable articles.Results: All literature shows that music therapy is very effective as an application in the treatment and care of pediatric patients in hospitals, especially in relation to pediatric patients who suffer from pain. Music therapy can help nurses provide better care to pediatric patients.Conclusion: Music therapy is a non-pharmacological intervention that is safe and acceptable for pediatric patients, reduces pain levels, improves mood, reduces stress, and helps reduce anxiety in hospitalized patients. However, music therapy is ineffective and has less effect on pediatric patients due to burns and pre-operative injuries in early childhood patients (0-3 years).Suggestion: Music therapy is a good choice for pain management in pediatric patients being treated in hospital, further research is needed to examine the effectiveness of music therapy in pediatric patients due to burns and pre-operative patients in early childhood (0-3 years).Keywords: Music Therapy; Pain; Pediatric Patients Pendahuluan: Penanganan atau perawatan anak-anak yang dirawat di rumah sakit diperlukan adanya perhatian secara khusus terutama beban psikologis anak yang sakit dalam merasakan nyeri akibat cedera atau penyakit. Rasa nyeri yang dialami pasien anak perlu ditangani dengan tepat untuk membantu mengurangi rasa ketidaknyamanan dan pengalihan fokus perasaan sakit yang dideritanya. Musik adalah bentuk komunikasi yang unik yang dapat menyampaikan emosi dan perasaan secara mendalam. Hal ini dapat bermanfaat secara emosional dan fisik, seperti meningkatkan mood, mengurangi stres, menurunkan tingkat nyeri serta kecemasan.Tujuan: Memaparkan dan menganalisis hasil-hasil penelitian tentang terapi musik sebagai intervensi non-farmakologis untuk manajemen nyeri pada anak.Metode: Literature review, penelusuran artikel akademik melalui Online Database. Pencarian melalui Online Database diantaranya Scopus, Science Direct, Pub med, dan ProQuest dari tahun 2018-2023 dan didapatkan 10 artikel yang sesuai.Hasil: Semua literatur menunjukkan bahwa terapi musik sangat efektif sebagai aplkasi dalam penanganan dan perawatan pasien anak di rumah sakit terutama terkait dalam pasien anak yang mengalami penderitaan akibat rasa nyeri. Terapi musik dapat membantu perawat dalam memberikan perawatan yang lebih baik pada pasien anak.Simpulan: Terapi musik adalah intervensi non-farmakologis yang aman dan dapat diterima oleh pasien anak, mengurangi tingkat nyeri, meningkatkan mood, mengurangi stres, dan membantu mengurangi rasa kecemasan pada pasien yang dirawat di rumah sakit. Tetapi terapi musik tidak efektif dan kurang berpengaruh pada pasien anak karena luka bakar dan pra operasi pada pasien anak usia dini (0-3 tahun ).Saran: Terapi musik menjadi pilihan yang baik dalam manajemen nyeri pada pasien anak dalam perawatan di rumah sakit, selebihnya diperlukan adanya penelitian lebih lanjut untuk mengkaji efektivitas terapi musik pada pasien anak akibat luka bakar dan pra operasi pasien anak usia dini (0-3 tahun ).
Sample size calculation is more complex and crucial area of attention in a research process. Appropriate sample size of the study act as a strong foundation for evidence based practice, as small sample size may fail to detect the effect or large sample size may waste the resources. As a researcher we have to ensure that needed sample size is estimated to generate desirable power from the study, so that the findings could be generalized to the population. But it is difficult unless the researcher is aware about the influence of each component of the sample size estimates on sample size. This article briefly reviewed the relationship between the components of the sample size estimates and sample size.
Background
Preoperative anxiety, otherwise managed preoperatively, can cause high rate of cardiac mortality, adverse effects during anesthetic induction and patient recovery which correlate with high postoperative pain, increased analgesic and anesthetic consumption, prolonged hospital stay, poor quality of life decrease satisfaction with perioperative care.
Objective
The systematic review and meta-analysis aimed to provide evidence on global prevalence and determinates of preoperative anxiety among surgical patients.
Methods
A three stage search strategy was conducted on PubMed/Medline, Cochran, Science Direct and LILACS databases. Publication bias was checked with a funnel plot and objective diagnostic test was conducted with Egger's correlation and Begg's regression tests.
Results
The global pooled prevalence of preoperative anxiety among surgical patients was 48% (95% confidence interval (CI): 39 to 47%, 28 studies, 14652 participants. The systematic review and Meta-Analysis revealed that preoperative anxiety was approximately 4 times more likely in patients who had fear of complications, RR = 3.53(95 % confidence interval (CI: 3.06 to 4.07, six studies).
Conclusion
The review revealed that approximately fifty percent of patients experienced preoperative anxiety which entails the policy makers and health care stakeholders should implement mitigating strategies to prevent and manage preoperative anxiety.
Registration
This systematic Review and Meta-Analysis is registered in research. Registry (UIN: researchregistry5619)
Background and aims:
There have been various methods tested for reducing preoperative anxiety in children, but very limited literature is available in the Indian scenario. Our aim was to analyse the effect of an informative video about the anaesthetic technique on preoperative anxiety in children.
Methods:
In all, 94 children were randomly allotted into two groups. Children in the study group were shown a peer modelling video depicting induction of general anaesthesia and recovery during the preanaesthetic check (PAC). Patients in the control group were given only verbal information during PAC. Anxiety was assessed on visual analog scale (VAS) for anxiety at two times. Baseline VAS score was recorded during PAC and preoperative VAS score was assessed prior to induction of anaesthesia. The VAS score was represented as median value. Data were analysed using the Mann-Whitney U-test for ordinal data and skewed quantitative data. Categorical data was analysed by using Chi-square test and t-test was applied for quantitative data. The significance threshold of P value was set at <0.05.
Results:
The median (interquartile range) preoperative VAS score was significantly lower in the study group [1 (0-1.3)] when compared with the control group [5 (3-5)] (P < 0.001). The mean preoperative pulse rate, mean preoperative systolic blood pressure and mean preoperative diastolic blood pressure were significantly lower in the study group when compared with the control group (P < 0.001).
Conclusion:
Multimedia information in the form of a peer modelling video helped reduce preoperative anxiety in children between 7 and 12 years of age.
Menstruation or menstruation is periodic vaginal bleeding due to the release of the uterine endometrium layer . Most women who experience dysmenorrhea overcome by taking painkillers on the market. There are several ways to reduce the pain when someone is experiencing dysmenorrhea is by engineering the pharmacological (drugs) and the technique of non-pharmacological (no drugs) such as distraction (music therapy) that can stimulate an increase in β-endorphin supplied by the body and guided imagery (guided imagery) which serves as a diversion from a painful stimulus thereby reducing the pain response. The research objective was to determine the effect of giving an guided imagery and music therapy on pain intensity changes dysmenorrhea. The research design used was True experimental . The study population was all students who had dysmenorrhea and large sample of 27 female students by using simple random sampling . Data collection using observation sheet then analyzed using Friedman test. The results showed that the significant probability value of 0.002 <0.05 means there is a significant difference between guided imagery , music therapy and control group on dysmenorrhea pain and there is a difference between before and after guided imagery on dysmenorrhea pain (p: 0,014 <0.05). There is a difference between before and after music therapy against dysmenorrhea pain (p: 0.004 <0.05). There is no difference between before and after the control group to the dysmenorrhea pain (p: 0.317> 0.05.) Among the three treatment groups most significantly affected the dysmenorrhea pain is music therapy because of its smallest significance value from the others.Based on the study, it was used as an alternative treatment in accordance with the condition of female students.
Several studies have shown the efficacy of psychological interventions in reducing preoperative anxiety in children undergoing surgery. This study aims to investigate the effectiveness of a specific non-pharmacological technique, the relaxation-guided imagery, in reducing both preoperative anxiety and postoperative pain in a sample of 60 children (6–12 years old) undergoing minor surgery who were randomly assigned to the experimental group (N = 30) or the control group (N = 30). The first group received the relaxation-guided imagery, before the induction of general anesthesia; the second group received standard care. The levels of preoperative anxiety and postoperative pain were assessed using, respectively, the modified Yale Preoperative Anxiety Scale and the Face, Legs, Activity, Cry, and Consolability Scale. The results showed a statistically significant difference between groups, with less anxiety and less pain for children included in the experimental group (p < .001; p < .001).
Conclusion: Results suggest that relaxation-guided imagery reduces preoperative anxiety and postoperative pain in children. Future studies should focus on developing protocols and studying the eventual reduction of administered drugs for anesthesia and pain.
Objectives: (1) To determine the effectiveness of visual imagery technique (VIT) on anxiety and depression in moderate chronic obstructive lung disease, (2) to determine the effectiveness of progressive relaxation technique (PRT) on anxiety and depression in moderate chronic obstructive lung disease (COPD), and (3) to compare the effectiveness of VIT and PRT on anxiety and depression in moderate COPD.Methods: Ethical clearance was obtained from the institutional ethical committee. A total of 45 stable moderate COPD patients were selected by simple random sampling, according to inclusion and exclusion criteria. 22 patients of Group A received VIT and 23 of Group B received PRT with a baseline treatment of conventional physiotherapy in both groups for 60 minutes twice a day for 5 days in the Pulmonology Department, Krishna Hospital, Karad.Result: Statistics was analyzed using paired t-test and unpaired t-test. In pre-intervention, there was no statistically significant difference seen for depression anxiety stress scale (DASS21) (p=D 0.0189, A 0.0002, S <0.0001) (t=D 2.440, A 4.053, S 5.105), hospital anxiety depression scale (HADS) (p=D 0.7677, A 0.5121) (t=D 0.2973, A 0.6610), and 6-min walk test (6MWT) (p=D 0.5948, RPE 0.0658) (t=D 0.5359, RPE 1.888). On comparing, the post-interventional values between the two groups using unpaired t-test proved that there was extremely statistically significant difference seen for DASS21 (p=D 0.0011, A <0.0001, S <0.0001) (t=D 3.504, A 9.220, S 13.508), HADS (p=D <0.0001, A <0.0001) (t=D <0.0001, A <0.0001), and 6MWT (p=distance 0.7041, RPE <0.0001) (t=distance 0.3824, RPE <0.0001).Conclusion: VIT along with conventional physiotherapy was significant both statistically and clinically compared to PRT on anxiety and depression in moderate COPD patients.
Objectives: Pediatric preoperative anxiety (PPOA) has been a concerning matter for the past decades with a high prevalence and several adverse outcomes branching into social, developmental, behavioral and perioperative fields. The management of anxious children is a priority for minimizing PPOA of the upmost importance. The aim of the study was to assess the levels of preoperative anxiety and their relation to a group of selected variables in a pediatric population being submitted to ambulatory surgery under general anesthesia.Methods: Children’s anxiety was assessed using the modified Yale Preoperative Anxiety Scale-Short Version at the preoperative holding area (Time 1) and at the operation room during induction of anesthesia (Time 2). A cutoff value of 30 was used to differentiate anxious children from non-anxious children (scores ≤ 30). Results: 67 children were included in the study. 9 (13.4%) were anxious children at T1 and 24 (35.8%) at T2. A gender difference was not present (p=0.634 for T1, p=0.303 for T2), but the boys presented higher scores at both times and tend to have a significant increase from T1 to T2 (p=0.049). An overall change in the anxiety status from T1 to T2 does not tend to occur (p=0.01). Younger children tend to have higher scores although not statistically significant. No statistical significant difference was found between the remaining variables. Conclusions: The prevalence of anxious children presented is lower than the estimated worldwide and reveals both the result of correct practices and best use of resources. However, the scarcity of national studies exploring this topic renders an indication to implement similar future studies, with larger samples and further studying of the potential predisposing and contributing variables. The never-ending purpose should be to institute more customized programs for minimizing PPOA by means of multimodal combinations of anxiolytic practices.
Up to 5 million children are affected by perioperative anxiety in North America each year. High perioperative anxiety is predictive of numerous adverse emotional and behavioral outcomes in youth. We developed the Children’s Perioperative Multidimensional Anxiety Scale (CPMAS) to address the need for a simple, age-appropriate self-report measure of pediatric perioperative anxiety in busy hospital settings. The CPMAS is a visual analog scale composed of 5 items, each of which is scored from 0–100. The objective of this study was to assess the psychometric properties of the CPMAS in children undergoing surgery. Eighty children aged 7 to 13 years who were undergoing elective surgery at a university-affiliated children’s hospital were recruited. Children self-completed the CPMAS and the Screen for Childhood Anxiety Related Disorders (SCARED-C) at 3 time points: at preoperative assessment (T1), on the day of the operation (T2), and 1 month postoperatively (T3). Internal consistency, test–retest reliability, and the convergent validity of the CPMAS were assessed across all 3 visits. The CPMAS demonstrated good internal consistency (Cronbach’s alpha ≥ .80) and stability (ICC = 0.71) across all 3 visits. CPMAS scores were moderately correlated with total SCARED-C scores (r values = .35 to .54, p values
Objective:
Music interventions are widely used, but have not yet gained a place in guidelines for pediatric surgery or pediatric anesthesia. In this systematic review and meta-analysis we examined the effects of music interventions on pain, anxiety and distress in children undergoing invasive surgery.
Data sources:
We searched 25 electronic databases from their first available date until October 2014.
Study selection:
Included were all randomized controlled trials with a parallel group, crossover or cluster design that included pediatric patients from 1 month to 18 years old undergoing minimally invasive or invasive surgical procedures, and receiving either live music therapy or recorded music.
Data extraction and synthesis:
4846 records were retrieved from the searches, 26 full text reports were evaluated and data was extracted by two independent investigators.
Main outcome measures:
Pain was measured with the Visual Analogue Scale, the Coloured Analogue Scale and the Facial Pain Scale. Anxiety and distress were measured with an emotional index scale (not validated), the Spielberger short State Trait Anxiety Inventory and a Facial Affective Scale.
Results:
Three RCTs were eligible for inclusion encompassing 196 orthopedic, cardiac and day surgery patients (age of 1 day to 18 years) receiving either live music therapy or recorded music. Overall a statistically significant positive effect was demonstrated on postoperative pain (SMD -1.07; 95%CI-2.08; -0.07) and on anxiety and distress (SMD -0.34 95% CI -0.66; -0.01 and SMD -0.50; 95% CI -0.84; - 0.16.
Conclusions and relevance:
This systematic review and meta-analysis indicates that music interventions may have a statistically significant effect in reducing post-operative pain, anxiety and distress in children undergoing a surgical procedure. Evidence from this review and other reviews suggests music therapy may be considered for clinical use.
Postoperative maladaptive behaviors (POMBs) are common following pediatric anesthesia, and preoperative anxiety is associated with POMBs. A family-centered preoperative preparation workshop was instituted with the aim of reducing the incidence of POMB and preoperative anxiety, and the study was constructed to evaluate its effectiveness.
A prospective cohort study was constructed, comparing patients who attended the workshop (workshop group) with patients who did not attend and who were matched for age and type of surgery (comparison group). Preoperative anxiety was measured using the mYPAS score, postoperative emergence agitation (EA) was measured using the PAED score, POMBs were assessed with the Post-Hospital Behavior Questionnaire (PHBQ) on postoperative day 7, and PACU morphine consumption and PACU length of stay were recorded. Statistical analysis was performed employing the X² test, the Fisher's exact test, and the Mann-Whitney test as appropriate. Data were expressed as median [minimum, maximum].
Fifty-six patients from 3 to 18 years of age were recruited. Twenty-seven patients in the workshop group were compared to 26 in the comparison group, after exclusions for missing data. Significant differences were demonstrated between groups for POMBs intensity (PHBQ score 2 [0; 9] vs 5 [0; 10], P = 0.008) and incidence (PHBQ score >6: 3.6% vs 35.7%, P = 0.003), and for mYPAS score (28 [23; 87] vs 37 [23;100], P = 0.015). No difference was found for EA, PACU morphine consumption, or PACU length of stay.
The workshop appears to result in reduced preoperative anxiety and POMBs.
© 2015 John Wiley & Sons Ltd.
Objective: The purpose of the current study was to investigate the effect of music therapy on preoperative anxiety levels in Turkish men undergoing urogenital surgery. Design: The study employed a quasi-experimental design. Patients were selected using randomized controlled sampling. Setting: The study was conducted in a urology clinic in Aziziye Research Hospital, Süleyman Demirel Medical Centre, Atatürk University, Erzurum, a city in the east of Turkey. Subjects: The study was conducted with a total of 64 patients; 32 in the experimental group; 32 in the control group; aged between 18 and 65; and able to speak, read and write Turkish. Intervention: The control group received routine preoperative care while the experimental group listened to their choice of music for 30 minutes in their room while they awaited surgery. Main outcome measures: Pre and post test anxiety was measured using the State Trait Anxiety Inventory (STAI) to assess anxiety before and after listening to the music preferred by the patient. Results: Anxiety score averages between the groups following the music therapy were statistically significant (p<0.001); 33.68 (SD=8.03) for the experimental group and 44.43(SD=10.42) for the control group. Conclusions: These findings support the use of music as an independent nursing intervention to manage preoperative anxiety in patients undergoing urogenital surgery. Listening to self-selected music during the preoperative period can effectively reduce anxiety levels and should be a useful tool for preoperative nursing.
To develop and validate a behavioral coding measure, the Children's Behavior Coding System-PACU (CBCS-P), for children's distress and nondistress behaviors while in the postanesthesia recovery unit.
A multidisciplinary team examined videotapes of children in the PACU and developed a coding scheme that subsequently underwent a refinement process (CBCS-P). To examine the reliability and validity of the coding system, 121 children and their parents were videotaped during their stay in the PACU. Participants were healthy children undergoing elective, outpatient surgery and general anesthesia. The CBCS-P was utilized and objective data from medical charts (analgesic consumption and pain scores) were extracted to establish validity.
Kappa values indicated good-to-excellent (κ's > .65) interrater reliability of the individual codes. The CBCS-P had good criterion validity when compared to children's analgesic consumption and pain scores.
The CBCS-P is a reliable, observational coding method that captures children's distress and nondistress postoperative behaviors. These findings highlight the importance of considering context in both the development and application of observational coding schemes.
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.
Local anesthetic agent is not usually used to reduce pain experienced by children undergoing venepuncture. This study was undertaken to determine comparative efficacy of local anesthetic cream, Indian classical instrumental music and placebo, in reducing pain due to venepuncture in children.
Children aged 5-12 yr requiring venepuncture were enrolled in a prospective randomized clinical trial conducted at a tertiary care center. They were randomly assigned to 3 groups: local anesthetic (LA), music or placebo (control) group. Eutactic mixture of local anesthetic agents (EMLA) and Indian classical instrumental music (raaga-Todi) were used in the first 2 groups, respectively. Pain was assessed independently by parent, patient, investigator and an independent observer at the time of insertion of the cannula (0 min) and at 1- and 5 min after the insertion using a Visual Analog Scale (VAS). Kruskal- Wallis and Mann-Whitney U tests were used to assess the difference amongst the VAS scores.
Fifty subjects were enrolled in each group. Significantly higher VAS scores were noted in control (placebo) group by all the categories of observers (parent, patient, investigator, independent observer) at all time points. The VAS scores obtained in LA group were lowest at all time points. However, the difference between VAS scores in LA group were significantly lower than those in music group only at some time-points and with some categories of observers (parent: 1 min; investigator: 0-, 1-, 5 min and independent observer: 5 min).
Pain experienced during venepuncture can be significantly reduced by using EMLA or Indian classical instrumental music. The difference between VAS scores with LA and music is not always significant. Hence, the choice between EMLA and music could be dictated by logistical factors.
This report presents national estimates of hospital inpatient care in the United States during 2006 and selected trend data. Numbers and rates of discharges, diagnoses, and procedures are shown by age and sex. Average lengths of stay are presented for all discharges and for selected diagnostic categories by age and by sex.
The estimates are based on data collected through the 2006 National Hospital Discharge Survey, an annual national probability sample survey of discharges from nonfederal, general, and short-stay hospitals. In this report, sample data are weighted to produce annual estimates of inpatient care, excluding newborns. Diagnoses and procedures presented are coded using the International Classification of Diseases, Ninth Revision, Clinical Modification.
Trends in the utilization of nonfederal short-stay hospitals show that the age distribution of inpatients has changed dramatically from 1970 through 2006. In 1970, 20 percent of inpatients were aged 65 years and over, with those aged 75 years and over comprising 9 percent of all inpatients. By 2006, 38 percent of inpatients were aged 65 years and over, with those aged 75 years and over comprising 24 percent of all inpatients. During this same time period, the percentage of inpatients under age 15 years declined from 13 to 7 percent, and inpatients aged 15-44 years declined 43 to 31 percent. In 2006, there were an estimated 34.9 million hospital discharges, excluding newborn infants. Fifty-eight percent of all discharges were hospitalized 3 days or fewer. The rate of hospitalizations for coronary atherosclerosis for all age groups, particularly those aged 65 years and over, has declined since 2002. There were 46 million procedures performed on inpatients during 2006. The rate of knee replacement for those aged 65 years old increased 46 percent between 2000-2006, whereas the rate doubled among those aged 45-64 years old during the same time period.
Using a multiply matched, concurrent cohort analysis, with 568 subjects matched from data obtained by our laboratory over the past 7 yr, we examined whether parental presence during induction of anesthesia (PPIA) reduces children's anxiety depending on the interaction between child and parent's baseline anxiety. Children's and parents' baseline anxiety was assessed preoperatively; children's anxiety was again assessed during induction of anesthesia. We found that anxious children who received PPIA from a calm parent were significantly less anxious during induction of anesthesia as compared with anxious children who did not receive PPIA (P = 0.03). In contrast, calm children who received PPIA from an overly anxious parent were significantly more anxious as compared with calm children who were not accompanied by a parent (P = 0.002). We found no effect of PPIA on children's anxiety during induction of anesthesia when calm parents accompanied calm children into the operating room (P = 0.15) or when overly anxious parents accompanied anxious children (P = 0.49). We conclude that the presence of a calm parent does benefit an anxious child during induction of anesthesia and the presence of an overly anxious parent has no benefit.
This report presents national estimates of the use of non-Federal short-stay hospitals in the United States during 2004 and selected trend data. Numbers and rates of discharges, diagnoses, and procedures are shown by age and sex. Average lengths of stay are presented for all discharges and for selected diagnostic categories by age and by sex.
The estimates are based on medical abstract data collected through the 2004 National Hospital Discharge Survey (NHDS). The survey has been conducted annually by the Centers for Disease Control and Prevention's National Center for Health Statistics (NCHS) since 1965. Diagnoses and procedures presented are coded using the International Classification of Diseases, 9th Revision, Clinical Modification, or ICD-9-CM.
Trends in the utilization of non-Federal short-stay hospitals show that the rate of hospitalization of the elderly (those 65 years and over) increased 24 percent from 1970 through 2004 despite a decrease in the 1980s. The rates for the other age groups declined overall. In 2004, those 65 years and over comprised 12 percent of the U.S. population, 38 percent of all hospital discharges, and used 44 percent of all inpatient days of care. In 2004, there were an estimated 34.9 million hospital discharges, excluding newborn infants. The average length of stay was 4.8 days for all inpatients and 5.6 days for the elderly. Almost one-half of hospital stays for heart disease had a first-listed discharge diagnosis of either congestive heart failure (25 percent) or coronary atherosclerosis (24 percent). There were 45 million procedures performed on inpatients during 2004. From 1995 through 2004, for those 65 years and over, the rate of hip replacements increased 38 percent, and the rate of knee replacements increased 70 percent. One-quarter of all procedures performed on females were obstetrical. Almost one-quarter of all procedures performed on males were cardiovascular.
MUSICAL INTERVENTIONS have been used in health care settings to reduce patient pain, anxiety, and stress, although the exact mechanism of these therapies is not well understood.
THIS ARTICLE PROVIDES A SYSTEMATIC review of 42 randomized controlled trials of the effects of music interventions in perioperative settings.
MUSIC INTERVENTION HAD POSITIVE effects on reducing patients' anxiety and pain in approximately half of the reviewed studies.
FURTHER RESEARCH into music therapy is warranted in light of the low cost of implementation and the potential ability of music to reduce perioperative patient distress. AORN J 87 (April 2008) 780–807. © AORN, Inc, 2008.
Background and aims:
Preoperative anxiety is a common problem among children undergoing surgery. The aim of the study was to assess the incidence and identify various predictors of preoperative anxiety in Indian children.
Material and methods:
A prospective, observational study was conducted on 60 children of the American Society of Anesthesiologists Physical status 1/2, aged 2-6 years and scheduled for elective surgery under general anesthesia in a tertiary care teaching hospital. Preoperative parental anxiety was assessed using the State-Trait Anxiety Inventory questionnaire. The children's anxiety was assessed in the preoperative room, at the time of parental separation, and at the induction of anesthesia using modified Yale Preoperative Anxiety Scale (mYPAS) scoring by an anesthesiologist and a psychologist. Sedative premedication was employed prior to parental separation. Logistic regression analysis was carried out to identify the possible predictors of anxiety.
Results:
The incidence of high preoperative anxiety among the studied children was 76% in the preoperative room, 93% during parental separation, and 96% during anesthetic induction. Among the nine possible predictors identified on univariate regression, the presence of siblings was found to be a significant independent predictor on multivariate regression analysis (P = 0.04). The inter-rater agreement was excellent for the assessment of preoperative anxiety using mYPAS by the anesthesiologist and psychologist (weighted Kappa, k = 0.79).
Conclusion:
The incidence of preoperative anxiety in Indian children in the age group of 2-6 years is very high. The preop anxiety escalates progressively at parental separation and induction of anesthesia despite sedative premedication. The presence of siblings is a significant predictor of preoperative anxiety.
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https://authors.elsevier.com/a/1dU%7EqivMu9WwG During COVID-19 pandemic, Italian pediatric oncology departments were obliged to adopt restrictive measures to minimize the risk of in-hospital infections in frail patients and staff members. Access to the wards was significantly reduced and music therapy (MT) activities were suspended. The aim of this study was to compare the level of anxiety and sedation in pediatric patients undergoing invasive procedure before (T1), during(T2) and after(T3) the pandemic, with and without the presence of MT.
From January to September 2020, all children aged 2-15 with oncological and hematological diseases undergoing to invasive procedure were enrolled. During T1 and T3 children received preoperative preparation with MT by a certified music-therapist. In T2 they received music or video by clinical staff. Preoperative anxiety scores were measured with the m- YPAS scale. Interviews with mothers were performed. The average consumption of drugs used was analyzed.
Significant differences in preoperative anxiety levels between scores in T1, T2 (p.value = 0,0000014) and in T2, T3 (p.value = 0,0000031) were observed. No difference between T1-T3 (p.value = 0,96). Higher dosage of midazolam in T2 (1,14 mg 0,189) compared to T1 (0, 71 mg 0,399) and T2 (1,14 mg 0,189) were observed. Mothers also recorded higher scores on anxiety and stress without music therapy.
Introduction:
Preoperative anxiety and postoperative pain are common problems in patients undergoing surgery. The aim of this study is to analyse the effect of using guided imagery prior to surgery in adults and children to reduce preoperative anxiety and acute postoperative pain, compared with conventional preoperative nursing care.
Methods:
A systematic review and meta-analysis were conducted. We searched randomised clinical trials in databases and search engines.
Results:
A total of 1101 records were identified, of which 21 were included in the qualitative synthesis. Two random model meta-analysis were performed with eight trials. Guided imagery preoperatively was shown to be effective in relieving preoperative state anxiety in children (d = -3.71), preoperative trait anxiety in adults (d = -0.64) and postoperative pain in adults (d = -0.24). Postoperative pain in children and preoperative state anxiety in adults was reduced but without significant difference.
Conclusion:
Guided imagery preoperatively is an effective, easy and low-cost intervention.
Objective:
To identify the predictors of pre-operative anxiety in school-going children in India.
Methods:
A prospective observational study was done at a tertiary care teaching hospital. Children aged 7-12 y scheduled for elective surgery and their parents were enrolled. Pre-operative anxiety in children and parents was assessed using STAI-C and STAI-P questionnaires respectively. The child's anxiety in pre-op room, at the time of parental separation and induction of anesthesia were assessed using m-YPAS scale. Possible predictors of anxiety under 'individual', 'social' and 'healthcare' domains were analyzed using logistic regression. The quality of mask induction of anesthesia was assessed using Induction Compliance Checklist.
Results:
Sixty children completed the study successfully. Receiver operating characteristic (ROC) curve indicted mYPAS score ≥ 30 (observed score) to identify children with high anxiety as identified by STAI-C ≥37 (self-reported score). The incidence of high anxiety escalated from pre-operative time (48%) to the time of parental separation (72%) and increased further at anesthetic induction (95%). Parental anxiety (p = 0.03) and socioeconomic background (p = 0.03) were significant predictors of the child's pre-operative anxiety. The presence of >4 people at induction (p = 0.002), but not pre-operative anxiety, was found significantly more in children with poor quality of mask induction.
Conclusions:
The incidence of peri-operative anxiety in Indian children is significant. Parental anxiety and socioeconomic background were found significant predictors of high pre-operative anxiety in our set-up.
Spinal fusion for idiopathic scoliosis is one of the most painful surgeries experienced by adolescents. Music therapy, utilizing music-assisted relaxation with controlled breathing and imagery, is a promising intervention for reducing pain and anxiety for these patients. It can be challenging to teach new coping strategies to post-operative patients who are already in pain. This study evaluated the effects of introducing music-assisted relaxation training to adolescents before surgery. Outcome measures were self-reported pain and anxiety, recorded on 0-10 numeric rating scale, and observed behavioral indicators of pain and relaxation. The training intervention was a 12-minute video about music-assisted relaxation with opportunities to practice before surgery. Forty-four participants between the ages of 10 and 19 were enrolled. Participants were randomly assigned to the experimental group that watched the video at the preoperative visit or to the control group that did not watch the video. All subjects received a music therapy session with a board certified music therapist on post-operative day 2 while out of bed for the first time. Pain and anxiety were significantly reduced from immediately pre-therapy to post-therapy (paired t-test; p).
Background:
Anticipation of an invasive procedure in hospital is likely to provoke feelings of anxiety and stress in patients. An unfamiliar environment, loss of control, perceived or actual physical risk, dependence on strangers and separation from friends and family are all factors that can contribute to the development of such feelings. Recently, there has been considerable interest in the anxiolytic potential of music listening in a variety of clinical settings, yet thus far, little is known about the impact of music listening on the pre-procedural patient population. A systematic review of all literature to date was indicated to improve understanding of outcomes and impact of music listening on pre-procedural anxiety, thus helping nurses decide whether or not to incorporate music listening into practice and to highlight a need, or otherwise, for a related primary research agenda.
Objective:
The objective of this review was to determine the best available evidence on the effectiveness of music listening in reducing adult hospital patients' pre-procedural state anxiety.
Inclusion criteria:
Types of studies This review included randomised controlled trials and quasi-experimental research designs that examined the efficacy of music listening in reducing state anxiety among pre-procedural hospital patients published between January 1985 and February 2006. The search was limited to publications after 1985 to coincide with the increasing interest and use of complementary therapies within health care during the 1980s and 1990s.Types of participants Participants of interest to the review were adult day patients, ambulatory patients and inpatients who were about to undergo any type of clinical procedure.Types of intervention The review focused on studies that investigated pre-procedural music listening employed and prescribed as a potentially therapeutic activity. It excluded any other form of music therapy.Types of outcome measures The primary outcome measures examined were alterations in state anxiety and a variety of physiological variables such as blood pressure and respiration and heart rates.
Search strategy:
A search for published and unpublished literature between January 1985 and February 2006 was conducted using all major electronic databases. A three-step search strategy was devised which consisted of using high-precision MeSH terminology and keywords to ensure that all material relevant to the review was captured.
Critical appraisal:
The methodological quality of included studies was assessed by two reviewers, who appraised each study independently, using the standard Joanna Briggs Institute (JBI) critical appraisal tools.
Data extraction and synthesis:
Data were extracted from the studies that were identified as meeting the criteria for methodological quality using a data-extraction tool developed for the review. Studies were grouped by outcome measure and summarised using tabular and narrative formats.
Results:
The review demonstrated that state anxiety is defined and measured using both psychological and physiological parameters. Music listening had a consistently positive and statistically significant effect on reducing psychological parameters of pre- procedural state anxiety. However, the results from the measurement of various pre- procedural physiological parameters failed to reveal any consistent positive changes in patients who had listened to music. This calls into question the adequacy of the theories in this area which link anxiety and the automated and central nervous systems and the effect that music listening may have on these processes and physiological responses.
Conclusions/implications for practice:
Increasing demands for hospitals to be more efficient mean that patients attending for an operation are generally admitted on the day of surgery. As a result, healthcare professionals have little time to talk to the patient to ascertain his or her wellbeing, to check for any signs of anxiety and ask whether the patient requires further information about the forthcoming procedure. Healthcare professionals should be encouraged to use appropriate interventions to identify and assess anxious patients. There are several instruments available to measure the patient’s level of pre-operative anxiety. This article reviews the Amsterdam Preoperative Anxiety and Information Scale, which is easy for patients to complete and may help to identify which individuals need extra support.
Importance
Many medical procedures aimed at helping children cause them pain and distress, which can have long-lasting negative effects. Music is a form of distraction that may alleviate some of the pain and distress experienced by children while undergoing medical procedures.Objective
To compare music with standard care to manage pain and distress.Design, Setting, and Participants
Randomized clinical trial conducted in a pediatric emergency department with appropriate sequence generation and adequate allocation concealment from January 1, 2009, to March 31, 2010. Individuals assessing the primary outcome were blind to treatment allocation. A total of 42 children aged 3 to 11 years undergoing intravenous placement were included.Interventions
Music (recordings selected by a music therapist via ambient speakers) vs standard care.Main Outcomes and Measures
The primary outcome was behavioral distress assessed blinded using the Observational Scale of Behavioral Distress–Revised. The secondary outcomes included child-reported pain, heart rate, parent and health care provider satisfaction, ease of performing the procedure, and parental anxiety.Results
With or without controlling for potential confounders, we found no significant difference in the change in behavioral distress from before the procedure to immediately after the procedure. When children who had no distress during the procedure were removed from the analysis, there was a significantly less increase in distress for the music group (standard care group = 2.2 vs music group = 1.1, P < .05). Pain scores among children in the standard care group increased by 2 points, while they remained the same in the music group (P = .04); the difference was considered clinically important. The pattern of parent satisfaction with the management of children’s pain was different between groups, although not statistically significant (P = .07). Health care providers reported that it was easier to perform the procedure for children in the music group (76% very easy) vs the standard care group (38% very easy) (P = .03). Health care providers were more satisfied with the intravenous placement in the music group (86% very satisfied) compared with the standard care group (48%) (P = .02).Conclusions and Relevance
Music may have a positive impact on pain and distress for children undergoing intravenous placement. Benefits were also observed for the parents and health care providers.Trial Registration
clinicaltrials.gov Identifier: NCT00761033
Background:
Patients awaiting surgical procedures often experience significant anxiety. Such anxiety may result in negative physiological manifestations, slower wound healing, increased risk of infection, and may complicate the induction of anaesthesia and impede postoperative recovery. To reduce patient anxiety, sedatives and anti-anxiety drugs are regularly administered before surgery. However, these often have negative side effects and may prolong patient recovery. Therefore, increasing attention is being paid to a variety of non-pharmacological interventions for reduction of preoperative anxiety such as music therapy and music medicine interventions. Interventions are categorized as 'music medicine' when passive listening to pre-recorded music is offered by medical personnel. In contrast, music therapy requires the implementation of a music intervention by a trained music therapist, the presence of a therapeutic process, and the use of personally tailored music experiences. A systematic review was needed to gauge the efficacy of both music therapy and music medicine interventions for reduction of preoperative anxiety.
Objectives:
To examine the effects of music interventions with standard care versus standard care alone on preoperative anxiety in surgical patients.
Search methods:
We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2012, Issue 7), MEDLINE (1950 to August 2012), CINAHL (1980 to August 2012), AMED (1985 to April 2011; we no longer had access to AMED after this date), EMBASE (1980 to August 2012), PsycINFO (1967 to August 2012), LILACS (1982 to August 2012), Science Citation Index (1980 to August 2012), the specialist music therapy research database (March 1 2008; database is no longer functional), CAIRSS for Music (to August 2012), Proquest Digital Dissertations (1980 to August 2012), ClinicalTrials.gov (2000 to August 2012), Current Controlled Trials (1998 to August 2012), and the National Research Register (2000 to September 2007). We handsearched music therapy journals and reference lists, and contacted relevant experts to identify unpublished manuscripts. There was no language restriction.
Selection criteria:
We included all randomized and quasi-randomized trials that compared music interventions and standard care with standard care alone for reducing preoperative anxiety in surgical patients.
Data collection and analysis:
Two review authors independently extracted the data and assessed the risk of bias. We contacted authors to obtain missing data where needed. Where possible, results were presented in meta analyses using mean differences and standardized mean differences. Post-test scores were used. In cases of significant baseline differences, we used change scores.
Main results:
We included 26 trials (2051 participants). All studies used listening to pre-recorded music. The results suggested that music listening may have a beneficial effect on preoperative anxiety. Specifically, music listening resulted, on average, in an anxiety reduction that was 5.72 units greater (95% CI -7.27 to -4.17, P < 0.00001) than that in the standard care group as measured by the Stait-Trait Anxiety Inventory (STAI-S), and -0.60 standardized units (95% CI -0.90 to -0.31, P < 0.0001) on other anxiety scales. The results also suggested a small effect on heart rate and diastolic blood pressure, but no support was found for reductions in systolic blood pressure, respiratory rate, and skin temperature. Most trials were assessed to be at high risk of bias because of lack of blinding. Blinding of outcome assessors is often impossible in music therapy and music medicine studies that use subjective outcomes, unless in studies in which the music intervention is compared to another treatment intervention. Because of the high risk of bias, these results need to be interpreted with caution.None of the studies included wound healing, infection rate, time to discharge, or patient satisfaction as outcome variables. One large study found that music listening was more effective than the sedative midazolam in reducing preoperative anxiety and equally effective in reducing physiological responses. No adverse effects were identified.
Authors' conclusions:
This systematic review indicates that music listening may have a beneficial effect on preoperative anxiety. These findings are consistent with the findings of three other Cochrane systematic reviews on the use of music interventions for anxiety reduction in medical patients. Therefore, we conclude that music interventions may provide a viable alternative to sedatives and anti-anxiety drugs for reducing preoperative anxiety.
To design clinical trials, efficiency, ethics, cost effectively, research duration and sample size calculations are the key things to remember. This review highlights the statistical issues to estimate the sample size requirement. It elaborates the theory, methods and steps for the sample size calculation in randomized controlled trials. It also emphasizes that researchers should consider the study design first and then choose appropriate sample size calculation method.
Unlabelled:
EXECUTIVE SUMMARY:
Background:
Anticipation of an invasive procedure in hospital is likely to provoke feelings of anxiety and stress in patients. An unfamiliar environment, loss of control, perceived or actual physical risk, dependence on strangers and separation from friends and family are all factors that can contribute to the development of such feelings. Recently, there has been considerable interest in the anxiolytic potential of music listening in a variety of clinical settings, yet thus far, little is known about the impact of music listening on the pre-procedural patient population. A systematic review of all literature to date was indicated to improve understanding of outcomes and impact of music listening on pre-procedural anxiety, thus helping nurses decide whether or not to incorporate music listening into practice and to highlight a need, or otherwise, for a related primary research agenda.
Objective:
The objective of this review was to determine the best available evidence on the effectiveness of music listening in reducing adult hospital patients' pre-procedural state anxiety.
Inclusion criteria:
Types of studies This review included randomised controlled trials and quasi-experimental research designs that examined the efficacy of music listening in reducing state anxiety among pre-procedural hospital patients published between January 1985 and February 2006. The search was limited to publications after 1985 to coincide with the increasing interest and use of complementary therapies within health care during the 1980s and 1990s. Types of participants Participants of interest to the review were adult day patients, ambulatory patients and inpatients who were about to undergo any type of clinical procedure. Types of intervention The review focused on studies that investigated pre-procedural music listening employed and prescribed as a potentially therapeutic activity. It excluded any other form of music therapy. Types of outcome measures The primary outcome measures examined were alterations in state anxiety and a variety of physiological variables such as blood pressure and respiration and heart rates.
Search strategy:
A search for published and unpublished literature between January 1985 and February 2006 was conducted using all major electronic databases. A three-step search strategy was devised which consisted of using high-precision MeSH terminology and keywords to ensure that all material relevant to the review was captured. CRITICAL APPRAISAL: The methodological quality of included studies was assessed by two reviewers, who appraised each study independently, using the standard Joanna Briggs Institute (JBI) critical appraisal tools.
Data extraction and synthesis:
Data were extracted from the studies that were identified as meeting the criteria for methodological quality using a data-extraction tool developed for the review. Studies were grouped by outcome measure and summarised using tabular and narrative formats.
Results:
The review demonstrated that state anxiety is defined and measured using both psychological and physiological parameters. Music listening had a consistently positive and statistically significant effect on reducing psychological parameters of pre-procedural state anxiety. However, the results from the measurement of various pre-procedural physiological parameters failed to reveal any consistent positive changes in patients who had listened to music. This calls into question the adequacy of the theories in this area which link anxiety and the automated and central nervous systems and the effect that music listening may have on these processes and physiological responses.
Conclusions/implications for practice:
1 In order to reduce anxiety, it is likely that patients will benefit psychologically from having the opportunity to listen to music in the immediate pre-procedural period. 2 Patients do not appear to experience any alteration in physiological status as a result of listening to music. 3 Further research is indicated in order to replicate existing studies, to strengthen the evidence to support such interventions and to establish intervention parameters. 4 Further research is needed analysing the physiological mechanisms by which music listening is believed to reduce state anxiety and the contribution of the automated and other nervous systems to this reduction.
Increasing demands for hospitals to be more efficient mean that patients attending for an operation are generally admitted on the day of surgery. As a result, healthcare professionals have little time to talk to the patient to ascertain his or her wellbeing, to check for any signs of anxiety and ask whether the patient requires further information about the forthcoming procedure. Healthcare professionals should be encouraged to use appropriate interventions to identify and assess anxious patients. There are several instruments available to measure the patient's level of pre-operative anxiety. This article reviews the Amsterdam Preoperative Anxiety and Information Scale, which is easy for patients to complete and may help to identify which individuals need extra support.
Hypnosis, guided imagery, and relaxation have been shown to improve the postoperative course of adult surgical patients. Children have successfully used hypnosis/guided imagery to significantly reduce the pain associated with invasive procedures and to improve selected medical conditions. The purpose of this study was to examine the effect of hypnosis/guided imagery on the postoperative course of pediatric surgical patients. Fifty-two children (matched for sex, age, and diagnosis) were randomly assigned to an experimental or control group. The experimental group was taught guided imagery by the investigator. Practice of the imagery technique included suggestions for a favorable postoperative course. Significantly lower postoperative pain ratings and shorter hospital stays occurred for children in the experimental group. State anxiety was decreased for the guided imagery group and increased postoperatively for the control group. This study demonstrates the positive effects of hypnosis/guided imagery for the pediatric surgical patient.
In this study, music was used as part of a comprehensive preoperative teaching session aimed at informing pediatric patients
about events pertaining to surgery. The purpose of the study was to investigate whether music therapy can transmit adequate
information about the surgical experience to the pediatric patient to help reduce his or her anxiety and fear behaviors during
induction of preoperative medication. Subjects were 75 children ages 3 through 8 who were admitted for elective surgery. The
experimental design incorporated a three-sample method, with the control group receiving only verbal preoperative instruction
the evening before surgery, Experimental 1 group receiving the previously mentioned verbal instruction with added music, and
Experimental 2 group receiving this treatment strategy plus music immediately prior to induction of preoperative medication
on the morning of surgery. The group receiving music therapy just prior to induction of preoperative medication was consistently
rated as indicating less anxiety before and during induction of preoperative medication.
Unlabelled:
We assessed the effectiveness of a behavioral intervention aimed at reducing the anxiety of children undergoing anesthesia and surgery. The intervention consisted of dimmed operating room (OR) lights (200 Lx) and soft background music (Bach's "Air on a G String," 50-60 dB). Only one person, the attending anesthesiologist, interacted with the child during the induction of anesthesia. Children undergoing anesthesia and surgery were randomly assigned either to a low sensory stimulation group (LSSG, n = 33) or to control group (n = 37). By using validated behavioral measures of anxiety (mYPAS) and compliance (ICC), children were evaluated at the preoperative holding area and during the induction of anesthesia. On postoperative Days 1, 2, 3, 7, and 14, the behavioral recovery of the children was assessed by using the Post Hospitalization Behavior Questionnaire. We found that the LSSG was significantly less anxious compared with the control group on entrance to the OR (P = 0.03) and on the introduction of the anesthesia mask (P = 0.003). Also, the compliance during the induction of anesthesia was significantly better in children assigned to the LSSG (P = 0.02). The incidence of postoperative behavioral changes, however, did not differ significantly between the two groups (P = ns). We conclude that children who are exposed to low-level sensory stimuli during the induction of anesthesia and who are exposed to background music exhibit lower levels of anxiety and increased compliance.
Implications:
Children are less anxious and show increased compliance during induction when exposed to a single care-provider in a dimmed, quiet operating room with background music.
• Medical advances have led to a considerable rise in the level of elective surgery undertaken as day-case surgery and with minimal hospital stay. However, amid such advances, preoperative psychological care has remained relatively static.
• A considerable number of patients are very anxious prior to elective surgery and little formal care is undertaken to address this major issue. A review of the literature from 1990 to 2002 was therefore undertaken in order to assess the present level of knowledge and interventions concerning patient anxiety when undergoing modern, intermediate surgical intervention.
• Thirty-four studies embracing data from 3754 patients undergoing both inpatient and day-case procedures were reviewed. Three main themes emerged – causes of anxiety, clinical concerns and measurement, and anxiety management.
• Each theme is discussed alongside details extracted from the relevant studies. Finally, the main issues arising are summarized and future research challenges identified.
Although many hospitals offer a surgical preparation program to children and families, minimal research has been conducted specifically on preparation by child life specialists. The purpose of this double-blind intervention study was to determine if children prepared for day surgery by a child life specialist exhibited less anxiety than those who received routine standard of care. One hundred forty-two children, aged between 5 and 11 years old, undergoing elective otolaryngology surgery completed the study. The "Child Drawing: Hospital" instrument developed by Clatworthy, Simon, and Tiedeman [Clatworthy, S., Simon, K., & Tiedeman, M. E. (1999). Child Drawing: Hospital - An instrument designed to measure the emotional status of hospitalized school-aged children. Journal of Pediatric Nursing, 14, 2-9] was used to determine children's anxiety levels preintervention and postintervention. Eighty children received formal preparation for their surgeries by a child life specialist and 62 received no intervention. The data were analyzed using a repeated-measures model with intervention, age, sex, and level of surgery for main effects. The anxiety score change was significantly better for the patients in the child life intervention group than for those in the nonintervention group, F(1,135) = 4.24, p = .04. The increase in anxiety scores in the nonintervention group suggests that children could benefit from preoperative preparation. Health professionals, including nurses, may impact children's abilities to cope with a surgical process. The information in this study will be useful in deciding whether all children, not just those with a perceived need, should be prepared prior to an elective day surgery.
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