Effect of Stress Ball Use or Hand-holding on Anxiety During Skin Cancer Excision: A Randomized Clinical Trial

Haptic coordination: Squeezing a vibrating stress ball decreases anxiety and arousal

We evaluated the effect of haptic coordination on anxiety and arousal. Participants looked at a stressful or calming image and then repeatedly squeezed a vibrating stress ball for 20 s. Using a pre-post paradigm with a control group, we showed that squeezing the vibrating ball reduced anxiety and arousal, as assessed by the State-Trait Anxiety Inventory and electrodermal activity, respectively. The stability of haptic coordination was manipulated by varying the detuning between the spontaneous squeezing frequency and the intrinsic frequency of ball vibration. Coordination stability affected arousal and stress affected stability. The data were discussed in the light of Kahneman's attentional resource-sharing model.

The Effect of Virtual Reality, Music Therapy, and Stress Ball Application on Pain and Anxiety During Outpatient Gynecological Procedures: A Randomized Controlled Trial

PURPOSE

The aim of this study was to determine the effect of virtual reality, music therapy, and stress ball applications, which are methods of distraction, on pain, anxiety, and patient satisfaction during outpatient gynecological procedures.

DESIGN

This study was a randomized controlled trial with control and intervention groups, pre-test and post-test.

METHODS

The study was conducted with 200 women who underwent gynecological surgical procedures without sedation in a state hospital on the European side of Istanbul between October 2022 and March 2023. There were four groups in the study: Virtual Reality (n = 50), Music Therapy (n = 50), Stress Ball (n = 50), and Control group (n = 50). Data were collected using a Descriptive Information Form, Visual Analog Scale, State-Trait Anxiety Inventory, Life Information Follow-up Form, and Patient Satisfaction Evaluation Form. The scales were completed separately by the investigator before the procedure, 10 minutes after the procedure, and 1 hour after the procedure.

FINDINGS

A statistically significant difference between the intervention groups and control groups of women who underwent a gynecological procedure at the 10th minute after the procedure (P=.000) and at the 1st hour after the procedure (P=.000) was significant. State-Trait Anxiety Inventory of women by groups decreased after the procedure and showed a statistically significant difference (P =.000). Satisfaction scores of the women with the intervention according to the groups also showed a significant difference (P =.000). When the satisfaction scores of the women with the intervention were compared by groups, the satisfaction scores ranged from the highest to the lowest, as virtual reality, music therapy, and stress ball application, respectively.

CONCLUSIONS

Virtual reality, music therapy, and stress ball applications, which are methods of distraction during the outpatient gynecological procedure, were effective in reducing anxiety and pain and increasing patient satisfaction.

The effect of rose oil aromatherapy and hand-holding on pain due to peripheral intravenous catheter insertion

INTRODUCTION

The study aimed to evaluate the effectiveness of rose oil (Rosa Damascene Mill.) aromatherapy and hand-holding in reducing pain associated with peripheral intravenous catheter insertion.

METHODS

A comparative mixed-method design. A total of 126 patients were included in the study. For the study's quantitative data, sociodemographic characteristics of the patients and the Patient Interview Form for the qualitative data of the Numeric Rating Scale were used. In all patients included in the study, PIVC insertion was performed a single time by the same nurse using a standard procedure. Chi-square and Bonferroni tests were used for comparative statistics.

RESULTS

No statistically significant difference between the groups regarding age, gender, marital status, BMI, and education level (p>0.05). Pain scores: it was 2.40±1.78 in the rose oil group, 3.53±1.98 in the hand-holding group, and 4.88±1.56 in the control group. The difference between the groups regarding pain scores is statistically significant (p=0.001).

CONCLUSIONS

The study determined that rose oil aromatherapy and hand-holding interventions reduce pain during PIVC. However, rose oil aromatherapy was more effective on pain than the hand-holding intervention. (Clinical Trial ID: NCT05425849).

Efficacy and Safety of Anxiolytics in Mohs Micrographic Surgery: A Randomized, Double-Blinded, Placebo-Controlled Trial

BACKGROUND

Patient anxiety can complicate surgical outcomes by elevating blood pressure, increasing the need for postoperative pain management, and reducing overall patient satisfaction. Despite the use of anxiolytic medications in outpatient procedures, there is limited comparative evidence on the efficacy and safety of these agents in Mohs micrographic surgery.

OBJECTIVE

To compare the effectiveness and safety of different preprocedural anxiolytic agents in Mohs surgery on perioperative patient anxiety and patient satisfaction.

MATERIALS AND METHODS

A double-blinded, randomized, placebo-controlled trial was conducted of 6 different preprocedural anxiolytic agents (lorazepam, diazepam, alprazolam, gabapentin, pregabalin, and melatonin) in 350 patients undergoing Mohs surgery. Anxiety and vital signs were recorded.

RESULTS

Diazepam demonstrated a statistically significant, sustained reduction in anxiety levels compared with placebo ( p = .03). Gabapentin significantly reduced early anxiety ( p = .02). Alprazolam showed a trend to early anxiety reduction ( p = .08). Lorazepam ( p = .73), pregabalin ( p = .53), and melatonin ( p = .24) failed to reduce patient anxiety compared with placebo at any time point. No anxiolytic significantly impacted any patient vital sign or cognition.

CONCLUSION

Although short-acting benzodiazepines and gamma-aminobutyric acid medications may have transient anxiolytic effects, a single oral dose of 5 mg of diazepam can provide a sustained anxiolytic effect in Mohs surgery, with excellent patient safety.

Effects of using a stress ball on anxiety and depression in patients undergoing hemodialysis: A prospective, balanced, single-blind, crossover study

INTRODUCTION

Use of a stress ball is a known t non-pharmacological method to distract attention and to relieve stress and anxiety. The goal of our study was to evaluate the effect of stress ball use on anxiety and depression in hemodialysis patients.

METHODS

The study utilized a single-blind, balanced crossover design. There were two sequential 4-week intervention periods separated by a 4-day washout period. During one intervention period stress ball use at home was encouraged while the other 4-week "intervention" period served as a control. The order in which the two evaluation periods were applied was randomized for a given patient. Anxiety and depression were assessed using the Hospital Anxiety and Depression Scale before and after each 4-week intervention period.

FINDINGS

A total of 65 patients participated in this study. There were statistically significant reductions in both anxiety (p < 0.001) and depression (p < 0.001) during the stress ball intervention periods vs. no change during the control interventions. A delayed follow-up evaluation showed that the anxiety level of patients remained reduced after 1 month of no longer using a stress ball.

DISCUSSION

The use of a stress ball at home for 4 weeks significantly decreased anxiety and depression levels in our group of hemodialysis patients.

A practical guide to reducing preoperative and intraoperative patient anxiety in dermatologic surgery

BACKGROUND

Dermatologists perform a variety of procedures including excisions, biopsies, and other minor surgical procedures. Patients can experience anxiety in anticipation of their surgeries or may develop anxiety during the procedure. Since most dermatologic procedures occur with the patient awake and alert, the physician can offer comforting methods to alleviate some of that anxiety.

AIMS

We wanted to provide a review of available methods that dermatologists can use to reduce patient anxiety.

MATERIALS & METHODS

In this paper, we review the current literature on methods that can be used in dermatology offices to reduce overall patient anxiety levels.

RESULTS

In the preoperative stage, providers can offer educational content to explain the procedure to their patients. Whether it be through telephone calls, educational videos, or utilization of visual models, educating the patient regarding their procedure may reduce their anxiety. Intraoperatively, there are multiple methods that can be used such as music, guided imagery, coloring books, medications, hypnosis, and distraction techniques.

DISCUSSION & CONCLUSION

There is a variety of approaches that can be easily implemented in the office and can help in reducing the anxiety of the patients to allow for a pleasant patient experience and an overall satisfactory procedure outcome.

Evaluating the effect of using anti-stress balls as a distraction technique in reducing pain during inferior alveolar nerve block injection: a randomized clinical trial

OBJECTIVE

The aim of this study is to evaluate the effect of using anti-stress balls in reducing patients' pain during injection of the inferior alveolar nerve block (IANB).

MATERIALS AND METHODS

In this randomized clinical trial, 32 individuals were divided into two groups. The conventional method of anesthesia injection was performed using IANB conventional injection technique. During the injection, individuals in the anti-stress ball group were asked to use the anti-stress ball as a distraction technique. For the control group, no supersede methods were used for pain control. Finally, both groups were asked to record their pain utilizing the numerical rating scale (NRS). The participants' vital signs were monitored before and after injection. Kolmogorov-Smirnov test, independent T-test, and Fisher's exact chi-square test were performed for statistical analysis (α = 0.05).

RESULTS

Sixteen females and 16 males in the age range of 40 to 20 years old participated in this study. The mean pain score in the anti-stress ball group was significantly lower (p < 0.001). In both sexes, the pain score in the anti-stress ball group was significantly lower (males p < 0.001 and females p = 0.001). In addition, in all age ranges, the pain score in the control group was higher except for the above 35 years old participants (p = 0.078). Moreover, there were no significant differences in individuals' vital signs (p > 0.05).

CONCLUSION AND CLINICAL RELEVANCE

Utilizing an anti-stress ball reduces patients' pain significantly during IANB in both sexes and individuals who are below 35 years without changing vital signs.

CLINICAL REGISTRATION NUMBER

IRCT20220815055704N1.

Using a haptic dynamic clamp to reduce arousal: preference, arousal, and coordination stability are related

We have developed a haptic dynamic clamp dedicated to the regulation of arousal. It takes the form of a vibrating stress ball to be squeezed, called Viball, controlled by Righetti's nonlinear adaptive Hopf oscillator. Participants squeezed an adaptive Viball which adapts its frequency of vibration to the current frequency of human squeezing. The adaptive Viball was compared to three non-adaptive Viballs, parametrized to vibrate at a lower, equal, or higher frequency than the participants' preferred frequency. While squeezing the ball, participants looked at stressful or calming pictures and their electrodermal activity was recorded. Using the preference paradigm, we show that participants preferred to interact with the adaptive Viball rather than with the most slowly vibrating ball that most strongly reduced arousal. The stability of the human-ball coordination was the highest with the adaptive Viball. There was also a positive correlation between the stability of coordination and arousal. The data are discussed in light of the energy-based interpretation of coordination dynamics.

Pain of local anesthetic injection of lidocaine during subsequent stages of Mohs micrographic surgery: A multicenter prospective cohort study

BACKGROUND

Patients awake during staged cutaneous surgery procedures may experience procedure-related pain.

OBJECTIVE

To determine whether the level of pain associated with local anesthetic injections prior to each Mohs stage increases with subsequent Mohs stages.

METHODS

Multicenter longitudinal cohort study. Patients rated pain (visual analog scale: 1-10) after anesthetic injection preceding each Mohs stage.

RESULTS

Two hundred fifty-nine adult patients presenting for Mohs who required multiple Mohs stages at 2 academic medical centers were enrolled; 330 stages were excluded due to complete anesthesia from prior stages, and 511 stages were analyzed. Mean visual analog scale pain ratings were nominally but not significantly different for subsequent stages of Mohs surgery (stage 1: 2.5; stage 2: 2.5; stage 3: 2.7: stage 4:2.8: stage 5: 3.2; P = .770). Between 37% and 44% experienced moderate pain, and 9.5% and 12.5% severe pain, during first as versus subsequent stages (P > .05) LIMITATIONS: Both academic centers were in urban areas. Pain rating is inherently subjective.

CONCLUSIONS

Patients did not report significantly increased anesthetic injection pain level during subsequent stages of Mohs.

The Effect of Using a Stress Ball During Endoscopy on Pain, Anxiety, and Satisfaction: A Randomized Controlled Trial

A stress ball is a simple and effective distraction method during painful procedures. The aim of this study was to evaluate the effect of using a stress ball during endoscopy on patients' pain, anxiety, and satisfaction levels. The randomized controlled study included 60 patients who underwent endoscopy in a training and research hospital in Istanbul. Patients were randomly assigned to the stress ball group or the control group. Patients in the stress ball group ( n = 30) squeezed a stress ball during endoscopy, whereas the control group ( n = 30) received no intervention during endoscopy. Data were collected using a sociodemographic form, a postendoscopy questionnaire, the Visual Analog Scale to assess pain and satisfaction, and the State-Trait Anxiety Inventory. Pain scores did not differ significantly between the groups before ( p = .925) or during ( p = .149) the endoscopy procedure but were significantly lower in the stress ball group after the procedure ( p = .008). Similarly, preprocedure anxiety scores were comparable ( p = .743), whereas postprocedure anxiety scores were significantly lower in the stress ball group ( p < .001). The satisfaction score after endoscopy was higher in the stress ball group, but the difference was not statistically significant ( p = .166). This study suggests that use of a stress ball during endoscopy reduces patients' pain and anxiety levels.

Evidence from Clinical Studies Related to Dermatologic Surgeries for Skin Cancer

Simple Summary

Although significant progress in pharmacotherapy for skin cancer has been made in the past several years, surgical removal of primary skin cancer is still the first choice of treatment unless distant metastases are evident. In the surgical treatment of primary skin tumors, the surgical margin is critical not only for reducing the possibility of tumor recurrence but also for minimizing the cosmetic and functional complications associated with wide local excision. In contrast, dermatologic surgeries including lymph node dissection and skin graft can cause various complications, and these complications are frequently associated with significant morbidity and discomfort. In this review, we summarize the evidence from previous clinical studies regarding the optimal surgical margin for skin cancer and the methods for diminishing the complications associated with dermatologic surgery.

Abstract

Despite the significant progress made in the past several years in pharmacotherapies for skin cancer, such as BRAF/MEK inhibitors, immune checkpoint inhibitors, and Hedgehog pathway inhibitors, surgical removal of primary skin cancer is still the first choice of treatment unless distant metastases are evident. In cases of lymph node metastases with clinically palpable lymphadenopathy, lymph node dissection (LND) is typically performed for most skin cancers. In the surgical treatment of primary skin tumors, the surgical margin is critical not only for reducing the possibility of tumor recurrence but also for minimizing the cosmetic and functional complications associated with wide local excision. In contrast, dermatologic surgery can cause various complications. Although skin graft is frequently used for reconstruction of the surgical defect, extensive graft necrosis may develop if optimal stabilization of the graft is not obtained. LND also sometimes causes complications such as intraoperative or postoperative bleeding and postoperative lymphoceles. Moreover, as in other types of surgery, surgical site infection, intraoperative anxiety, and intraoperative and postoperative pain may also develop. These complications are frequently associated with significant morbidity and discomfort. In this review, we summarize the evidence from previous clinical studies regarding the optimal surgical margin for skin cancer and the methods for diminishing the complications associated with dermatologic surgery.

Environmental Enrichment in Postoperative Pain and Surgical Care: Potential Synergism With the Enhanced Recovery After Surgery Pathway

BACKGROUND

Holistic biopsychosocial care has been underemphasized in perioperative pathway designs. The importance and a cost-effective way of implementing biopsychosocial care to improve postoperative pain and facilitate surgical convalescence are not well established, despite the recent popularization of Enhanced Recovery After Surgery (ERAS) programs.

OBJECTIVE

We have explored the evidence and rationale of environmental enrichment (EE) as a complementary multimodal psychosocial care pathway to reduce postoperative pain, optimize patient recovery and improve existing weaknesses in surgical care.

METHODS

We conducted a database search to identify and grade potential EE techniques for their evidence quality and consistency in the management of acute postoperative pain, perioperative anxiety and the etiologically comparable acute procedural or experimental pain.

FINDINGS AND CONCLUSIONS

The introduction of music, virtual reality, educational information, mobile apps, or elements of nature into the healthcare environment can likely improve patients' experience of surgery. Compared with traditional psychological interventions, EE modalities are voluntary, therapist-sparing and more economically sustainable. We have also discussed practical strategies to integrate EE within the perioperative workflow. Through a combination of sensory, motor, social and cognitive modalities, EE is an easily implementable patient-centered approach to alleviate pain and anxiety in surgical patients, create a more homelike recovery environment and improve quality of life.

Investigating different stress-relief methods using Electroencephalogram (EEG)

Mental stress is a prevalent issue in the modern society and a prominent contributing factor to various physical and psychological diseases. This paper investigates the feasibility of detecting different stress levels using electroencephalography (EEG), and evaluates the effectiveness of various stress-relief methods. EEG data were collected from 25 subjects while they were at rest and under 3 different levels of stress induced by mental arithmetic tasks. Nine features that correlate with stress from existing literature were extracted. Subsequently, discriminative features were selected by Fisher Ratio and used to train a Linear Discriminant Analysis classifier. Results from 10-fold cross-validation yielded averaged intra-subject classification accuracy of 85.6% for stress versus rest, 7l.2% for two levels of stress and rest, and 58.4% for three levels of stress and rest. The results showed high promise of using EEG to detect level of stress, and the features selected showed that Beta brain waves (13-30HZ) and prefrontal relative Gamma power are most discriminative. Five different stress-relief methods were then evaluated, and the method of hugging a pillow was found to be the most effective measure relatively in decreasing the stress level detected using EEG. These results show promise of future research in real-time stress detection and reduction using EEG for stress management and relief.

The effect of a stress ball on stress, vital signs and patient comfort in hemodialysis patients: A randomized controlled trial

OBJECTIVE

In this study, an investigation was made of the effect of the use of a stress ball, a method of distraction-attracting the attention elsewhere - on stress, vital signs andcomfort levels in hemodialysis patients.

METHODS

This randomized, controlled experimental study, between July 2019 and September 2019 was carried out in a dialysis unit in the inner regions of Turkey. The study was conducted with 45 patients (23 experiments, 22 controls) who were receiving hemodialysis treatment. The experimental group were asked to squeeze a stress ball for approximately 10-15 min throughout eight successive dialysis sessions. The data were obtained with an Individual Description Form, the Distress Thermometer and the Hemodialysis Comfort Scale.

RESULTS

At the end of the study, no significant difference was found in the vital signs and comfort levels of the experimental and control groups (p > 0.05). However, while the stress score of the experimental group decreased significantly, the stress score of the control groups increased (p < 0.05).

CONCLUSION

This study shows that although the use of the stress ball did not affect vital signs and comfort in hemodialysis patients, it had a positive effect on stress.

Mohs Micrographic Surgery at Challenging Anatomical Sites

BACKGROUND

Mohs micrographic surgery (MMS) is often the treatment of choice for skin cancer removal as it maximizes normal tissue sparing and can be paired with a reconstructive approach that optimizes function and cosmesis. Many tumors on the eyelid, nose, ear, and genitals are particularly well suited for MMS but can be challenging for the dermatologic surgeon.

OBJECTIVE

To review the complex anatomy, as well as the authors' approach to executing and interpreting Mohs layers, at each of these anatomical sites.

METHODS

A review of the literature on MMS of the eyelid, nose, ear, and genitals was performed using the PubMed database and relevant search terms.

CONCLUSION

These sites present potential pitfalls for tumor resection and reconstruction, but with the proper technique, the dermatologic surgeon can minimize tumor recurrence and MMS complications. Warning signs for potentially difficult tumor resection can signify when an interdisciplinary approach is warranted.

Pharmacologic and Nonpharmacologic Interventions for Perioperative Anxiety in Patients Undergoing Mohs Micrographic Surgery: A Systematic Review

BACKGROUND

Perioperative anxiety is associated with negative patient outcomes in Mohs micrographic surgery (MMS). Both pharmacologic and nonpharmacologic therapies have been used to alleviate perioperative anxiety in MMS.

OBJECTIVE

To systematically evaluate the efficacy of therapies aimed at reducing perioperative anxiety in MMS.

METHODS AND MATERIALS

Eligible articles were identified using PubMed MEDLINE, Cochrane Central Register of Controlled Trials, metaRegister of Controlled Trials, ClinicalTrials.gov, and World Health Organization International Clinical Trials Registry Platform. All available studies investigating interventions to reduce perioperative anxiety during MMS were considered.

RESULTS

Of the 183 abstracts identified and screened, 5 studies met inclusion criteria. Three studies reported a postintervention reduction in patient anxiety (midazolam, educational video, and personalized music). Two studies reporting on similar interventions did not find an effect.

CONCLUSION

There is currently limited evidence to support either pharmacologic or nonpharmacologic therapy for alleviation of perioperative patient anxiety in MMS. Midazolam may provide patients a short-term benefit, though any estimate of the effect is very uncertain. Personalized music may be a promising nonpharmacologic intervention for future research.