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Srifuengfung M, Abraham J, Avidan MS, Lenze EJ. Perioperative Anxiety and Depression in Older Adults: Epidemiology and Treatment. Am J Geriatr Psychiatry 2023; 31:996-1008. [PMID: 37482501 PMCID: PMC10592367 DOI: 10.1016/j.jagp.2023.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 06/20/2023] [Accepted: 07/03/2023] [Indexed: 07/25/2023]
Abstract
The intervals before and after major surgery is a high-risk period for older adults; in this setting, anxiety and depression are common and serious problems. We comprehensively reviewed current evidence on perioperative anxiety and depression in older adults, focusing on epidemiology, impact, correlates, medication risks, and treatment. Principles of perioperative mental healthcare are proposed based on the findings. Prevalence estimates of clinically significant anxiety and depression range from 5% to 45% for anxiety and 6% to 52% for depression, depending on surgical populations and measurement tools. Anxiety and depression may increase risk for surgical complications and reduce patient participation during rehabilitation. Medical comorbidities, pain, insomnia, cognitive impairment, and delirium are common co-occurring problems. Concomitant uses of central nervous system acting medications (benzodiazepines, anticholinergics, and opioids) amplify the risks of delirium and falls. Based on these findings, we propose that anxiety and depression care should be part of perioperative management in older adults; components include education, psychological support, opioid-sparing pain management, sleep management, deprescribing central nervous system active medications, and continuation and optimization of existing antidepressants. More research is needed to test and improve these care strategies.
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Affiliation(s)
- Maytinee Srifuengfung
- Department of Psychiatry (MS, EJL), Washington University School of Medicine, St. Louis, MO; Department of Psychiatry (MS), Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
| | - Joanna Abraham
- Department of Anesthesiology (JA, MSA), Washington University School of Medicine, St. Louis, MO; Institute for Informatics (JA), Washington University School of Medicine, St. Louis, MO
| | - Michael S Avidan
- Department of Anesthesiology (JA, MSA), Washington University School of Medicine, St. Louis, MO
| | - Eric J Lenze
- Department of Psychiatry (MS, EJL), Washington University School of Medicine, St. Louis, MO
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Yousif J, Alkhouri F, St Claire K, Potts G. A practical guide to reducing preoperative and intraoperative patient anxiety in dermatologic surgery. Int J Dermatol 2023; 62:1154-1159. [PMID: 37529942 DOI: 10.1111/ijd.16802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 07/05/2023] [Accepted: 07/13/2023] [Indexed: 08/03/2023]
Abstract
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.
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Affiliation(s)
- Jenna Yousif
- Wayne State University School of Medicine, Detroit, MI, USA
| | - Faris Alkhouri
- Oakland University William Beaumont School of Medicine, Auburn Hills, MI, USA
| | - Kayla St Claire
- Department of Dermatology, Wayne State University, Detroit, MI, USA
| | - Geoffrey Potts
- Department of Dermatology, Wayne State University, Detroit, MI, USA
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Hayoun M, Misery L. Pain Management in Dermatology. Dermatology 2023; 239:675-684. [PMID: 37433287 DOI: 10.1159/000531758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 06/23/2023] [Indexed: 07/13/2023] Open
Abstract
BACKGROUND The dermatologist has to deal with many situations where the patient feels pain and must therefore know how to manage it. SUMMARY The aim of this review was to explore the treatments available to manage pain in dermatology in different circumstances, with an emphasis on pharmacological and non-pharmacological interventions specifically studied in dermatology.
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Affiliation(s)
- Mathilde Hayoun
- Department of Dermatology, University Hospital of Brest, Brest, France
| | - Laurent Misery
- Department of Dermatology, University Hospital of Brest, Brest, France
- LIEN, University Brest, Brest, France
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Effectiveness of Hypnosis for the Prevention of Anxiety During Coronary Angiography (HYPCOR study): a prospective randomized study. BMC Complement Med Ther 2022; 22:315. [PMID: 36447198 PMCID: PMC9707301 DOI: 10.1186/s12906-022-03792-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 11/14/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Coronary angiography is the gold standard for the diagnosis of coronary artery disease. This intervention is nevertheless a source of anxiety for the patient both by its discomfort and by the consequences linked to the discovery of potential diseases. OBJECTIVES The aim of this study was to determine the effectiveness of hypnosis in reducing anxiety in patients undergoing coronary angiography. METHODS One hundred sixty-nine patients with planned coronary angiography and no history of coronary angiography were randomized to a hypnosis or control group. Patients in the hypnosis group underwent a hypnosis session with self-hypnosis posthypnotic suggestions, while those in the control group had a conversational interview with the hypnotherapist. The primary endpoint was pre-exam anxiety level assessed by the Spielberger State-Trait Anxiety Inventory (STAI-Y A). RESULTS Performing a hypnosis session did not result in a significant decrease in anxiety before the intervention. Age, high trait anxiety, high state anxiety the day before, and belief that hypnosis works in general were associated with increased anxiety before the procedure. No adverse events were reported after hypnosis. There was no statistically significant difference between the 2 groups for the occurrence of complications of the intervention. CONCLUSION In this study, performing a hypnosis session before coronary angiography did not reduce the state of anxiety measured just before the intervention. In all cases, the hypnotic experience appears to be positive for the patient, encouraging further research efforts. TRIAL REGISTRATION The research protocol has been registered on the ClinicalTrials.gov registry (NCT02818101; 29/06/2016) and with the ANSM (IDRCB 2016-A00205-46; 02/02/2016).
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Hayoun-Vigouroux M, Misery L. Dermatological Conditions Inducing Acute and Chronic Pain. Acta Derm Venereol 2022; 102:adv00742. [DOI: 10.2340/actadv.v102.284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Pain is a common condition in dermatology. The aim of this review is to analyse the characteristics of pain in dermatology. Some skin diseases are conventionally known to cause pain; e.g. ulcers, pyoderma gangrenosum and herpes zoster. Common dermatoses, such as psoriasis or atopic dermatitis, can also cause significant pain. Some conditions are characterized by neuropathic pain and/or pruritus, without visible primary lesions: e.g. the neurocutaneous diseases, including small fibre neuropathies. Patients often fear pain in skin surgery; however, surgical procedures are rather well tolerated and any pain is mainly due to administration of local anaesthetic. Some therapies may also be uncomfortable for the patient, such as photodynamic therapy or aesthetic procedures. Thus, pain in dermatology is common, and its aetiology and characteristics are very varied. Knowledge of the different situations that cause pain will enable dermatologists to propose suitable analgesic solutions.
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Torres-Gomez J, Arnason SC, Hoopes WL, Vandewalle KS. Management of dental anxiety via distraction technique. J Clin Exp Dent 2021; 13:e350-e356. [PMID: 33841733 PMCID: PMC8020318 DOI: 10.4317/jced.57660] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 11/02/2020] [Indexed: 11/17/2022] Open
Abstract
Background The purpose of this study was to evaluate the use of a stress ball as a distraction technique on stress levels of patients undergoing a dental procedure.
Material and Methods A randomized, split-mouth design was conducted using 20 adult subjects requiring scaling and root planing (Sc/RP) in all four quadrants. Each side of the mouth (maxillary/mandibular) received Sc/RP with local anesthetic with or without the use of a stress-ball distraction over two separate sessions. Subjects completed two pre-procedural questionnaires (Spielberger State-Trait Anxiety Inventory, STAI; Modified Dental Anxiety Scale, MDAS) before and after each treatment session. A Galvanic Skin Response (GSR) sensor (Neulog) was used throughout each session to measure skin conductance or sweat.
Results No significant difference in GSR scores was found during treatment with or without the use of the stress ball. Also, no significant differences in the change in STAI or MDAS scores were found with or without the use of a stress ball.
Conclusions The results of this study found that the use of a stress ball as a distraction technique did not result in any significant reduction in stress levels in subjects undergoing scaling and root planing with local anesthesia. Key words:Anxiety, distraction, stress ball.
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Affiliation(s)
- Job Torres-Gomez
- DMD, MS. Capt, USAF, DC. Deputy Program Director. Advanced Education in General Dentistry Residency. Air Force Postgraduate Dental School. Uniformed Services University of the Health Sciences. 2501 Capehart Rd. Offutt, Air Force Base, Bellevue, NE, USA
| | - Stephen C Arnason
- DDS, MS. Maj, USAF, DC. Training Officer. Advanced Education in General Dentistry Residency. Air Force Postgraduate Dental School. Uniformed Services University of the Health Sciences. 1615 Truemper St. Joint Base San Antonio - Lackland, TX, USA
| | - Wyeth L Hoopes
- DDS, MS. Maj, USAF, DC. Training Officer. Advanced Education in General Dentistry Residency. Air Force Postgraduate Dental School. Uniformed Services University of the Health Sciences. 1615 Truemper St. Joint Base San Antonio - Lackland, TX, USA
| | - Kraig S Vandewalle
- DDS, MS. Col (ret), USAF, DC. Director of Dental Research. Advanced Education in General Dentistry Residency. Air Force Postgraduate Dental School. Uniformed Services University of the Health Sciences. 1615 Truemper St. Joint Base San Antonio - Lackland, TX, USA
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A systematic review of effectiveness of interventions applicable to radiotherapy that are administered to improve patient comfort, increase patient compliance, and reduce patient distress or anxiety. Radiography (Lond) 2020; 26:314-324. [PMID: 32245711 DOI: 10.1016/j.radi.2020.03.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 03/04/2020] [Accepted: 03/05/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVES The aim of this review was to search existing literature to identify comfort interventions that can be used to assist an adult patient to undergo complex radiotherapy requiring positional stability for periods greater than 10 min. The objectives of this review were to; 1) identify comfort interventions used for clinical procedures that involve sustained inactivity similar to radiotherapy; 2) define characteristics of comfort interventions for future practice; and 3) determine the effectiveness of identified comfort interventions. The Preferred Reporting Items for Systematic Reviews and meta-analyses statement and the Template-for-Intervention-Description-and Replication guide were used. KEY FINDINGS The literature search was performed using PICO criteria with five databases (AMED, CINAHL EMBASE, MEDLINE, PsycINFO) identifying 5269 titles. After screening, 46 randomised controlled trials met the inclusion criteria. Thirteen interventions were reported and were grouped into four categories: Audio-visual, Psychological, Physical, and Other interventions (education/information and aromatherapy). The majority of aromatherapy, one audio-visual and one educational intervention were judged to be clinically significant for improving patient comfort based on anxiety outcome measures (effect size ≥ 0.4, mean change is greater than the Minimal-Important-Difference and low-risk-of-bias). Medium to large effect sizes were reported in many interventions where differences did not exceed the Minimal-Important-Difference for the measure. These interventions were deemed worthy of further investigation. CONCLUSION Several interventions were identified that may improve comfort during radiotherapy assisting patients to sustain and endure the same position over time. This is crucial for the continual growth of complex radiotherapy requiring a need for comfort to ensure stability for targeted treatment. IMPLICATIONS FOR PRACTICE Further investigation of comfort interventions is warranted, including tailoring interventions to patient choice and determining if multiple interventions can be used concurrently to improve effectiveness.
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Álvarez-García C, Yaban ZŞ. The effects of preoperative guided imagery interventions on preoperative anxiety and postoperative pain: A meta-analysis. Complement Ther Clin Pract 2019; 38:101077. [PMID: 32056813 DOI: 10.1016/j.ctcp.2019.101077] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 11/30/2019] [Accepted: 12/03/2019] [Indexed: 12/14/2022]
Abstract
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.
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Affiliation(s)
- Cristina Álvarez-García
- Department of Nursing, University of Jaén, Campus Las Lagunillas, 23071, Building B3, Office 221, Jaén, Spain.
| | - Züleyha Şimşek Yaban
- Department of Nursing, Faculty of Health Sciences, Kocaeli University, Kocaeli, Turkey
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Yanes AF, Weil A, Furlan KC, Poon E, Alam M. Effect of Stress Ball Use or Hand-holding on Anxiety During Skin Cancer Excision: A Randomized Clinical Trial. JAMA Dermatol 2019; 154:1045-1049. [PMID: 30027283 DOI: 10.1001/jamadermatol.2018.1783] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Importance Patients undergoing skin surgery under local anesthesia can experience anxiety. Adjuvant intraoperative anxiety reduction methods may help. Objectives To assess whether hand-holding or holding a stress ball reduces patient anxiety during excisional surgery of head or neck skin cancer with the patient under local anesthesia and to measure pain and patient satisfaction. Design, Setting, and Participants In this nonblinded, single-center randomized clinical trial, performed from January 24 through April 26, 2017, at a dermatology outpatient service in an urban, academic medical center, a consecutive sample of 135 adults who required excisional removal of nonmelanoma skin cancer of the head or neck was randomized and studied. Interventions Participants were randomized 1:1:1 to 3 groups: hand-holding, stress ball, or control (treatment as usual). Participants in the hand-holding group had a female researcher hold one of their hands during administration of anesthesia and extirpation, and those in the stress ball group held a round compressible ball and squeezed it as desired during the same period. Main Outcomes and Measures The primary outcome was anxiety, measured by a visual analog scale (VAS), 6-item State Trait Anxiety Inventory (STAI), and physiologic measures (blood pressure and heart rate). Secondary outcomes were pain during the procedure and overall participant satisfaction. In addition, participants were asked how many hours they spent researching the procedure before surgery. Results A total of 135 participants, 45 per study arm, were enrolled (mean [SD] age, 65.5 [13.9] years; 84 [62.2%] male; 134 [99.3%] white). There were no withdrawals or dropouts. Anxiety decreased over time in all groups, but no significant differences were found in the 3 anxiety measures across the 3 groups (VAS anxiety score before: control group, 3.11; hand-holding group, 3.04; stress ball group, 3.09 [P > .99]; VAS anxiety score during: control group, 1.89; hand-holding group, 2.31; stress ball group, 2.47 [P = .55]; STAI score: control group, 8.91; hand-holding group, 8.93; stress ball group, 8.76 [P = .96]). The 3 groups also did not significantly differ in postprocedure pain scores (control group, 0.78; hand-holding group, 0.64; stress ball group, 0.67; P = .85). Almost all participants (134 [99.2%]) were very satisfied. Participants who had done research had higher preoperative VAS anxiety scores (researched, 3.84; did not research, 2.62; P = .04). Conclusions and Relevance Hand-holding and squeezing a stress ball do not appear to provide incremental anxiety reduction in patients during excisional skin cancer surgery. It is possible that some subgroups may respond better or that patients may respond better when able to select and tailor their preferred anxiety reduction method. Trial Registration ClinicalTrials.gov identifier: NCT02816996.
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Affiliation(s)
- Arianna F Yanes
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Alexandra Weil
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | | | - Emily Poon
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Murad Alam
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.,Department of Otolaryngology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.,Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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Pharmacologic and Nonpharmacologic Interventions for Perioperative Anxiety in Patients Undergoing Mohs Micrographic Surgery: A Systematic Review. Dermatol Surg 2019; 46:299-304. [PMID: 31453905 DOI: 10.1097/dss.0000000000002062] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
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.
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Noergaard MW, Håkonsen SJ, Bjerrum M, Pedersen PU. The effectiveness of hypnotic analgesia in the management of procedural pain in minimally invasive procedures: A systematic review and meta-analysis. J Clin Nurs 2019; 28:4207-4224. [PMID: 31410922 DOI: 10.1111/jocn.15025] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Revised: 07/18/2019] [Accepted: 08/04/2019] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Patients undergoing minimally invasive procedures under a light conscious sedation perceive pain and anxiety. Hypnosis used together with analgesics has been investigated in numerous studies. AIMS AND METHODS To assess the effectiveness of hypnotic analgesia in management of pain, anxiety, analgesic consumption, procedure length and adverse events in adults undergoing minimally invasive procedures. Clinical controlled trials in which hypnosis was used together with pharmacological analgesia compared to pharmacological analgesia alone during invasive procedures were included. Seven databases were searched. The methodological quality of the studies was assessed by two reviewers using a standardised instrument for critical appraisal from Joanna Briggs Institute, 'Meta-Analysis of statistics assessment and review Instrument'. Meta-analyses using the review manager version 5.3 software were conducted on procedure length and adverse events. Results for pain, anxiety and analgesics were synthesised in narrative summaries. Conduction of the review adheres to the PRISMA checklist. RESULTS Ten studies comprising 1,365 participants were included. A reduction in the consumption of pain medication was found between 21%-86% without aggravating pain intensity and anxiety. In few studies, significant reduction in pain intensity and anxiety was found. Meta-analysis including seven studies revealed a small beneficial effect on reducing procedure length. A meta-analysis on adverse events showed no significant reduction. Statistical heterogeneity was found among the studies included. CONCLUSION For patients undergoing invasive procedures, hypnotic analgesia was effective in reducing consumption of analgesics. Only a slight effect was, however, found on experienced anxiety and pain intensity. It did not prolong the procedure and was safe to provide. RELEVANCE TO CLINICAL PRACTICE Hypnosis is recommended as pain management for adults during invasive procedures. A reduced consumption of pain medication potentially has a major impact on monitoring and observation of patients following the procedure, thus improving patient safety and reducing resource consumption.
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Affiliation(s)
- Marianne Wetendorff Noergaard
- Cardiology Clinic, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Danish Centre of Systematic Review - A JBI Center of Excellence, Aalborg University, Aalborg, Denmark
| | - Sasja Jul Håkonsen
- Danish Centre of Systematic Review - A JBI Center of Excellence, Aalborg University, Aalborg, Denmark.,Centre of Clinical Guidelines, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Merete Bjerrum
- Department of Nursing, Institute of Public Health, Aarhus University, Aarhus, Denmark
| | - Preben U Pedersen
- Danish Centre of Systematic Review - A JBI Center of Excellence, Aalborg University, Aalborg, Denmark.,Centre of Clinical Guidelines, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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Thomson L. The Evolution of Hypnosis in the Profession of Nursing: We've Come a Long Way, Baby, and Still Have a Long Way to Go. AMERICAN JOURNAL OF CLINICAL HYPNOSIS 2019; 61:370-393. [PMID: 31017544 DOI: 10.1080/00029157.2018.1500879] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Registered nurses (RNs) are the largest, most diverse, and most respected of all healthcare professions in the United States, numbering over 3.5 million (Gallup poll, 2017). Nurses have evolved from being the handmaidens of physicians and bedpan handlers to highly trained and educated clinicians who have assumed an important, integral, and indispensable role in the healthcare system. The capabilities of nurses to expand the excellent care they can provide has historically been thwarted by others in the healthcare field, including in the area of hypnosis. This article begins with a historical perspective on the education, training, and ever-expanding profession of nursing. The multiplicity of settings where nurses have the opportunity to incorporate clinical hypnosis into the care of their patients is discussed.
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Affiliation(s)
- Linda Thomson
- Springfield Medical Care Systems, Springfield, Vermont, USA
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Shenefelt PD. Mindfulness-Based Cognitive Hypnotherapy and Skin Disorders. AMERICAN JOURNAL OF CLINICAL HYPNOSIS 2018; 61:34-44. [PMID: 29771216 DOI: 10.1080/00029157.2017.1419457] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Mindfulness-based cognitive hypnotherapy integrates mindfulness, cognitive-behavioral therapy, and hypnotherapy to improve physical, emotional, mental, and/or spiritual aspects of skin disorders. Meditation, including mindfulness meditation, and hypnosis both utilize trance phenomena to help produce focalization and specific improvements in skin disorders through psycho-neuro-endocrine-immunologic mechanisms. Hypnosis, cognitive hypnotherapy, focused meditation, and mindfulness meditation are discussed with respect to improving various skin disorders including acne, acne excoriée, alopecia areata, atopic dermatitis, congenital ichthyosiform erythroderma, dyshidrotic dermatitis, erythema nodosum, erythromelalgia, furuncles, glossodynia, herpes simplex, hyperhidrosis, ichthyosis vulgaris, lichen planus, neurodermatitis, nummular dermatitis, postherpetic neuralgia, prurigo nodularis, pruritus, psoriasis, rosacea, trichotillomania, urticaria, verruca vulgaris, and vitiligo. Their integration into mindfulness-based cognitive hypnotherapy is then discussed and illustrated with improvement in a patient with systemic lupus erythematosus.
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Nørgaard MW, Pedersen PU, Bjerrum M. Understanding how patients use visualization during ablation of atrial fibrillation in reducing their experience of pain, anxiety, consumption of pain medication and procedure length: Integrating quantitative and qualitative results. Appl Nurs Res 2018; 39:229-240. [DOI: 10.1016/j.apnr.2017.11.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Accepted: 11/19/2017] [Indexed: 11/26/2022]
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Kreicher KL, Bordeaux JS. Addressing Practice Gaps in Cutaneous Surgery: Advances in Diagnosis and Treatment. JAMA FACIAL PLAST SU 2017; 19:147-154. [PMID: 27768177 DOI: 10.1001/jamafacial.2016.1269] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Importance Cutaneous surgery is performed by otolaryngologists, plastic surgeons, oculoplastic surgeons, dermatologic surgeons, and some primary care physicians. Practice gaps exist among cutaneous surgeons, as do differences in how different physicians approach preoperative, intraoperative, and postoperative decision-making. Objective To present the newest and best evidence to close common practice gaps in cutaneous surgery. Evidence Review We performed a detailed search of peer-reviewed publications that were identified through a search of PubMed/MEDLINE (January 1, 2000, through June 30, 2016) using the literature search terms "cutaneous surgery," "Mohs micrographic surgery," "plastic surgery," in combination with "safety," "cost," "anesthesia," "anti-coagulation," "bleeding," "pain," "analgesia," "anxiety," or "infection," among others. Bibliographies from these references, as well as meta-analyses, were also reviewed. Findings A total of 73 peer-reviewed studies, including randomized clinical trials, were selected to support the conclusions of the article. Levels of evidence were analyzed for selected studies using recommendations from the American Association of Plastic Surgeons based on guidelines from the Oxford Centre for Evidence-Based Medicine. Large cutaneous surgical resections can be done effectively and safely, taking steps to assure patient comfort under local anesthesia. Medically necessary anticoagulant and antiplatelet medication should be continued during cutaneous surgery. In preparation for surgery, patient anxiety and pain must be addressed. Music and anxiolytics limit anxiety, prevent cardiovascular compromise, and improve patient satisfaction. Cutaneous surgeons and support staff should carefully consider the dose and injection angle of local anesthetic. Postoperative opioids and topical antibiotics might cause harm to patients and should be avoided. Acetaminophen and ibuprofen provide adequate pain control with fewer adverse effects than opioid medications. Conclusions and Relevance Clinicians performing cutaneous surgery should understand the importance of patient safety and comfort, as guided by recent evidence.
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Affiliation(s)
- Kathryn L Kreicher
- University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, Ohio
| | - Jeremy S Bordeaux
- University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, Ohio
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Utility of recorded guided imagery and relaxing music in reducing patient pain and anxiety, and surgeon anxiety, during cutaneous surgical procedures: A single-blinded randomized controlled trial. J Am Acad Dermatol 2016; 75:585-589. [DOI: 10.1016/j.jaad.2016.02.1143] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Revised: 02/03/2016] [Accepted: 02/07/2016] [Indexed: 11/21/2022]
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Darakjy J, Barabasz M, Barabasz A. Effects of Dry Flotation Restricted Environmental Stimulation on Hypnotizability and Pain Control. AMERICAN JOURNAL OF CLINICAL HYPNOSIS 2015; 58:204-14. [PMID: 26264543 DOI: 10.1080/00029157.2014.979275] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The effects of dry flotation restricted environmental stimulation (REST) on hypnotizability and pain control were tested in lighted and unlighted conditions. Participants (N = 30, ages 18-30) were exposed to hypnosis maximizing (plateauing) experiences prior to the experiment. Participants were exposed to 6 hours of lighted REST (N = 10), 6 hours of unlighted REST (N = 10), or 6 hours of normal stimulation (N = 10). The Stanford Hypnotic Susceptibility Scale: Form C (SHSS: C) (Weitzenhoffer & Hilgard, 1962) and standardized ischemic pain tests were administered before and after the conditions and at a 2-week follow-up. Both REST groups shared significantly higher SHSS: C scores and significantly lower pain scores from pre-test to post-test and follow-up. The lighted REST group showed significantly higher SHSS: C scores and significantly lower pain scores than the unlighted REST group at post-test and follow-up. The findings supported Barabasz's (1982) theory of REST responding.
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Göktay F, Altan ZM, Talas A, Akpınar E, Özdemir EÖ, Aytekin S. Anxiety Among Patients Undergoing Nail Surgery and Skin Punch Biopsy: Effects of Age, Gender, Educational Status, and Previous Experience. J Cutan Med Surg 2015; 20:35-9. [PMID: 26040581 DOI: 10.1177/1203475415588645] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Patient anxiety about nail surgery relates mainly to pain associated with needle puncture, anesthetic flow during the procedure, and postoperative care, as well as possible past traumatic experience. OBJECTIVE The aims of this study were to compare anxiety levels among patients undergoing nail surgery and skin punch biopsy and to assess the effects of demographic characteristics on anxiety. METHODS Forty-eight consecutive patients who were referred to a dermatological surgery unit for nail surgery intervention (group 1) and 50 age- and sex-matched patients referred to the same unit for skin punch biopsy (group 2) were enrolled in the study. Patients' anxiety levels were measured using Spielberger's State-Trait Anxiety Inventory. RESULTS There was no significant difference in median anxiety level between group 1 (42.00; interquartile range, 6.50) and group 2 (41.00; interquartile range, 8.25) (P = .517). The demographic factors of patient sex, educational status, and prior surgery showed no significant effects on anxiety levels. CONCLUSION Nail surgery does not seem to cause significantly greater anxiety than skin punch biopsy.
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Affiliation(s)
- Fatih Göktay
- Department of Dermatology, Haydarpaşa Numune Training and Research Hospital, İstanbul, Turkey
| | - Zeynep Müzeyyen Altan
- Department of Dermatology, Haydarpaşa Numune Training and Research Hospital, İstanbul, Turkey
| | - Anıl Talas
- Department of Psychiatry, Haydarpaşa Numune Training and Research Hospital, İstanbul, Turkey
| | - Esma Akpınar
- Department of Psychiatry, Haydarpaşa Numune Training and Research Hospital, İstanbul, Turkey
| | - Ekin Özge Özdemir
- Department of Dermatology, Haydarpaşa Numune Training and Research Hospital, İstanbul, Turkey
| | - Sema Aytekin
- Department of Dermatology, Haydarpaşa Numune Training and Research Hospital, İstanbul, Turkey
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Effectiveness of guided imagery relaxation on levels of pain and depression in patients diagnosed with fibromyalgia. Holist Nurs Pract 2015; 29:13-21. [PMID: 25470476 DOI: 10.1097/hnp.0000000000000062] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
AIM The aim of this study was to evaluate the effects of guided imagery as a nursing intervention for pain management and depression in patients diagnosed with fibromyalgia. BACKGROUND Many studies support the use of guided imagery to improve patient outcomes. Guided imagery has been used for different purposes and it is thought to be an effective intervention for people suffering from nonmalignant pain. DESIGN A 2-group quasi-experimental study was conducted during 8 weeks by the University of Nursing in Almeria (Spain). METHODS Patients diagnosed with fibromyalgia aged 18 to 70 years (n = 60) were randomly assigned to a guided imagery group (n = 30) or a control group (n = 30). The outcomes measures were scores for pain with the McGill Pain Questionnaire long form (MPQ-LF) and the Visual Analogue Scale (VAS) and depression with the Beck Depression Inventory and the VAS for depression. The effects were examined at baseline, postintervention (4th week), and at the end of the study (8th week). RESULTS Treatment efficacy was analyzed by using a t test for paired samples. Temporal changes in the scores were examined by using a 2-way repeated-measures analysis of variance. The treatment group reported statistically significantly lower levels of pain (P < .046) and depression (P < .010) than the control group at the week 4 evaluation. A statistically significant effect on pain as measured by the daily VAS diary was also found in the experimental group. At week 8, no significant differences were found for pain. CONCLUSION Patients diagnosed with fibromyalgia may benefit from this nursing intervention in terms of relieving pain and depression. Guided imagery relaxation therapy could be incorporated as part of fibromyalgia treatment to promote health among people with fibromyalgia. RELEVANCE TO CLINICAL PRACTICE Guided imagery as a nursing intervention can alleviate pain and depression in patients diagnosed with fibromyalgia.
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Hudson B, Ogden J, Whiteley M. Randomized controlled trial to compare the effect of simple distraction interventions on pain and anxiety experienced during conscious surgery. Eur J Pain 2015; 19:1447-55. [DOI: 10.1002/ejp.675] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/07/2015] [Indexed: 12/19/2022]
Affiliation(s)
- B.F. Hudson
- School of Psychology; University of Surrey; Guildford UK
| | - J. Ogden
- School of Psychology; University of Surrey; Guildford UK
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McLaren N, Mackereth P, Hackman E, Holland F. Working out of the 'tool box': an exploratory study with complementary therapists in acute cancer care. Complement Ther Clin Pract 2014; 20:207-12. [PMID: 25486855 DOI: 10.1016/j.ctcp.2013.11.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Accepted: 11/12/2013] [Indexed: 11/18/2022]
Abstract
AIMS The aim of this research was to explore and capture complementary therapists' experiences of and preparation for working with patients in an acute cancer care setting. METHOD Semi structured interviews with therapists (n = 18) in an acute cancer hospital in the North West of England. The interviews were transcribed and analysed using thematic coding. RESULTS Key themes identified included; the need for a 'tool box' of skills that develop beyond those taught in initial training, building confidence when adapting these new skills in practice, helping patients to become empowered, the need to support carers, research evidence and resources issues, and the role of supervision. CONCLUSION This study was limited by being set in a single acute cancer site. Therapists valued having a 'tool box' but needed confidence and support to navigate the challenges of clinical practice.
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