Development and psychometric validity of the perioperative anxiety scale-7 (PAS-7)

PAS-7 is Superior to APAIS for Assessing Preoperative Anxiety in the Chinese Population

PURPOSE

The purpose of this study was to analyze the reliability and validity of the Perioperative Anxiety Scale-7 (PAS-7), which was created by Chinese medical professionals, by using the State-Trait Anxiety Scale (STAI-S) as the standard for the diagnosis of preoperative anxiety, and to compare whether there is a difference between the PAS-7 and the Amsterdam Preoperative Anxiety and Information Scale (APAIS) in the diagnosis of preoperative anxiety in the Chinese population.

DESIGN

This study was an observational study.

METHODS

The PAS-7, APAIS, and STAI-S were all completed the day before surgery. The internal consistency test was used to evaluate the scale's reliability, and exploratory factor analysis and confirmatory factor analysis were used to assess the scale's construct validity. Pearson correlation was used to analyze the correlation between PAS-7 and STAI-S, and APAIS. The area under the receiver operating characteristic (ROC) curve was used to compare the diagnostic value of PAS-7 and APAIS.

FINDINGS

The PAS-7 Cronbach's α coefficient was 0.804. The indicators of the overall fitting coefficient were within the acceptable range. PAS-7 scores correlated well with STAI-S and APAIS scores (P < .01). The area under the ROC curve of PAS-7 was 0.808 (0.752-0.856), and the area under the ROC curve of APAIS was 0.674 (0.611-0.733). The difference between areas was 0.133 (0.0612-0.206), P < .001, and the diagnostic value of PAS-7 was higher than that of APAIS.

CONCLUSIONS

The PAS-7 scale has high reliability and validity and can be used to assess preoperative anxiety in patients undergoing elective surgery. PAS-7 is superior to APAIS for assessing preoperative anxiety in the Chinese population.

Randomized, Single-Blind, Comparative Study of Remimazolam Besylate vs Propofol for Facial Plastic Surgery

BACKGROUND

Use of local anesthesia and conscious sedation with a combination of a sedative and anesthetic drug during a surgical procedure is an approach designed to avoid intubation, which produces fewer adverse events compared to general anesthesia. In the present study, a comparison was made between the efficacy and safety of remimazolam besylate and propofol for facial plastic surgery.

OBJECTIVES

The objective was to evaluate the clinical efficacy, comfort, and incidence of adverse events of remimazolam compared with propofol combined with alfentanil in outpatient facial plastic surgery.

METHODS

In this randomized, single-blind, single-center, comparative study, facial plastic surgery patients were randomly divided into remimazolam-alfentanil (n = 50) and propofol-alfentanil (n = 50) groups for sedation and analgesia. The primary endpoint was the incidence of hypoxemia, while secondary endpoints included efficacy and safety evaluations.

RESULTS

There were no significant differences regarding the surgical procedure, sedation and induction times, pain and comfort scores, muscle strength recovery, heart rate, respiratory rate, and blood pressure, but the dosage of alfentanil administered to the remimazolam group (387.5 μg) was lower than that for the propofol group (600 μg). The incidence of hypoxemia (P = .046) and towing of the mandibular (P = .028), as well as wake-up (P = .027) and injection pain (P = .008), were significantly higher in the propofol group than the remimazolam group.

CONCLUSIONS

Remimazolam and propofol had similar efficacies for sedation and analgesia during facial plastic surgery, but especially the incidence of respiratory depression was significantly lower in patients given remimazolam.

LEVEL OF EVIDENCE: 2

Pain Trajectory after Short-Stay Anorectal Surgery: A Prospective Observational Study

The evolution of pain after anorectal surgery has not been well characterized. The main objective of this study is to evaluate patterns in acute postoperative pain in patients undergoing short-stay anorectal surgery. A total of 217 patients were included in the study, which used group-based trajectory modeling to estimate postoperative pain and then examined the relationships between sociodemographic or surgical factors and pain trajectories. Three distinct postoperative pain trajectories were determined: hemorrhoidectomy (OR, 0.15), higher anxiety (OR, 3.26), and a higher preoperative pain behavior score (OR, 3.15). In multivariate analysis, they were associated with an increased likelihood of being on the high pain trajectory. The pain trajectory group was related to postoperative analgesic use (p < 0.001), with the high-low group needing more nonsteroidal analgesics. The study showed that there were three obvious pain trajectories after anorectal surgery, including an unreported low-moderate-low type. More than 60% of patients maintained moderate to severe pain within 7 days after the operation. These postoperative pain trajectories were predominantly defined by surgery factors and patient factors.

Awareness, perception and perpetration of cyberbullying by high school students and undergraduates in Thailand

The modern online society requires everyone, especially children and young people, to learn how to use the Internet. Cyberbullying is one misuse that can be detrimental to the cyberbullied individuals’ mental health and lifestyle, and it often ends up with the victim becoming depressed, fearful of society, and in the worst cases, suicidal ideation. The aim of this study is to investigate the awareness, perception, and perpetration of cyberbullying by high school students and undergraduates to find ways to prevent cyberbullying in the future. For this cross-sectional study, data were collected in 2020 from 14 schools throughout Thailand and 4 universities in Chiang Mai, Thailand, using two-stage sampling. Chi-squared tests were used to compare differences between the groups. Of the 2,683 high school students, girls perceived cyberbullying more than boys (81.6% vs. 75.4%; p <0.001), with those from the later academic years being more aware of cyberbullying (p = 0.033) and more likely to conduct cyberbullying behavior (p = 0.027). Of the 721 undergraduates, women were more aware of cyberbullying than men (92.1% vs. 82.7%; p <0.001). The most common cause of cyberbullying was aiming to tease the target (67.6% of high school students vs. 82.5% of undergraduates). The most commonly cyberbullying victimization was sending mocking or rebuking messages (29.6% of high school students and 39.6% of undergraduates). The most popular solutions for cyberbullying were to avoid leaving a trace on social media and be with friends who accept who you are. Our findings show that most of the cyberbullying perpetrators did not consider that their actions would have serious consequences and only carried out cyberbullying because of wanting to tease their victims. This is useful information for the cyberbullying solution center, teachers, and parents to recognize how to make the students realize the effects of cyberbullying on the victims.

Preoperative Anxiety in Chinese Adult Patients Undergoing Elective Surgeries: A Multicenter Cross-Sectional Study

BACKGROUND

Preoperative anxiety is associated with increased use of anesthetics and poorer postoperative outcomes. However, the prevalence of preoperative anxiety has not been characterized in Chinese patients. In this study, we aimed to estimate the overall prevalence of preoperative anxiety in Chinese adult patients and to explore the sociodemographic and clinical factors associated with preoperative anxiety in China.

METHODS

This study was a multicenter cross-sectional study conducted at 32 tertiary referral centers in China from September 1 to October 31, 2020. Adult patients scheduled for elective surgery were evaluated by the 7-item Perioperative Anxiety Scale (PAS-7) for preoperative anxiety after entrance to the operating zone.

RESULTS

A total of 5191 patients were recruited, and 5018 of them were analyzed. The prevalence of preoperative anxiety measured by PAS-7 was 15.8% (95% CI 14.8 to 16.9%). Multivariable analyses showed female sex, younger age, non-retired, first in a lifetime surgery, surgery of higher risk, and poorer preoperative sleep were associated with higher prevalence of preoperative anxiety.

CONCLUSIONS

Preoperative anxiety was relatively common (prevalence of 15.8%) among adult Chinese patients undergoing elective surgeries. Further studies are needed using suitable assessment tools to better characterize preoperative anxiety, and additional focus should be placed on perioperative education and intervention, especially in primary hospitals.

TRIAL REGISTRATION

This study was registered prospectively at www.chictr.org.cn (ChiCTR1900027639) on November 22, 2019.