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Patients undergoing surgery often experience stress and anxiety, which can increase complications and hinder recovery. Effective management of these psychological factors is key to improving outcomes. Preoperative anxiety is inversely correlated with the amount of information patients receive, but accessible, personalized support remains limited, especially in preoperative settings. Face-to-face education is often impractical due to resource constraints. Digital health (DH) interventions offer a promising alternative, enhancing patient engagement and empowerment. However, most current tools focus on providing information, overlooking the importance of personalization and psychological support. This study aimed to assess the viability of a DH intervention known as the Adhera CARINAE DH Program. This program is specifically designed to offer evidence-based and personalized stress- and anxiety-management techniques. It achieves this by using a comprehensive digital ecosystem that incorporates wearable devices, mobile apps, and virtual reality technologies. The intervention program also makes use of advanced data-driven techniques to deliver tailored patient education and lifestyle support. A total of 74 patients scheduled for surgery across 4 hospitals in 3 European countries were enrolled in this study from September 2021 to March 2022. Surgeries included cardiopulmonary and coronary artery bypass surgeries, cardiac valve replacements, prostate or bladder cancer surgeries, hip and knee replacements, maxillofacial surgery, and scoliosis procedures. After assessment for eligibility, participants were randomized into 2 groups: the intervention group (n=23) received the Adhera CARINAE DH intervention in addition to standard care, while the control group (n=27) received standard care alone. Psychological metrics such as self-efficacy, self-management, and mental well-being were assessed before and after the intervention, alongside physiological markers of stress. The intervention group demonstrated significant improvements across several psychological outcomes. For example, Visual Analogue Scale Stress at the hospital improved at admission by 5% and at hospital discharge by 11.1% and Visual Analogue Scale Pain at admission improved by 31.2%. In addition, Hospital Anxiety and Depression Scale Anxiety after surgery improved by 15.6%, and Positive and Negative Affect Scale-Negative at hospital admission improved by 17.5%. Overall, patients in the intervention study spent 17.12% less days in the hospital. Besides these individual scores, the intervention group shows more positive relationships among the psychological dimensions of self-efficacy, self-management, and mental well-being, suggesting that the CARINAE solution could have a positive effect and impact on the reduction of stress and negative emotions. Our results provide an important first step toward a deeper understanding of optimizing DH solutions to support patients undergoing surgery and for potential applications in remote patient monitoring and communication. ClinicalTrials.gov NCT05184725; https://clinicaltrials.gov/study/NCT05184725. RR2-10.2196/38536.

Background More than 60% of patients who undergo surgery for colorectal cancer experience anxiety at some point during the perioperative period. In addition to the obvious impact on the experience of the therapeutic process, the presence of anxiety has also been associated with the appearance of complications. Virtual reality could reduce it by simulating the controlled exposure of the patient to the conscious part of the surgical process.Methods Single-center randomized clinical trial (NCT04058600) in which patients who were to undergo surgery for colorectal cancer and who had not previously undergone surgery as adults were exposed, prior to hospital admission, to virtual reality software in which all perioperative phases in which the patient is awake, from admission to discharge, were recreated. The main objective was to determine the presence of pre- and post-exposure anxiety using the validated State-Trait Anxiety Inventory Scale (STAI-S) and Hospital Anxiety and Depression Scale (HADS).ResultsA total of 126 patients were recruited (58 exposed, 68 unexposed). There were no differences between the groups in terms of age, gender, anesthetic risk, type of surgery. or levels of preoperative anxiety or depression. After exposure, all anxiety/depression rating scales decreased significantly.ConclusionsThe use of simulation using virtual reality can reduce perioperative anxiety in patients undergoing surgery for colorectal cancer.

Perioperative anxiety is a major burden to patients undergoing surgeries with general anesthesia. This study investigated whether a virtual operating room tour (VORT) before surgery can be used to ameliorate perioperative anxiety. We employed a randomized parallel-group design with 2 study arms to compare VORT to the standard operation preparation procedure. The study included 84 patients. A validated inventory (state-trait operation anxiety-state) was used to assess perioperative state anxiety before (T1) and after (T2) surgery. In addition, trait operation anxiety was evaluated with an additional validated inventory (state-trait operation anxiety-trait). Moreover, user ratings on the usefulness of VORT were assessed with an evaluation questionnaire. Study arms were compared for perioperative state anxiety with two-tailed independent samples t tests. Subjective ratings were correlated with STOA-Trait values to investigate possible associations between perioperative anxiety with perceived usefulness. There were no significant differences in perioperative state anxiety between VORT and standard operation preparation procedures before and after the surgery. Nonetheless, patients' ratings of VORT overall were positive. The tour was perceived as useful and, therefore, showed acceptance for VR use. These ratings were unrelated to the degree of perioperative anxiety. The subjective benefit of VORT could not be explained by a reduction of perioperative anxiety. Instead, VORT appears to serve the need for information and reduce uncertainty. In addition, VORT is perceived as beneficial regardless of the age of the patients. Considering this effect and the manageable organizational and financial effort toward implementation, the general use of VORT can be recommended. ClinicalTrials.gov NCT04579354; https://clinicaltrials.gov/ct2/show/NCT04579354.

Preoperative anxiety is a common yet often neglected problem for patients undergoing surgery. Virtual reality (VR)-based intervention is a promising alternative with benefits for managing preoperative anxiety. However, the components of VR-based intervention and its effectiveness on preoperative anxiety in patients undergoing elective surgery with anesthesia remain unclear. This study aimed to identify the major components (ie, device, medium, format, and duration) of VR-based interventions and summarize evidence regarding their effectiveness in reducing preoperative anxiety in patients undergoing elective surgery with anesthesia. Allied and Complementary Medicine, Chinese University of Hong Kong Full Text Journals, CINAHL via EBSCOhost, Cochrane Library, Joanna Briggs Institute EBP Database, EMBASE, MEDLINE via OvidSP, PubMed, PsychINFO, Scopus, China Journal Net, and WanFang Data Chinese Dissertations Database were searched from inception to February 2025. Randomized controlled trials (RCTs) of VR-based interventions for patients undergoing elective surgery with anesthesia were included. The Cochrane Collaboration's tool was used for risk of bias assessment. A random effect model was used for pooling the results. A total of 35 RCTs with 3341 patients (female: n=1474, 44.1%) were included in this review, of which 29 RCTs were included for meta-analysis. Compared with usual care, VR-based interventions showed substantial benefits in decreasing preoperative anxiety in patients undergoing elective surgery (standardized mean difference [SMD] 0.65, 95% CI 0.37-0.92; P<.001). Regarding the subgroup analysis, VR-based intervention showed significant but moderate effects on preoperative anxiety in the pediatric population (SMD 0.77, 95% CI 0.32-1.22; P<.001) compared to the adult population (SMD 0.58, 95% CI 0.23-0.93; P=.001). The distraction approach showed more significant effects (SMD 0.73, 95% CI 0.24-1.21; P=.004) on preoperative anxiety than the exposure approach (SMD 0.61, 95% CI 0.27-0.95; P<.001). Patients undergoing elective surgery with anesthesia may benefit from VR as a novel alternative to reduce preoperative anxiety, especially pediatric patients via the distraction approach. However, more rigorous research is needed to confirm VR's effectiveness.

Psychological distress is a common problem associated with cancer. The main objective of the present study was to test the Hospital Anxiety and Depression Scale (HADS) in a sample of Ethiopian cancer patients and to compare the results with those obtained from a sample in Germany. Data were collected from 256 cancer patients who visited the University of Gondar Hospital between January 2019 and June 2019 using the HADS, the European Organization for Research and Treatment of Cancer Quality of Life questionnaire (EORTC QLQ-C30), and the Multidimensional Fatigue Inventory MFI-20. The reliability of the HADS was good, with Cronbach’s α coefficients of 0.86 (anxiety), 0.85 (depression), and 0.91 (total scale). The Ethiopian cancer patients were more anxious (M = 7.9) and more depressed (M = 9.3) than the German patients (M = 6.8 for anxiety and M = 5.5 for depression). Only a weak level of measurement invariance was detected between the Ethiopian and the German sample. In the Ethiopian sample, anxiety and depression were associated with tumor stage (high levels in stage 4) and treatment (high levels for patients not receiving surgery and chemotherapy). Both anxiety and depression were significantly associated with all of the EORTC QLQ-C30 and MFI-20 scales. The HADS proved to be applicable for use with Ethiopian cancer patients. The high level of anxiety and depression present in that group indicates a need for psychosocial care.

To investigate parents’ experiences of being present during anesthesia induction in young infants. Design. A mixed randomized controlled study. Parents of the included infants were randomized to either one parent present during induction or control (not present). In the holding area, parents completed the Amsterdam Preoperative Anxiety and Information Scale (APAIS) before and after the induction. Differences in APAIS between groups as well as before and after scores were analyzed. Postoperatively, available parents were interviewed, and data were analysed using meaning-oriented thematic analysis. Pre-induction anxiety was common in both fathers (51 %) and mothers (73 %) but there was no difference in the full APAIS score between present and absent groups. However, the qualitative data revealed that parents preferred to be present despite different levels of anxiety. Being present was to gain certainty, to be able to protect and to be a resource. Being absent was to be floating in uncertainty, not being allowed to protect or to be a resource. Pre-induction anxiety was common, especially in mothers. If given the choice, most parents would prefer to be present. Parents can be a resource for both the infant and anesthesia team during induction. Setting up routines for parental presence during anesthesia induction is important. The parents’ message to the anesthesia team and to the organization is let the parents of small infants be present during induction.

Perioperative patient anxiety is a pervasive problem that can have far-reaching effects. Among these effects are increased postoperative pain, increased risk for infection, and longer healing times. Many factors affect perioperative patient anxiety, including the need for surgery, perceived loss of control, fear of postoperative pain, and alteration of body image. This systematic review of current literature was undertaken to identify evidence-based interventions for decreasing patient anxiety in perioperative practice. According to the current research literature, perioperative education and music therapy can be used to successfully reduce surgical patients' anxiety.

Preoperative surgical anxiety is an unpleasant and common reaction exhibited by patients who are scheduled for surgical procedures. Beyond emotional effects on the patient, it can also have negative repercussions on the surgery including longer hospital stays and poorer outcomes. Given the widespread impacts of preoperative anxiety, it is critical for surgeons to gain a better understanding of how to identify and reduce surgical anxiety in their patients. This study used the PubMed database to review the current literature to evaluate screening tools and interventions for surgically anxious patients. Psychiatric anxiety surveys are currently the most appropriate form of assessment for surgical anxiety. Patient education is important for preventing and reducing anxiety levels in patients. Both nonpharmacological and pharmacological interventions have been shown to be effective in reducing patient anxiety and treatment should be based on patient preference, resources available, and the surgeon’s experience. •Psychiatric anxiety surveys provide a valid and reliable means to screen for surgical anxiety and are currently the most appropriate form of assessment.•Patient education is important for preventing and reducing anxiety levels and should include information pertaining to patient’s condition, the procedure, outcomes, expectations, as well as patient instructions.•Various treatment options are available, with both nonpharmacological and pharmacological interventions shown to be effective in reducing patient anxiety.•Treatment should be based on patient preference, resources availability, and the surgeon’s experience.

Purpose The sleep disturbance in cancer patients is more prevalent, and it significantly affects these patients’ recovery after the operation. However, the clinical characteristics regarding sleep quality are scarce. This study aimed to evaluate the quality of preoperative sleep quality and its risk factors in different cancer patients requiring elective surgery. Patients and methods Cancer patients who were scheduled for elective surgery were selected. The demographic data, basic preoperative diseases, and factors related to the preoperative hospital environment were also recorded. Self-made questionnaires (such as gender, age, and personal history), and the Anxiety Self-Assessment Scale were used to assess the patient's underlying condition. The modified Pittsburgh Sleep Quality Index (PSQI) was used to evaluate the preoperative sleep status. Results A total of 297 patients completed the investigation. The incidence of preoperative sleep disturbance in cancer patients was 47.8%. Multiple logistic regression showed that patients with PSQI ≥ 7 were associated with females (odds ratios [95% confidence intervals]): 1.815 [1.031–3.193], p  = 0.039), and the ward space was confined (3.127 [1.016–9.625], p  = 0.047), which increased the possibility of sleep disturbance in cancer patients. Meanwhile, increased anxiety levels (1.323 [1.261–1.439], p  < 0.001) significantly increased the likelihood of sleep disorders in cancer patients. Conclusion 47.8% of sleep disturbance in cancer patients before surgery. Female patients, preoperative anxiety, and confined ward environment were independent risk factors of subjective sleep disturbance.

As pediatric ambulatory surgeries are rising and existing methods to reduce perioperative anxiety and pain are lacking in this population, a serious game for health (SGH), CliniPup, was developed to address this unmet need. CliniPup was generated using the SERES framework for serious game development. The goal of the research was to clinically evaluate CliniPup as an adjunct therapy to existing pharmacological interventions aimed at reducing perioperative anxiety and pain in children undergoing ambulatory surgery. CliniPup was evaluated in a prospective randomized controlled pilot trial in 20 children aged 6 to 10 years who underwent elective surgery and their parents. Study participants were randomly assigned to the test (n=12) or control group (n=8). Children in the test group played CliniPup 2 days prior to surgery, and children in the control group received standard of care. On the day of surgery, pediatric anxiety was measured with the modified Yale Preoperative Anxiety Scale and parental anxiety was assessed with the State-Trait Anxiety Inventory. Pediatric postoperative pain was assessed by the Wong-Baker Faces Pain Rating Scale. Child and parent user experience and satisfaction were also evaluated in the test group using structured questionnaires. Despite the small sample, preoperative anxiety scores were significantly lower (P=.01) in children who played CliniPup prior to surgery compared to controls. Parental preoperative anxiety scores were also lower in the test group (P=.10) but did not reach significance. No significant differences were observed in postoperative pain scores between groups (P=.54). The evaluation of user experience and satisfaction revealed that both children and parents were satisfied with CliniPup and would recommend the game to peers. Results of the pilot trial introduce CliniPup as a potentially effective and attractive adjunct therapy to reduce preoperative anxiety in children undergoing ambulatory surgery with a trend toward positive impact on parental preoperative anxiety. These results support the use of the SERES framework to generate an evidence-based SGH that results in positive health outcomes for patients. Based on these preliminary findings, we propose a research agenda to further develop and investigate this tool. ClinicalTrials.gov NCT03874442; https://clinicaltrials.gov/ct2/show/NCT03874442 (Archived by WebCite at http://www.webcitation.org/78KZab8qc).