Financial-legal navigation reduces financial toxicity of pediatric, adolescent, and young adult cancers.

BACKGROUND: Pediatric, adolescent, and young adult patients with cancer and their caregivers are at high risk of financial toxicity, and few evidence-based oncology financial and legal navigation programs exist to address it. We tested the feasibility, acceptability, and preliminary effectiveness of Financial and Insurance Navigation Assistance, a novel interdisciplinary financial and legal navigation intervention for pediatric, adolescent and young adult patients and their caregivers. METHODS: We used a single-arm feasibility and acceptability trial design in a pediatric hematology and oncology clinic and collected preintervention and postintervention surveys to assess changes in financial toxicity (3 domains: psychological response/Comprehensive Score for Financial Toxicity [COST], material conditions, and coping behaviors); health-related quality of life (Patient-Reported Outcomes Measurement Information System Physical and Mental Health, Anxiety, Depression, and Parent Proxy scales); and perceived feasibility, acceptability, and appropriateness. RESULTS: In total, 45 participants received financial navigation, 6 received legal navigation, and 10 received both. Among 15 adult patients, significant improvements in FACIT-COST (P = .041) and physical health (P = .036) were noted. Among 46 caregivers, significant improvements were noted for FACIT-COST (P < .001), the total financial toxicity score (P = .001), and the parent proxy global health score (P = .0037). We were able to secure roughly $335 323 in financial benefits for 48 participants. The intervention was rated highly for feasibility, acceptability, and appropriateness. CONCLUSIONS: Integrating financial and legal navigation through Financial and Insurance Navigation Assistance was feasible and acceptable and underscores the benefit of a multidisciplinary approach to addressing financial toxicity. CLINICALTRIALS.GOV REGISTRATION: NCT05876325.

Health economic evaluations of preventative care for perinatal anxiety and associated disorders: a rapid review.

OBJECTIVES: Perinatal mental health problems affect one in five women and cost the UK £8.1 billion for every year of births, with 72% of this cost due to the long-term impact on the child. We conducted a rapid review of health economic evaluations of preventative care for perinatal anxiety and associated disorders. DESIGN: This study adopted a rapid review approach, using principles of the standard systematic review process to generate quality evidence. This methodology features a systematic database search, Preferred Reporting Items for Systematic Reviews and Meta-Analyses diagram, screening of evidence, data extraction, critical appraisal and narrative synthesis. DATA SOURCES: PubMed, Cumulative Index to Nursing and Allied Health Literature, Cochrane Library, Applied Social Sciences Index and Abstracts, PsycINFO and MEDLINE. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Studies that evaluated the costs and cost-effectiveness of preventative care for perinatal anxiety and associated disorders carried out within the National Health Service and similar healthcare systems. DATA EXTRACTION AND SYNTHESIS: A minimum of two independent reviewers used standardised methods to search, screen, critically appraise and synthesise included studies. RESULTS: The results indicate a lack of economic evaluation specifically for perinatal anxiety, with most studies focusing on postnatal depression (PND). Interventions to prevent postnatal mental health problems are cost-effective. Modelling studies have also been conducted, which suggest that treating PND with counselling would be cost-effective. CONCLUSION: The costs of not intervening in maternal mental health outweigh the costs of preventative interventions. Preventative measures such as screening and counselling for maternal mental health are shown to be cost-effective interventions to improve outcomes for women and children. PROSPERO REGISTRATION NUMBER: CRD42022347859.

Benefits of cardiac coherence combined with medical hypnosis on preoperative anxiety before cancer surgery: the COHEC II study trial protocol.

INTRODUCTION: Preoperative anxiety is a frequent problem that can lead to complications both during anaesthesia and in the postoperative period, especially in oncology. Studies have shown that it can be managed using non-pharmacological approaches, but few works have evaluated psychoeducational programmes. The aim of the COHErence Cardiaque (COHEC) II Study is to evaluate the combination of medical hypnosis (MH) and cardiac coherence (CC) training to manage preoperative anxiety in patients with cancer. METHODS AND ANALYSIS: COHEC II is an ongoing multicentre randomised clinical trial carried out in three French comprehensive cancer centres. In total, 296 patients who will undergo surgery for cancer will be recruited during 18 months and will be randomised in the control arm or the intervention arm. Patients in the intervention arm will follow a daily programme that combines MH and CC, starting 7 days before surgery. The control arm will receive the standard treatment to manage preoperative anxiety. The primary endpoint is the anxiety level on surgery day, measured using a Visual Analogue Scale. Secondary endpoints are patient adherence to the programme, satisfaction and postsurgery recovery quality. ETHICS AND DISSEMINATION: The study protocol was approved by the French Ethics Committee (Comité de Protection des Personnes EST-II) on 24 November 2021 and will be carried out following the good practice guidelines and the Declaration of Helsinki. Results will be published in peer-reviewed journals and presented at conferences. TRIAL REGISTRATION NUMBER: NCT05197972.

Minimising Young Children's Anxiety through Schools (MY-CATS): statistical analysis plan for a cluster randomised controlled trial to evaluate the effectiveness and cost-effectiveness of an online parent-led intervention compared with usual school practice for young children identified as at risk for anxiety disorders.

BACKGROUND: The Minimising Young Children's Anxiety through Schools (MY-CATS) trial is being conducted to determine whether an online evidence-based parent-guided cognitive behavioural therapy intervention in addition to usual school practice is effective and cost-effective compared with usual school practice in reducing anxiety disorders in children aged 4-7 deemed 'at risk' of anxiety disorders. This update article describes the detailed statistical analysis plan for the MY-CATS trial and reports a review of the underpinning sample size assumptions. METHODS AND DESIGN: The MY-CATS study is a two-arm, definitive superiority pragmatic parallel group cluster randomised controlled trial in which schools will be randomised 1:1 to receive either the intervention (in addition to usual school practice) or the usual school practice only. This update to the (published) protocol provides a detailed description of the study methods, the statistical principles, the trial population and the planned statistical analyses, including additional analyses comprising instrumental variable regression and mediation analysis. TRIAL REGISTRATION: ISRCTN82398107 . Prospectively registered on 14 January 2021.

Effects of personalized depression prevention on anxiety through 18-month follow-up: A randomized controlled trial.

Depression and anxiety frequently co-occur and share several risk factors. There is some evidence for transdiagnostic effects of prevention programs on depression and anxiety. In the Personalized Depression Prevention (PDP) study, youth (n = 98, Mage = 13.94 years, SD = 1.67) were classified as high or low on cognitive and interpersonal risk factors and randomized to either a cognitive-behavioral or an interpersonal prevention program. Some participants received a match between risk and prevention, others received a mismatch. Our initial work found evidence for the benefits of personalization on depression outcomes. In this paper, we focus on secondary anxiety outcomes through 18-months post-intervention. We found evidence for the benefits of personalized prevention on anxiety symptoms during the 18-month follow-up period, but not during the intervention. From post-intervention to 18-month follow-up matched youth showed a decrease in anxiety symptoms whereas mismatched youth showed a significant increase in symptoms (d = 0.87, p = .001). The rates of anxiety disorders were equivalent across the groups (p = 1.00). Given the comorbidity of depression and anxiety, interventions that have effects on both may be an efficient and cost-effective approach to reducing the burden associated with these conditions. A risk-informed personalization approach to prevention may be one way to enhance the transdiagnostic effects of depression prevention.

Assessment of anxiety levels in children aged 4-9 years about the pediatric dentists donning a personal protective equipment during treatment in the COVID-19 pandemic.

Background: Managing anxiety in children during the pandemic will be a concern for many pediatric dentists. Aim: The aim of this study was to assess the anxiety levels in children aged between 4 and 9 years about the pediatric dentists donning a personal protective equipment (PPE) for dental treatment during the COVID-19 pandemic era in Bengaluru. Methods: The study was done in two parts with a sample size of 100 each. The first part was a questionnaire-based survey addressed to the pediatric dentists practicing in Bengaluru. The second part of the study was clinical assessment of dental anxiety at three time intervals (T1, T2, and T3) using the animated emoji scale. Results: The study revealed that 87% use preprocedural behavior management post-COVID. Majority of the dentists donned the PPE before conditioning the child (59%) and 41% wore the PPE after conditioning the child. The mean anxiety level in the study children showed an increase in anxiety level at T2 of 3.58 (P < 0.001 ± 1.32) in children aged 4-6 years when compared to T1 and T3 of 3.27 (P < 0.001 ± 1.64) and 3.07 (P < 0.001 ± 1.32), respectively. Conclusion: Children aged between 4 and 6 years showed increased levels of anxiety compared to the 7-9-year age group to the pediatric dentists donning a PPE during treatment in the COVID-19 pandemic. Pediatric dentists also showed a satisfactory knowledge regarding disinfection and fumigation procedures.

Minimising young children's anxiety through schools (MY-CATS): protocol for a cluster randomised controlled trial to evaluate the effectiveness and cost-effectiveness of an online parent-led intervention compared with usual school practice for young children identified as at risk for anxiety disorders.

BACKGROUND: Identifying and supporting young children who are at risk of developing anxiety disorders would benefit children, families, and wider society. Elevated anxiety symptoms, inhibited temperament, and high parental anxiety are established risk factors for later anxiety disorders, but it remains unclear who is most likely to benefit from prevention and early intervention programmes. Delivering an online intervention through schools to parents of young children who have one or more of these risks could maximise reach. The primary aim of this trial is to evaluate the effectiveness and cost-effectiveness of delivering an online parent-led intervention, compared with usual school provision only, for children (aged 4-7) identified as at risk for anxiety disorders on the basis of at least one risk factor. We also aim to identify the characteristics of children who do and do not benefit from intervention and mechanisms of change from the intervention. METHODS: The design will be a parallel group, superiority cluster randomised controlled trial, with schools (clusters) randomised to intervention or usual school practice arms in a 1:1 ratio stratified according to level of deprivation within the school. The study will recruit and randomise at least 60 primary/infant schools in England, and on the basis of recruiting 60 schools, we will recruit 1080 trial participants (540 per arm). Parents of all children (aged 4-7) in sampled Reception, Year 1, and Year 2 classes will be invited to complete screening questionnaires. Children who screen positive on the basis of anxiety symptoms, and/or behavioural inhibition, and/or parent anxiety symptoms will be eligible for the trial. Parents/carers of children in schools allocated to the intervention arm will be offered a brief online intervention; schools in both arms will continue to provide any usual support for children and parents throughout the trial. Assessments will be completed at screening, baseline (before randomisation), 6 weeks, 12 weeks, and 12 months post-randomisation. The primary outcome will be the absence/presence of an anxiety disorder diagnosis at 12 months. DISCUSSION: The trial will determine if delivering an online intervention for parents of young children at risk of anxiety disorders identified through screening in schools is effective and cost-effective. TRIAL REGISTRATION: ISRCTN 82398107 . Prospectively registered on Jan. 14, 2021.

The Effects of Acupressure on Improving Health and Reducing Cost for Patients Undergoing Thoracoscopic Surgery.

OBJECTIVES: This study aimed to assess the effectiveness of practicing acupressure on the Shenmen and Neiguan acupoints with a view to reduce anxiety and improve the comfort and physical health of patients undergoing thoracoscopic surgery. METHODS: A total of 100 hospitalized patients undergoing thoracoscopic surgery were assigned randomly into the experimental (n = 49) and control groups (n = 51). Subjects in the experimental group received routine care plus acupressure on the Shenmen and Neiguan acupoints, while those in the control group received regular routine care. The data were collected using demographic information, physical and surgical data, the Visual Analog Scale (VAS)-A, the State-Trait Anxiety Inventory Y Form (STAI-Y1), and Shortened General Comfort Questionnaire scores. The linear mixed model was used to examine the influences of acupressure on VAS-A and STAI-Y1 scores at different time points before and after the surgery to observe group-by-time interactions. RESULTS: The mean age of the subjects was 60.97 years. All subjects had mild-to-moderate anxiety after surgery and showed a statistically significant decline in regression coefficients on the first and second days after the intervention (ß = -11.61, p = 0.002; ß = -18.71, p < 0.001). Similarly, for STAI-YI scores, the data showed a significant difference in the pre-test and post-test interactions between the two groups (ß = 4.72, p = 0.031). Conversely, acupressure did not have a statistically significant difference on comfort (F = 2.953, p = 0.057). Compared with the control subjects, the experimental subjects used less morphine and developed side effects less frequently (p < 0.01). They were also able to get out of bed after surgery 163.79 min earlier (p < 0.05). CONCLUSIONS: Acupressure is a simple and easy-to-practice treatment. Acupressure on the Shenmen and Neiguan acupoints reduces anxiety and improves recovery in patients after undergoing thoracoscopic surgery.

Prática de lazer em adolescentes e fatores associados: implicações para o cuidado / Práctica de actividades recreativas en adolescentes y factores asociados: consecuencias para el cuidado / Leisure practice in adolescents and associated factors: implications for care

Resumo Objetivo Relacionar a realização de práticas de atividades de lazer com qualidade de vida, bem-estar subjetivo, ansiedade e depressão em adolescentes. Métodos Estudo quantitativo, transversal analítico, desenvolvido com 272 adolescentes do ensino médio de três escolas públicas estaduais de uma capital da região centro-oeste. A coleta de dados ocorreu no mês de maio de 2019, mediante autoaplicação de quatro instrumentos: escala de bem-estar subjetivo, escala hospitalar de ansiedade e depressão, questionário de qualidade de vida kidscren-52 e questionário sociodemográfico. A associação entre as variáveis independentes foi verificada por meio do teste t-student e qui-quadrado de fischer. Resultados Quase a metade dos adolescentes (49,6%) realizava alguma atividade de lazer, e nestes foi verificado escores mais baixo para depressão (p=0,008), mais alto nos afetos positivos do bem-estar subjetivo (p=<0,001), e para algumas dimensões da qualidade de vida, tais como saúde e atividade física (p=<0,001), sentimentos (p=0,0046), estado emocional (p=0,033), autonomia e tempo livre (p=0,007), aspecto financeiro (p=0,001) e amigos e apoio social (p=0,002). Não houve associação significante entre a prática de atividade de lazer com os escores de ansiedade, afetos negativos e satisfação com a vida. Conclusão A prática de atividades de lazer por adolescentes é baixa e associa-se a menores escores para depressão e escores mais altos para algumas dimensões da qualidade de vida e bem-estar subjetivo.

Resumen Objetivo Relacionar la práctica de actividades recreativas con calidad de vida, bienestar subjetivo, ansiedad y depresión en adolescentes. Métodos Estudio cuantitativo, transversal analítico, llevado a cabo con 272 adolescentes de tres escuelas secundarias públicas regionales de una capital de la región centro-oeste. La recopilación de datos se realizó en el mes de mayo de 2019, mediante la autoaplicación de cuatro instrumentos: escala de bienestar subjetivo, escala hospitalaria de ansiedad y depresión, cuestionario de calidad de vida KIDSCREEN-52 y cuestionario sociodemográfico. La asociación entre las variables independientes se verificó a través del test-T student y ji cuadrado de Fischer. Resultados Casi la mitad de los adolescentes (49,6 %) realizaba alguna actividad recreativa, en los que se verificó puntuación más baja de depresión (p=0,008), más alta en los afectos positivos de bienestar social subjetivo (p=<0,001), y en algunas dimensiones de calidad de vida, tales como salud y actividad física (p=<0,001), sentimientos (p=0,0046), estado emocional (p=0,033), autonomía y tiempo libre (p=0,007), aspecto financiero (p=0,001) y amigos y apoyo social (p=0,002). No hubo relación significativa entre la práctica de actividades recreativas y la puntuación de ansiedad, afectos negativos y satisfacción con la vida. Conclusión La práctica de actividades recreativas de adolescentes es baja y se relaciona con una menor puntuación de depresión y una mayor puntuación en algunas dimensiones de la calidad de vida y el bienestar subjetivo.

Abstract Objective To relate the performance of leisure activity practices with quality of life, subjective well-being, anxiety, and depression in adolescents. Methods This is a quantitative, cross-sectional, analytical study, developed with 272 high school adolescents from three public schools in a center-western capital. Data collection occurred in May 2019 through self-application of four instruments: subjective well-being scale, hospital anxiety and depression scale, kidscren-52 quality of life questionnaire and sociodemographic questionnaire. The association among the independent variables was verified by Student's t-test and Fischer's chi-square test. Results Almost half of adolescents (49.6%) performed some leisure activity and it was verified lower scores for depression (p=0.008), higher in the positive affects of subjective well-being (p=<0.001), and for some dimensions of quality of life, such as health and physical activity (p=<0.001), feelings (p=0.0046), emotional status (p=0.033), autonomy and free time (p=0.007), financial aspect (p=0.001) and friends and social support (p=0.002). There was no significant association between leisure activity and anxiety scores, negative affects and life satisfaction. Conclusion The practice of leisure activities by adolescents is low and is associated with lower scores for depression and higher scores for some dimensions of quality of life and subjective well-being.

Effects of a group-based lifestyle medicine for depression: A pilot randomized controlled trial.

Given the growing evidence that a range of lifestyle factors are involved in the etiology of depression, a 'lifestyle medicine' approach can be potentially safe and cost-effective to prevent or treat depression. To examine the effects and acceptability of a group-based, integrative lifestyle medicine intervention as a standalone treatment for managing depressive symptoms, a pilot randomized controlled trial (RCT) was conducted in a Chinese adult population in 2018. Participants (n = 31) with PHQ-9 score above the cut-off of ≥ 10, which was indicative of moderate to severe depression, were recruited from the general community in Hong Kong and randomly assigned to lifestyle medicine group (LM group) or care-as-usual group (CAU group) in a ratio of 1:1. Participants in the LM group received 2-hour group sessions once per week for six consecutive weeks, which covered diet, exercise, mindfulness, psychoeducation, and sleep management. Linear mixed-effects model analyses showed that the LM group had a significant reduction in PHQ-9 scores compared to the CAU group at immediate posttreatment and 12-week posttreatment follow-up (d = 0.69 and 0.73, respectively). Moreover, there were significantly greater improvements in anxiety, stress, and insomnia symptoms (measured by DASS-21 and ISI) at all time points in the LM group (d = 0.42-1.16). The results suggests that our 6-week group-based, integrative lifestyle intervention program is effective in lowering depressive, anxiety, stress, and insomnia symptoms in the Chinese population. Further studies in clinical populations with a larger sample size and longer follow-up are warranted.

Stress management interventions among socioeconomically disadvantaged parents: A meta-analysis and moderation analysis.

BACKGROUND: Socioeconomically disadvantaged parents experience high levels of stress, anxiety, and depression. Many interventions have been tested to reduce parental stress, but no meta-analysis has been conducted to quantitatively summarize the effects and explore the moderators of intervention effects among socioeconomically disadvantaged parents. OBJECTIVE: This meta-analysis aimed to (1) quantitatively examine the intervention effects of prior stress management interventions among socioeconomically disadvantaged parents on reducing stress, depression, and anxiety; and (2) explore the potential moderators of intervention effects. METHODS: Six databases, including CINAHL, PubMed, PsycINFO, Sociological Abstracts, Web of Science, and Cochrane, were searched in February 2021. After a two-step literature screening by two independent reviewers, 45 eligible articles were retained. Two evaluators independently assessed each eligible study's quality using the Evidence Project risk of bias tool. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement guided the report. Meta-analyses (random-effects model) and moderation analyses (mixed-effects model) were performed. RESULTS: Previous stress management interventions had a small effect of -0.24 in reducing parental stress (95% confidence interval [CI]: -0.33, -0.15) with a 7.6-month follow-up effect of -0.12 (95% CI: -0.27, 0.04). The pooled effects on reducing depression were -0.15 (95% CI: -0.26, -0.04) with a 9-month follow-up effect of 0.02 (95% CI: -0.21, 0.26). Two studies measured anxiety, and the average effects were -0.03 (95% CI: -0.16, 0.11). Intervention effects on stress were significantly moderated by country (p = .005), study design (p < .001), and intervention duration (p = .030). Interventions conducted in developing countries (g = -0.52) had a significantly larger effect in reducing stress than those conducted in developed countries (g = -0.19). Studies using a quasi-experimental design (g = -0.47) resulted in a significantly greater effect in reducing stress than RCTs (g = -0.12). Interventions with a duration of 1-3 months (g = -0.36) had a greater effect in reducing stress than those with a longer duration (g = -0.11 for 3-6 months, -0.20 for >6 months). Intervention effects on reducing depression were significantly moderated by intervention component (p = .030). Cognitive behavioral therapy (g = -0.20) and mindfulness-based interventions (g = -0.16) resulted in greater effects in reducing depression than interventions focusing on parenting/life/self-care skills (g  =  0.003). CONCLUSIONS: Previous stress management interventions have short-term beneficial effects on reducing parental stress and depression, but long-term follow-up effects are limited. Short-duration (1-3 months) mindfulness-based interventions and cognitive behavioral therapy in clinical settings are recommended for socioeconomically disadvantaged parents to reduce stress and depression.

Managing COVID-19 related distress in primary care: principles of assessment and management.

COVID-19 will cause normal feelings of worry and stress and many of those who experience higher levels of distress will experience resolution of their symptoms as society returns to pre-COVID-19 functioning. Only a minority are likely to develop a psychiatric disorder. Certain individuals may be vulnerable to experiencing persisting symptoms, such as those with pre-existing comorbidity. Management approaches could centre around using collaborative approaches to provide and build on already existing socioeconomic support structures, the avoidance of over-medicalisation, watchful waiting and finally treating those who do meet the criteria for psychiatric diagnosis. Primary care clinicians are likely be the first healthcare point of contact for most COVID-19 related distress and it is important that they are able to provide evidence based and evidence informed responses, which includes social, psychological and pharmacological approaches. This expert opinion paper serves to summarise some approaches, based primarily on indirect extrapolation of evidence concerning the general management of psychological distress, in the absence of COVID-19 specific evidence, to assist primary care clinicians in their assessment and management of COVID-19 related distress.

Beyond Sociodemographic and COVID-19-Related Factors: The Association Between the Need for Psychological and Information Support from School and Anxiety and Depression.

BACKGROUND In addition to sociodemographic and COVID-19- related factors, the needs of school support, including material, psychological and information support, have seldom been discussed as factors influencing anxiety and depression among college students during the COVID-19 pandemic. MATERIAL AND METHODS In this cross-sectional study, 3351 college students from China were surveyed through questionnaires about their sociodemographic and COVID-19 characteristics, the needs of school support, and their experiences with anxiety and depression. RESULTS Anxiety and depression were reported by 6.88% and 10.50% of students, respectively. Married, higher education, non-medical, and urban students had significantly higher risks of anxiety or depression. Additionally, symptoms such as cough and fever, especially when following a possible contact with suspected individuals, quarantine history of a personal contact, going out 1-3 times a week, not wearing a mask, and spending 2-3 hours browsing COVID-19-related information were significantly associated with the occurrence of anxiety or depression. Those who used methods to regulate their emotional state, used a psychological hotline, and who had visited a psychiatrist showed higher anxiety or depression. Those who used online curricula and books, used preventive methods for COVID-19, and who had real-time information about the epidemic situation of the school showed lower anxiety and depression. CONCLUSIONS In addition to sociodemographic and COVID-19-related aspects, students' needs for psychological assistance and information from schools were also associated with anxiety and depression among college students.

A Survey of Current Preferences of Plastic Surgeons Regarding the Assessment and Reduction of Preoperative Patient Anxiety.

BACKGROUND: Preoperative anxiety is a common phenomenon in plastic surgery that has been associated with numerous negative patient outcomes. Little is known about the preferences of plastic surgeons regarding management of patient preoperative anxiety OBJECTIVE: To determine the preferences of plastic surgeons regarding the assessment and reduction of adult preoperative patient anxiety in their primary practice setting. METHODS: The membership of the American Council of Academic Plastic Surgeons (ACAPS) was surveyed using an anonymous, online questionnaire from April to June of 2020. RESULTS: A total of 100 participants from a membership of 532 responded (19%). The majority of respondents (63%) did not formally assess patient anxiety but supported the use of standardized scales to measure anxiety (57%). Most plastic surgeons preferred patient education (81%), family member presence (69%), and visit from the anesthesiologist (54%) to reduce patient anxiety. Plastic surgeons also allocated the most responsibility to anesthesiologists (63%) and plastic surgeons (62%) to reduce preoperative anxiety. DISCUSSION: Most plastic surgeon members of ACAPS did not assess their patients' anxieties preoperatively but appeared willing to use anxiety scales. Plastic surgeons also supported several measures to reduce anxiety, especially patient education, family member preferences, and anesthesiologist visits. Although plastic surgeons appeared to hold multiple parties responsible to manage preoperative anxiety, they held themselves and anesthesiologists most responsible. Future studies are needed to determine whether these views cohere with those of other healthcare providers and whether these preferences change for pediatric patients. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these evidence-based medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

The Effect of Spirituality Intervention on the Anxiety Parents of Hospitalized Newborns in a Neonatal Department.

Admission leads to many problems in the family, one of the most important of which is Stress parents. Therefore, specify The Effect of Religious Intervention on the Anxiety parents of hospitalized newborns in a neonatal department. The study was a semi-experimental study with experimental and control groups and before and after the intervention, Anxiety and care pressure questionnaires were given to parents. The religion intervention in the 8 Session parents of hospitalized newborns in a neonatal. Data were analyzed by SPSS16 and descriptive and analytical tests. The study indicated that religion has an effective role in enhancing and bettering stress of parents. Thus, it is suggested that a cleric be present in the section for religious intervention. Moreover, it is suggested that religious interventions should be done by nurses as a group of people with a close relationship with the patients and their parents.

The Impact of COVID-19 on Healthcare Worker Wellness: A Scoping Review.

At the heart of the unparalleled crisis of COVID-19, healthcare workers (HCWs) face several challenges treating patients with COVID-19: reducing the spread of infection; developing suitable short-term strategies; and formulating long-term plans. The psychological burden and overall wellness of HCWs has received heightened awareness in news and research publications. The purpose of this study was to provide a review on current publications measuring the effects of COVID-19 on wellness of healthcare providers to inform interventional strategies. Between April 6-May 17, 2020, we conducted systematic searches using combinations of these keywords and synonyms in conjunction with the controlled vocabulary of the database: "physician," "wellness, "wellbeing," "stress," "burnout," "COVID-19," and "SARS-CoV-2." We excluded articles without original data, research studies regarding the wellness of non-healthcare occupations or the general public exclusively, other outbreaks, or wellness as an epidemic. A total of 37 studies were included in this review. The review of literature revealed consistent reports of stress, anxiety, and depressive symptoms in HCWs as a result of COVID-19. We describe published data on HCW distress and burnout but urge future research on strategies to enhance HCW well-being.

Respiratory patient experience of measures to reduce risk of COVID-19: findings from a descriptive cross-sectional UK wide survey.

OBJECTIVES: To assess the experience of people with long-term respiratory conditions regarding the impact of measures to reduce risk of COVID-19. DESIGN: Analysis of data (n=9515) from the Asthma UK and British Lung Foundation partnership COVID-19 survey collected online between 1 and 8 April 2020. SETTING: Community. PARTICIPANTS: 9515 people with self-reported long-term respiratory conditions. 81% female, age ranges from ≤17 years to 80 years and above, from all nations of the UK. Long-term respiratory conditions reported included asthma (83%), chronic obstructive pulmonary disease (10%), bronchiectasis (4%), interstitial lung disease (2%) and 'other' (<1%) (eg, lung cancer and pulmonary endometriosis). OUTCOME MEASURES: Study responses related to impacts on key elements of healthcare, as well as practical, psychological and social consequences related to the COVID-19 pandemic and social distancing measures. RESULTS: 45% reported disruptions to care, including cancellations of appointments, investigations, pulmonary rehabilitation, treatment and monitoring. Other practical impacts such as difficulty accessing healthcare services for other issues and getting basic necessities such as food were also common. 36% did not use online prescriptions, and 54% had not accessed online inhaler technique videos. Psychosocial impacts including anxiety, loneliness and concerns about personal health and family were prevalent. 81% reported engaging in physical activity. Among the 11% who were smokers, 48% reported they were planning to quit smoking because of COVID-19. CONCLUSIONS: COVID-19 and related social distancing measures are having profound impacts on people with chronic respiratory conditions. Urgent adaptation and signposting of services is required to mitigate the negative health consequences of the COVID-19 response for this group.

Quality improvement initiative for improved patient communication in an ED rapid assessment zone.

INTRODUCTION: Patient-clinician communication in the Emergency Department (ED) faces challenges of time and interruptions, resulting in negative effects on patient satisfaction with communication and failure to relieve anxiety. Our aim was to improve patient satisfaction with communication and to decrease related patient anxiety. METHODS: A multistage quality improvement (QI) initiative was conducted in the ED of Toronto General Hospital, a quaternary care centre in Ontario, Canada, from January to May 2018. We engaged stakeholders widely including clinicians, allied health and patients. We developed a 5-point Likert scale survey to measure patient and clinician rating of their communication experience, along with open-ended questions, and a patient focus group. Inductive analyses yielded interventions that were introduced through three Plan-Do-Study-Act (PDSA) cycles: (1) a clinician communication tool called Acknowledge-Empathize-Inform; (2) patient information pamphlets; and (3) a multimedia solution displaying patient-directed material. Our primary outcome was to improve patient satisfaction with communication and decrease anxiety by at least one Likert scale point over 6 months. Our secondary outcome was clinician-perceived interruptions by patients. We used statistical process control (SPC) charts to identify special cause variation and two-tailed Mann-Whitney U tests to compare means (statistical significance p<0.05). RESULTS: A total of 232 patients and 104 clinicians were surveyed over baseline and three PDSA cycles. Communication about wait times, ED process, timing of next steps and directions to patient areas were the most frequently identified gaps, which informed our interventions. Measurements at baseline and during PDSA 3 showed: patient satisfaction increased from 3.28 (5 being best; n=65) to 4.15 (n=59, p<0.0001). Patient anxiety decreased from 2.96 (1 being best; n=65) to 2.31 (n=59, p<0.001). Clinician-perceived interruptions by patients changed from 4.33 (5 being highest; n=30) to 4.18 (n=11, p=0.98) and did not meet significance. SPC charts showed special cause variation temporally associated with our interventions. CONCLUSIONS: Our pragmatic low-cost QI initiative led to statistically significant improvement in patient satisfaction with communication and decreased patient anxiety while narrowly missing our a priori improvement aim of one full Likert scale point.