The Effect of Music-Moving Toys to Reduce Fear and Anxiety in Preschool Children Undergoing Intravenous Insertion in a Pediatric Emergency Department: A Randomized Clinical Trial.

INTRODUCTION: Intravenous catheter insertion is a highly invasive medical procedure that causes fear and anxiety in children. This study aimed to analyze the effect of a toy (with music and movement) distraction method on fear and anxiety in children aged 4 to 6 years. METHODS: This experimental, randomized clinical trial used parallel trial design guided by the Consolidated Standards of Reporting Trials checklist. Using simple randomization, eligible children (age 4-6; N = 60) were assigned to the intervention group (n = 30), who received the toy distraction method, or to the control group (n = 30), who received standard care. The Children's Fear Scale was used to evaluate the fear levels, and Children's State Anxiety Scale was used to evaluate anxiety levels. Physiological parameters (pulse, oxygen saturation) and crying time were monitored by the researcher as indicators of fear and anxiety. The chi-square test, repeated measures analysis of variance, Friedman test, t test, the Mann-Whitney U test, Wilcoxon test, and the intraclass correlation test were used for data analysis. RESULTS: There was no statistically significant difference in terms of fear and anxiety scores, physiological parameters, and crying time during the procedure between the children in the intervention and control group. DISCUSSION: We found that this method of toy distraction was not effective in reducing fear or anxiety during the intravenous catheter insertion procedure. Accordingly, we recommend that this distraction method be performed in different age groups and with larger samples in various painful and stressful practices in the future and that comparison be made with various distraction methods.

Psychological factors and intermittent self-catheterisation.

This article explores the factors less widely discussed in research that relate to the psychological aspects of those who may be eligible for or using intermittent self-catheterisation (ISC). Guidance indicates that cognition and ability to consent should be considered, and research indicates that a person is more likely to cope with ISC if they exhibit resilience and other positive attributes; further, a person's quality of life (QoL) is impacted by factors, such as social isolation, which need to be considered. This article takes an in-depth look at the available information on these factors.

Quality of life after interventions for malignant pleural effusions: a systematic review.

BACKGROUND: Malignant pleural effusion (MPE) results in breathlessness and impairment of health-related quality of life (HRQOL). This study reviews the existing literature on HRQOL following invasive interventions in MPE. METHODS: Five electronic databases were systematically searched and assessed three times during the review process and last completed on 15 June 2018. We included all studies evaluating HRQOL outcomes for the following interventions: therapeutic thoracocentesis, talc slurry (TS) pleurodesis, indwelling pleural catheter (IPC) insertion and thoracoscopic talc poudrage (TTP) pleurodesis. Meta-analysis was not performed due to substantial heterogeneity in the published data. RESULTS: 17 studies were included in the review reporting HRQOL outcomes in 2515 patients. TTP, TS and IPC were associated with modest but inconsistent improvements in HRQOL up to 12 weeks. No intervention was significantly different from another in HRQOL outcomes at any time point. The attrition to follow-up was 48.3% (664/1374) at 3 months. The overall quality of studies was inadequate. CONCLUSION: TTP, TS and IPC seem to improve HRQOL in MPE over 4-12 weeks, but there are insufficient longer term data due to high attrition rates. Evidence on the most effective treatment strategy is limited by the small number of randomised or comparative studies. TRIAL REGISTRATION NUMBER: CRD42016051003.

Assessment of Intermittent Self-Catheterization Procedures in Patients with Neurogenic Lower Urinary Tract Dysfunction: Dutch Translation and Validation of the Intermittent Catheterization Satisfaction Questionnaire, Intermittent Catheterization Acceptance Test, Intermittent Self Catheterization Questionnaire and Intermittent Catheterization Difficulty Questionnaire.

BACKGROUND: Intermittent self-catheterization (ISC) is by far the most appealing therapy to achieve a complete bladder emptying in patients with neurogenic lower urinary tract dysfunction (NLUTD). Four questionnaires have been developed in French in order to assess patient's satisfaction, difficulties and acceptance of this technique. OBJECTIVES: The aim of this study was to translate, culturally adapt and validate Dutch versions of the Intermittent Catheterization Satisfaction Questionnaire (InCaSaQ), the Intermittent Catheterization Acceptance Test (ICAT), the Intermittent Self Catheterization Questionnaire (ISCQ) and the Intermittent Catheterization Difficulty Questionnaire (ICDQ). METHODS: (1) Translation and cross-cultural adaptation of the questionnaires were performed according to the standardized guidelines. (2) The test of the pre-final version was performed by a group of bilingual lay people by comparing the original version of the questionnaires and the back translated one, assessing the comparability of language and comparability of interpretation. (3) Problematic issues were reviewed for correction. (4) Reliability was examined by intra-class correlation coefficients (ICC) statistics and Cronbach alpha analysis. RESULTS: Pre-test by 45 raters who are fluent in the source language led to an adapted and improved version of the translated questionnaires. Fifty native Dutch-speaking patients performing ISC (>6 months) due to an NLUTD were prospectively included. InCaSaQ, ICAT, ISCQ and ICDQ showed good internal consistency (α respectively (test and re-test): 0.79-0.88, 0.88-0.92, 0.85-0.88, and 0.88-0.86) and reproducibility (ICC respectively 0.77, 0.84, 0.84, and 0.87). CONCLUSION: The translated versions of InCaSaQ, ICAT, ISCQ and ICDQ are reliable and valid, allowing self-reported assessment of satisfaction, acceptance, difficulties and quality of life related to ISC in Dutch-speaking patients with NLUTD.

A Vibrating Cold Device to Reduce Pain in the Pediatric Emergency Department: A Randomized Clinical Trial.

OBJECTIVE: Pain of intravenous (IV) catheter insertion can be mitigated with appropriate analgesia, thereby avoiding unnecessary distress. Our objective was to compare the self-reported pain of IV catheter insertion in children when using a vibrating cold device (VCD) versus standard of care 4% topical lidocaine cream (TL). METHODS: This was a 2-arm randomized controlled noninferiority trial with a convenience sample of 4- to 18-year-olds requiring nonemergent IV catheter insertion. Self-reported pain was measured with the Faces Pain Scale-Revised, anxiety with the Child's Rating of Anxiety scale, and observed pain with the Face, Legs, Activity, Crying, Consolability scale. Caregivers and nurses completed satisfaction surveys. RESULTS: Two hundred twenty-four children were included in the analysis: 114 (90%) of 127 in the VCD group and 110 (89%) of 124 in the TL group. Faces Pain Scale-Revised scores for both groups were equivalent (median, 2.0 cm; interquartile range, 0-5 cm; linear regression difference, 0 [95% confidence interval, -0.82 to 0.82]), as were median Face, Legs, Activity, Crying, Consolability scale scores (difference, 0.33 [95% confidence interval, -0.01 to 0.68]). The time of completion for the IV procedure was significantly shorter for the VCD group compared with the TL group (median, 3.0 vs 40.5 minutes; P < 0.0001). There were no significant differences between groups for self-reported state or trait anxiety, success of IV catheter insertion on first attempt, or satisfaction of caregivers or staff. CONCLUSIONS: A VCD and TL showed equal effectiveness in reducing pain and distress for children undergoing IV catheter insertion. The VCD has the added benefit of quick onset time and an acceptable alternative for caregivers and nurses.

Ansiedade e desfechos clínicos em pacientes coronariopatas submetidos ao cateterismo não programado / Ansiedad y resultados clínicos en pacientes con coronariopatías sometidos a cateterismo no programado / Anxiety and clinical outcomes in coronary patients undergoing unplanned catheterization

Resumo Objetivos Descrever o nível de ansiedade traço e estado em pacientes com síndrome coronariana aguda submetidos a cateterismo não programado; verificar a influência da ansiedade traço na ansiedade estado antes e após o cateterismo e verificar se a ansiedade (traço e estado) é preditiva da ocorrência de arritmias não fatais, da gravidade dos pacientes medida pela classificação Killip e pelo índice de comorbidade de Charlson, e do tempo de permanência hospitalar. Métodos Estudo observacional, correlacional e longitudinal, no qual foram avaliados participantes com síndrome coronariana aguda aguardando cateterismo cardíaco não programado. No encontro inicial (Ti) foram coletados dados sociodemográficos e clínicos, aplicados inventários de ansiedade traço e estado (IDATE) e de depressão de Beck. No encontro final (Tf), aplicou-se o IDATE-estado. Os participantes foram acompanhados até alta hospitalar ou óbito quanto a ocorrência de arritmias não fatais e tempo de permanência hospitalar. Resultados Foram incluídos 100 participantes (62,2±11,4 anos; 61% do sexo masculino). O escore do IDATE-traço foi 42,2±10,4 e influenciou o escore do IDATE-estado em Ti e Tf (p<0,005). O IDATE-estado diminuiu significativamente de Ti para Tf (40,2±10,4 vs 37,2±11,2, respectivamente, p=0,002). Não se observou associação do IDATE-traço ou do IDATE-estado com os índices de gravidade, tempo de permanência hospitalar ou ocorrência de arritmias. Entretanto, o escore de depressão aumentou 9,5% a chance de ocorrência de arritmias (OR=1,009; IC95%=0,913-1,115). Conclusão O nível de ansiedade reduziu de forma significativa após a realização do cateterismo, e não foi um preditor de desfechos clínicos em curto prazo.

Resumen Objetivos Describir el nivel de ansiedad rasgo y estado en pacientes con síndrome coronario agudo sometidos a cateterismo no programado, verificar la influencia de la ansiedad rasgo en la ansiedad estado antes y después del cateterismo, y verificar si la ansiedad (rasgo y estado) es predictiva de la ocurrencia de arritmias no fatales, de la gravedad de los pacientes medida por clasificación Killip e índice de comorbilidad de Charlson, y del tiempo de permanencia hospitalaria. Métodos Estudio observacional, correlacional y longitudinal. Fueron evaluados participantes con síndrome coronario agudo esperando cateterismo cardíaco no programado. En el encuentro inicial (Ti) fueron recolectados datos sociodemográficos y clínicos, aplicando inventarios de ansiedad rasgo y estado (IDATE) y de depresión de Beck. En el encuentro final (Tf), se aplicó IDATE-estado. Los participantes recibieron seguimiento hasta el alta o el deceso, respecto de la ocurrencia de arritmias no fatales y tiempo de permanencia hospitalaria. Resultados Fueron incluidos 100 participantes (62,2+11,4 años; 61% de sexo masculino). El puntaje de IDATE-rasgo fue 42,2±10,4, influyendo en el puntaje del IDATE-estado en Ti y Tf (p<0,005). El IDATE-estado disminuyó significativamente entre Ti y Tf (40,2±10,4 vs 37,2±11,02 respectivamente; p=0,002). No se observó asociación del IDATE-rasgo ni del IDATE-estado con los índices de gravedad, tiempo de permanencia hospitalaria u ocurrencia de arritmias (OR=1,099; IC%=0,913-1,115). Conclusión El nivel de ansiedad se redujo significativamente luego de realizarse el cateterismo, y no constituyó un predictor de resultados clínicos en el corto plazo.

Abstract Objectives To describe the state and trait anxiety level in patients with acute coronary syndrome undergoing unplanned catheterization; to assess the influence of trait anxiety on state anxiety before and after catheterization, and check if anxiety (state and trait) is predictive of non-fatal arrhythmias, of patients' clinical severity measured by the Killip score and the Charlson Comorbidity Index (CCI), and of length of hospital stay. Methods An observational, correlational and longitudinal study in which were evaluated participants with acute coronary syndrome waiting for unplanned cardiac catheterization. At the initial meeting (Ti), were collected sociodemographic and clinical data, and were applied the State and Trait Anxiety Inventory (STAI) and Beck Depression Inventory (BDI). At the final meeting (Tf), was applied the STAI-state. Participants were followed up until hospital discharge or death regarding the occurrence of non-fatal arrhythmias and length of hospital stay. Results A total of 100 participants were included (62.2±11.4 years; 61% male sex). The STAI-trait score was 42.2±10.4 and it influenced the STAI-state score at Ti and Tf (p<0.005). The STAI-state decreased significantly between Ti and Tf (40.2±10.4 vs 37.2±11.2, respectively, p=0.002). There was no association of STAI-trait or STAI-state with severity indexes, length of hospital stay or arrhythmia occurrence. However, the depression score increased the chance of occurrence of arrhythmias by 9.5% (OR=1.009, 95% CI=0.913-1.115). Conclusion The level of anxiety reduced significantly after catheterization, and was not a predictor of short-term clinical outcomes.

Self-management of peripherally inserted central catheters after patient discharge via the WeChat smartphone application: A systematic review and meta-analysis.

WeChat is a smartphone application that may help patients self-manage peripherally inserted central catheters (PICC), although additional data are needed regarding this topic. This systematic review and meta-analysis aimed to determine whether WeChat helped improve PICC-related complications, self-care ability, PICC maintenance dependency in that the behavior of a patient is in compliance with a doctor's order or a will, knowledge mastery, and satisfaction among patients with a PICC. The PubMed, Embase, Cochrane Library, China Biology Medicine, China national Knowledge Infrastructure, Wanfang, Wiper, and Baidu Scholar databases were searched to identify related reports that were published up to April 2018. This search revealed 36 reports that were published during 2014-2018, including 2,623 controls and 2,662 patients who used the WeChat application. Relative to the traditional follow-up group, the group that received WeChat follow-up had a lower risk of PICC-related complications (odds ratio [OR]: 0.23, 95% confidence interval [CI]: 0.19-0.27, P < 0.00001), better self-care ability (mean difference: 36.41, 95% CI: 34.68-38.14, P < 0.00001), higher PICC maintenance dependency (OR: 4.27, 95% CI: 3.35-5.44, P < 0.00001), and higher patient satisfaction (OR: 6.20, 95% CI: 4.32-8.90, P < 0.00001). Eight studies reported knowledge mastery, although the different evaluation tools precluded a meta-analysis. Nevertheless, those eight studies revealed that knowledge mastery was significantly higher in the WeChat group than in the traditional follow-up group (P < 0.05). To the best of our knowledge, this is the first meta-analysis to evaluate the effects of WeChat follow-up on self-management among patients who are discharged with a PICC. It appears that WeChat follow-up can help improve the incidence of complications, self-care ability, PICC maintenance dependence, and patient satisfaction. However, the WeChat application itself cannot improve patients' self-management ability. Further studies are needed to produce high-quality evidence to determine whether WeChat is an effective follow-up tool.

Preliminary validation of a Urinary Symptom Questionnaire for individuals with Neuropathic Bladder using Intermittent Catheterization (USQNB-IC): A patient-centered patient reported outcome.

BACKGROUND: We developed a Urinary Symptom Questionnaire for individuals with neurogenic bladder due to spinal cord injury (SCI) and spina bifida (SB) who manage their bladders with intermittent catheterization, the USQNB-IC. This project followed an approach to patient-centered patient reported outcomes development that we created and published in 2017, specifically to ensure the primacy of the patient's perspective and experience. PARTICIPANTS: Two sets of responses were collected from individuals with neurogenic bladder due to either SCI (n = 336) and SB (patients, n = 179; and caregivers of patients with NB, n = 66), and three sets of "controls", individuals with neurogenic bladder who do not have a history of UTIs (n = 49) individuals with chronic mobility impairments (neither SCI nor SB) and without neurogenic bladder (n = 46), and those with no mobility impairment, no neurogenic bladder, and no history of UTIs (n = 64). METHOD: Data were collected from all respondents to estimate these psychometric or measurement domains characterizing a health related PRO: Reliability (minimization of measurement error; internal consistency or interrelatedness of the items; and maximization of variability that is due to "true" difference between levels of the symptoms across patients), and validity (content, reflection of the construct to be measured; face, recognizability of the contents as representing the construct to be measured; structural, the extent to which the instrument captures recognizable dimensions of the construct to be measured; and criterion, association with a gold standard). RESULTS: Evidence from these five groups of respondents suggest the instrument has face, content, criterion, convergent, and divergent validity, as well as reliability. The items were all more descriptive of our patient (focus) groups and were only weakly endorsed by the control groups. CONCLUSIONS: The instrument is unique in its emphasis on, and origination from, the lived experiences of patients with neurogenic bladder who use intermittent catheterization; this preliminary psychometric evidence suggests the instrument could be useful for research and in the clinic. These results justify further development of the instrument, including formal exploration of the scoring and estimation of responsivity of these items to clinical interventions as well as patient-directed self care.

Brief Clinical Report: A Systematic Review and Meta-analysis of Pain Memory-reframing Interventions for Children's Needle Procedures.

OBJECTIVE: Children's pain memories play a powerful role in shaping future pain experiences. Interventions aiming to reframe children's memories of painful medical procedures hold promise for altering pain memories and improving subsequent pain experience; however, this evidence has not been synthesized. This brief clinical report includes a systematic review and meta-analysis of existing memory-reframing interventions for needle procedures in children and adolescents to stimulate future research. METHODS: Database searches identified relevant randomized and quasi-randomized controlled trials. Data were extracted and pooled using Grading of Recommendations, Assessment, Development and Evaluation (GRADE) and Cochrane methodologies. Critically important outcomes included fear during a subsequent needle procedure; important outcomes included memory of fear and pain following the needle procedure and pain and distress during a subsequent needle procedure. RESULTS: Three studies including 158 children 3 to 18 years of age were identified. The quality of evidence was low to very low. There was no benefit for the critically important outcome of anticipatory fear; however, the test for overall effect trended toward significance (P = 0.07). Memory-reframing interventions were efficacious in altering children's memories of needle procedures to be less distressing. No benefit was found for acute fear or anticipatory, acute, or overall distress. CONCLUSIONS: There are limited data suggesting that interventions that reframe children's memories of needle procedures hold promise for altering pain memories and potentially reducing anticipatory fear. High-quality intervention development work is needed to determine how these interventions can be adapted to the developing child in order to lead to lasting reductions in pain, fear, and distress at future needle procedures.

Association Between Allergies and Psychiatric Disorders in Patients Undergoing Invasive Procedures.

BACKGROUND: Associations between allergies and psychiatric disorders have been reported in the context of depression and suicide; psychiatric disorders may affect pain perception. OBJECTIVE: To investigate the relationship of allergies with psychiatric disorders and pain perception in the context of invasive procedures, specifically during tunneled hemodialysis catheter placement. METHODS: We identified 89 patients (51 men, 38 women), mean age 66 years (range: 23-96), who underwent tunneled hemodialysis catheter placement (1/2014-2/2015), recording numeric rating scale pain scores, medications, psychiatric history, allergies, and smoking status. RESULTS: Of 89 patients, 47 patients had no allergies, and 42 had ≥1 allergy. Patients with allergies were more likely to have a pre-existing psychiatric disorder compared to those without allergies, odds ratio 2.6 (95% CI: 1.0-6.8). Having allergies did not affect procedural sedation or postprocedural pain scores. Multiple logistic regression with age, sex, smoking, presence of allergies, psychiatric history, inpatient/outpatient status, procedure time, and procedural sedation administration as inputs and postprocedural pain as the outcome showed that the only independent predictor was receiving procedural sedation (P = 0.005). CONCLUSIONS: Findings corroborate anecdotal reports of allergies as a marker for psychiatric history. However, having allergies was not associated with increased pain or need for more sedation. Further studies could prospectively assess whether allergies and psychiatric disorders affect patient/doctor perceptions beyond pain during invasive procedures.

The Effects of Child Life Specialists on Success Rates of Intravenous Cannulation.

BACKGROUND: Child life specialists (CLS) work with children directly to minimize long-term psychological sequelae of traumatic or medical events such as intravenous cannulation. There has been little done to measure how CLS impact outcomes of medical procedures. The objective of this study is to determine the impact of interventions by CLS upon successful attainment of intravenous (IV) cannulation among pediatric patients in the emergency department setting. METHOD: This was an eight month retrospective review within an urban tertiary-care freestanding pediatric Emergency Department (ED), using nursing and CLS documentation of ED patients younger than 21years who underwent IV cannulation. CLS self selected which children received procedural support, and the duration of CLS staffing was not a full 24h. Children with CLS documentation were compared against those without documented interventions by CLS. IV cannulation success and number of IV cannulation attempts were the primary outcomes. Confounding variables such as location of intravenous site, intravenous gauge, and professional qualifications were added. Chi-square determined the impact of CLS on primary outcomes. Logistic regression examined the association between successful IV cannulation with age. RESULTS: In all, 5460 children had documented IV cannulation, and 240 of those received CLS intervention. CLS intervention was not associated with IV cannulation success (p=0.5). The only significant association for successful IV cannulation was intravenous site (p<0.001). There was no interaction effect between patient age and CLS (p=0.12). CONCLUSION: Interventions by CLS do not affect the procedural outcome of intravenous cannulation success. Benefits of CLS are likely better measured in psychological impact of anxiolysis and improved experience, rather than in procedural outcome.

Changes in the Concentrations of Corticoid Metabolites--The Effect of Stress, Diet and Analytical Method.

A precisely measured corticoid level is important for decision-making in daily clinical practice. These levels can be influenced in the pre-analytical phase, when the effect of stress, timing, and diet can be important. The aim of this study was to elucidate optimal conditions for blood sampling as well as the choice of analytical methods, which they will be used in measuring of corticoids. By studying ten women, we focused on the influences of the stress of cannulation and a large lunchtime meal on cortisol, cortisone, aldosterone and corticosterone levels. We further compared results of cortisol measurements from RIA and LC-MS/MS. Stress from cannulation caused increase of cortisol, cortisone and corticosterone already, when the cannula was being inserted. This indicates that this increase is stimulated by fear of the blood withdrawing rather, than just by the needle insertion itself. The effect of stress on corticosterone disappeared after an hour, while effect on other corticoids was still apparent. Concerning the lunchtime meal, we found an increase in all measured corticoids between 11 and 12 o'clock. After the food, there were marked decreases in cortisone and aldosterone, while declining levels of cortisol and corticosterone had rather plateaus. We compared cortisol in 90 plasma samples measured by a commercial RIA kit and the LC-MS/MS method. Results from both methods showed a strong correlation (r=0.85). When measuring corticoid metabolites, the chosen analytical method, eliminating stress factors, and precisely timed blood sampling considering the daily rhythm and food intake are critical.

The Effect of Preintervention Preparation on Pain and Anxiety Related to Peripheral Cannulation Procedures in Children.

This study was performed to determine the effect of several preintervention preparation practices on pain and anxiety related to the peripheral cannulation procedure in children ages 9-12 years. The study included 60 Turkish children (28 female, 32 male, randomly selected by lot), 30 of whom were included in the intervention group and 30 of whom were included in the control group. The children's demographic data were collected by a data collection form prepared by the researcher. The children in the intervention group read the training manual before peripheral cannulation, and the procedure was demonstrated on a teddy bear. Their level of pain was assessed using the Wong-Baker Faces Rating Scale, and their level of anxiety was determined by the Spielberger State-Trait Anxiety Inventory for Children, before and during the procedure in both groups. Results showed that while anxiety and pain scores increased during the actual procedure compared to the preparatory procedure in the control group (anxiety t = -4.957, pain Z(a) = -4.048), anxiety and pain scores decreased during the actual procedure in the intervention group compared to the preparatory procedure (anxiety t = 7.896, pain t = 6.196). When the pain and anxiety scores were examined, it was found that both anxiety and pain scores in the intervention group were significantly lower than in the control group. In conclusion, children in this study experienced pain and situational anxiety during peripheral cannulation, and this pain can be reduced by preparing the child in advance of the procedure. It is suggested that children should be informed about and able to practice the procedure on a toy or model before peripheral cannulation. Preparation of the children to painful procedures in accordance with their cognitive development can reduce anxiety and pain.

[Placement of a portacath under hypnosis]. / Pose d'une chambre implantable sous hypnose.

The portacath reflects the cancer and its future treatments. Its insertion causes high levels of anxiety for patient. Thanks to medical hypnosis, he can use its internal resources to help them manage the situation and the symptoms he feels.

Who decides? A qualitative study on the decisional roles of patients, their caregivers and doctors on the method of bladder drainage after spinal cord injury.

STUDY DESIGN: Qualitative study using individual in-depth interviews. OBJECTIVE: To explore the roles of patients, their caregivers and doctors when making decisions on the method of bladder drainage after spinal cord injury (SCI). SETTING: Five public hospitals in Malaysia. METHODS: Semistructured (one-to-one) interviews with 17 male patients with SCI, 4 caregivers and 10 rehabilitation professionals. RESULTS: Eight themes describing the respective decisional roles of patients, their caregivers and doctors emerged from the analysis: patient's right and responsibilities, patient as an informed decision maker, forced to accept decision; surrogate decision maker, silent partner; doctor knows best, over-ride patient's decision, or reluctant decision maker. Both patients and doctors acknowledged the importance of patient autonomy but not all patients had the chance to practice it. Some felt that they were forced to accept the doctor's decision and even alleged that the doctor refused to accept their decision. Doctors considered the caregiver as the decision maker in cases that involved minors, elderly and those with tetraplegia. Some patients considered bladder problems an embarrassing subject to discuss with their caregivers and did not want their involvement. Doctors were described as knowledgeable and were trusted by patients and their caregivers to make the most appropriate option. Some doctors were happy to assume this role whereas some others saw themselves only as information providers. CONCLUSIONS: A paternalistic model is prevalent in this decision-making process and there is a discrepancy between patients' preferred and actual decisional roles.

Patients' perspectives on hemodialysis vascular access: a systematic review of qualitative studies.

BACKGROUND: Delayed creation of vascular access may be due in part to patient refusal and is associated with adverse outcomes. Concerns about vascular access are prevailing treatment-related stressors for patients on hemodialysis therapy. This study aims to describe patients' perspectives on vascular access initiation and maintenance in hemodialysis. STUDY DESIGN: Systematic review and thematic synthesis of qualitative studies. SETTING & POPULATION: Patients with chronic kidney disease who express opinions about vascular access for hemodialysis. SEARCH STRATEGY & SOURCES: MEDLINE, EMBASE, PsycINFO, CINAHL, reference lists, and PhD dissertations were searched to October 2013. ANALYTICAL APPROACH: Thematic synthesis was used to analyze the findings. RESULTS: From 46 studies involving 1,034 patients, we identified 6 themes: heightened vulnerability (bodily intrusion, fear of cannulation, threat of complications and failure, unpreparedness, dependence on a lifeline, and wary of unfamiliar providers), disfigurement (preserving normal appearance, visual reminder of disease, and avoiding stigma), mechanization of the body (bonded to a machine, internal abnormality, and constant maintenance), impinging on way of life (physical incapacitation, instigating family tension, wasting time, and added expense), self-preservation and ownership (task-focused control, advocating for protection, and acceptance), and confronting decisions and consequences (imminence of dialysis therapy and existential thoughts). LIMITATIONS: Non-English articles were excluded. CONCLUSIONS: Vascular access is more than a surgical intervention. Initiation of vascular access signifies kidney failure and imminent dialysis, which is emotionally confronting. Patients strive to preserve their vascular access for survival, but at the same time describe it as an agonizing reminder of their body's failings and "abnormality" of being amalgamated with a machine disrupting their identity and lifestyle. Timely education and counseling about vascular access and building patients' trust in health care providers may improve the quality of dialysis and lead to better outcomes for patients with chronic kidney disease requiring hemodialysis.

Effects of music therapy on pain and anxiety in patients undergoing port catheter placement procedure.

BACKGROUND: Patients scheduled to invasive medical procedures experience high levels of anxiety, which may lead to increased perceptions of pain and vital sign instability throughout. AIMS: To examine the effect of a music intervention (MI) on stress hormones, physiologic parameters, pain, and anxiety state before and during port catheter placement procedures (PCPPs). METHODS: We conducted a prospective, randomized, controlled study in 100 oncology patients, who were randomly assigned to an MI group (n=50) or a control group (n=50). The effects of music were assessed by determination of serum cortisol and adrenocorticotropic hormone (ACTH) levels, heart and respiratory rate (HR, RR) and systolic and diastolic blood pressure (SBP, DBP), on arrival in the surgical intervention room, as well as immediately prior to and immediately after the PCPP, in both groups. Furthermore, pain and anxiety levels were identified using visual analogue scale and state-trait anxiety inventory scales. RESULTS: On arrival, there were no differences between the patients in terms of serum cortisol and ACTH levels, HR, RR, SBP, DBP and anxiety levels. There were significant reductions in hormone levels (p<0.05 for all), HR (p<0.001), RR (p<0.001), SBP (p<0.05) and DBP (p<0.05), immediately prior to and immediately after the PCPP in participants in the MI group compared to those in the control group. Furthermore, music led to a significant reduction in pain (p<0.05) and anxiety scores (p<0.05) in the MI group compared to control group. CONCLUSION: During invasive medical procedures, MI significantly decreases stress hormone levels, physiological parameters, acute procedural pain and anxiety.

Validation of a screening instrument for the fear of injection in dialysis patients.

BACKGROUND: Very little research has been conducted on the fear of injection (FOI) in patients on dialysis. However, feedback from hospital practice indicate that FOI is widespread. OBJECTIVES: The aim of this study was to develop and validate a screening instrument to assess FOI in dialysis patients. METHOD AND DESIGN: A group of patients (n = 86) completed the Dialysis Fear of Injection Questionnaire (DFIQ) and the Hospital Anxiety and Depression Scale (HADS). In semi-structured interviews, these patients were also asked about their FOI, general anxiety and depressive symptoms. Various analyses were used to examine the factor structure, sensitivity, accuracy and cut-off score. RESULTS: The most optimal set of items consists of 9 items. These items have the sensitivity of 0.88, a specificity of 0.72 and a cut-off value of 3.5. The Cronbach's α is 0.87. CONCLUSION: The DFIQ appears to be a good predictor for the presence of FOI. APPLICATION TO PRACTICE: Nurses can use this validated screening instrument to detect FOI. The cut-off score provides a good indication for psychological counselling.