Music versus distraction for procedural pain and anxiety in patients with cancer. Gender Differences When Using Sedative Music During Colonoscopy Poor Reliability between Cochrane Reviewers and Blinded External Reviewers When Applying the Cochrane Risk of Bias Tool in Physical Therapy Trials Randomized controlled trial of relaxation music to reduce heart rate in patients undergoing cardiac CT Is it possible to improve radiotherapy team members' communication skills? A randomized study assessing the efficacy of a 38-h communication skills training program. A randomized trial of a cognitive-behavioral therapy and hypnosis intervention on positive and negative affect during breast cancer radiotherapy. Randomized, Crossover Study of Immersive Virtual Reality to Decrease Opioid Use During Painful Wound Care Procedures in Adults. Positive effect on patient experience of video information given prior to cardiovascular magnetic resonance imaging: A clinical trial Aromatherapies using Osmanthus fragrans oil and grapefruit oil are effective complementary treatments for anxious patients undergoing colonoscopy: A randomized controlled study. The effectiveness of an accessibility-enhanced multimedia informational educational programme in reducing anxiety and increasing satisfaction of patients undergoing cardiac catheterisation. Randomized controlled trial to compare the effect of simple distraction interventions on pain and anxiety experienced during conscious surgery. Validation of visual analogue scale for anxiety (VAS-A) in preanesthesia evaluation. Treatment efficacy of virtual reality distraction in the reduction of pain and anxiety during cystoscopy. The thresholds for statistical and clinical significance – a five-step procedure for evaluation of intervention effects in randomised clinical trials Distraction therapy with nature sights and sounds reduces pain during flexible bronchoscopy: a complementary approach to routine analgesia. Effect of listening to Vedic chants and Indian classical instrumental music on patients undergoing upper gastrointestinal endoscopy: A randomized control trial The effect of different types of music on patients' preoperative anxiety: A randomized controlled trial. Effects of Swedish Massage on the Improvement of Mood Disorders in Women with Breast Cancer undergoing Radiotherapy Machine learning for identifying Randomized Controlled Trials: An evaluation and practitioner's guide No Effect of Music on Anxiety and Pain During Transrectal Prostate Biopsies: A Randomized Trial. Intraoperative stress and anxiety reduction with music therapy: a controlled randomized clinical trial of efficacy and safety. The effects of guided imagery on comfort of women with early stage breast cancer undergoing radiation therapy. Clinical Efficacy, Safety, and Feasibility of Using Video Glasses during Interventional Radiologic Procedures: A Randomized Trial. Pain and anxiety during interventional radiologic procedures: effect of patients' state anxiety at baseline and modulation by nonpharmacologic analgesia adjuncts. Aromatherapy for reducing colonoscopy related procedural anxiety and physiological parameters: a randomized controlled study. A Music Intervention to Reduce Anxiety Prior to Gastrointestinal Procedures Adjunctive non-pharmacological analgesia for invasive medical procedures: a randomised trial Study of the effectiveness of musical stimulation during intracardiac catheterization A clinical trial of distraction techniques for pain and anxiety control during cataract surgery. Effects of patient education and therapeutic suggestions on cataract surgery patients: a randomized controlled clinical trial. The effects of hypnotherapy during transrectal ultrasound-guided prostate needle biopsy for pain and anxiety A music intervention to reduce anxiety before vascular angiography procedures. A Randomized Controlled Trial Provides Evidence to Support Aromatherapy to Minimize Anxiety in Women Undergoing Breast Biopsy Effectiveness of music interventions for women with high anxiety during coronary angiographic procedures: a randomized controlled A randomized trial of supine vs. prone positioning in patients undergoing escalated dose conformal radiotherapy for prostate cancer. Music Interventions in Patients During Coronary Angiographic Procedures: A Randomized Controlled Study of the Effect on Patients' Anxiety and Well-Being Does therapeutic touch ease the discomfort or distress of patients undergoing stereotactic core breast biopsy? A randomized clinical trial. Anxiety Reduction Using Hypnotic Induction and Self-Guided Imagery for Relaxation During Dermatologic Procedures Randomized controlled trial on the impact of music therapy during cardiac catheterization on reactive hyperemia index and patient satisfaction: the Functional Change in Endothelium After Cardiac Catheterization, With and Without Music Therapy (FEAT) study. The Effect of Music Intervention in Relation to Gender During Coronary Angiographic Procedures: A Randomized Clinical Trial Effects of a single music therapy intervention on anxiety, discomfort, satisfaction, and compliance with screening guidelines in outpatients undergoing flexible sigmoidoscopy. Audiovisual distraction as an adjunct to pain and anxiety relief during minor surgery. Effect of Verbal Empathy and Touch on Anxiety Relief in Patients Undergoing Flexible Bronchoscopy: Can Empathy Reduce Patients' Anxiety? Massage for perioperative pain and anxiety in placement of vascular access devices. A prospective examination of mask anxiety during radiotherapy for head and neck cancer and patient perceptions of management strategies A Randomized Trial of Hypnosis for Relief of Pain and Anxiety in Adult Cancer Patients Undergoing Bone Marrow Procedures Effects of music therapy on pain and anxiety in patients undergoing bone marrow biopsy and aspiration. Effects of Visual and Audiovisual Distraction on Pain and Anxiety Among Patients Undergoing Colonoscopy Use of music to reduce anxiety during office hysteroscopy: prospective randomized trial. Meditative music listening to reduce state anxiety in patients during the uptake phase before positron emission tomography (PET) scans. The UK HeartSpare Study (Stage IB): randomised comparison of a voluntary breath-hold technique and prone radiotherapy after breast conserving surgery.
PURPOSE / OBJECTIVES To test the hypotheses that the effects of a music intervention are greater than those of simple distraction and that either intervention is better at controlling procedural pain and anxiety than treatment as usual . DESIGN R and omized , controlled experiment . SETTING A midwestern comprehensive cancer center . SAMPLE 60 people with cancer having noxious medical procedures such as tissue biopsy or port placement or removal ; 58 provided usable data . METHODS Participants completed measures of pain and anxiety before and after their medical procedures and provided a rating of perceived control over pain and anxiety after the procedure . MAIN RESEARCH VARIABLES Procedural pain , state anxiety , and perceived control over pain and anxiety . FINDINGS Contrary to hypotheses , outcomes achieved with music did not differ from those achieved with simple distraction . Moreover , outcomes achieved under treatment as usual were not significantly different from those obtained with music or distraction interventions . Some patients found that the interventions were bothersome and reported that they wanted to attend to the activities of the surgeon and the medical procedure itself . CONCLUSIONS The effects of music , distraction , and treatment as usual are equivocal . In addition , patients have individual preferences for use of distraction during painful or anxiety-provoking procedures . IMPLICATION S FOR NURSING Patients having noxious medical procedures should be asked about their desire to be distracted before and during the procedure and offered a strategy that is consistent with their preferences Colonoscopy is a procedure often experienced as uncomfortable and worrying . Music has been reported to reduce discomfort during colonoscopy ; however , no study in a Swedish setting has been found . The purpose of this r and omized controlled trial was to analyze the effects of sedative music on patients ' experience of anxiety , pain , relaxation , and well-being during colonoscopy . Prior to colonoscopy , adult patients ( n = 120 ) , aged 18–80 years , were r and omly assigned to either an intervention group ( n = 60 ) who listened to sedative instrumental music with 60–80 beats per minute during the colonoscopy or a control group . After the colonoscopy , both groups completed a question naire on anxiety , the State Trait Anxiety Inventory  , and an anxiety Visual Analogue Scale . Pain , relaxation , and well-being were also measured with Visual Analogue Scales . Women in the intervention group had a lower level of anxiety during the colonoscopy than those in the control group ( p = .007 ) and well-being was significantly higher in the intervention group , especially among men , than in the controls ( p = .006 and p = .025 , respectively ) . Men in the intervention group were more relaxed during the colonoscopy than those in the control group ( p = .065 ) . Listening to sedative music  decreased anxiety among women and increased well-being among men during colonoscopy Objectives To test the inter-rater reliability of the RoB tool applied to Physical Therapy ( PT ) trials by comparing ratings from Cochrane review authors with those of blinded external review ers . Methods R and omized controlled trials ( RCTs ) in PT were identified by search ing the Cochrane Data base of Systematic Review s for meta- analysis of PT interventions .  RoB assessment s were conducted independently by 2 review ers blinded to the RoB ratings reported in the Cochrane review s. Data on RoB assessment s from Cochrane review s and other characteristics of review s and trials were extracted . Consensus assessment s between the two review ers were then compared with the RoB ratings from the Cochrane review s. Agreement between Cochrane and blinded external review ers was assessed using weighted kappa ( κ ) . Results In total , 109 trials included in 17 Cochrane review s were assessed . Inter-rater reliability on the overall RoB assessment between Cochrane review authors and blinded external review ers was poor ( κ = 0.02 , 95%CI : −0.06 , 0.06 ] ) . Inter-rater reliability on individual domains of the RoB tool was poor ( median κ = 0.19 ) , ranging from κ = −0.04 ( “ Other bias ” ) to κ = 0.62 ( “ Sequence generation ” ) . There was also no agreement ( κ = −0.29 , 95%CI : −0.81 , 0.35 ] ) in the overall RoB assessment at the meta- analysis level . Conclusions Risk of bias assessment s of RCTs using the RoB tool are not consistent across different research groups . Poor agreement was not only demonstrated at the trial level but also at the meta- analysis level . Results have implication s for decision making since different recommendations can be reached depending on the group analyzing the evidence . Improved guidelines to consistently apply the RoB tool and revisions to the tool for different health areas are needed Abstract Objectives To evaluate the heart rate lowering effect of relaxation music in patients undergoing coronary CT angiography ( CCTA ) , pulmonary vein CT ( PVCT ) and coronary calcium score CT ( CCS ) . Methods Patients were r and omised to a control group ( i.e. st and ard of care protocol ) or to a relaxation music group ( ie . st and ard of care protocol with music ) . The groups were compared for heart rate , radiation dose , image quality and dose of IV metoprolol . Both groups completed State-Trait Anxiety Inventory anxiety question naires to assess patient experience . Results One hundred and ninety-seven patients were recruited ( 61.9 % males ) ; mean age 56y ( 19 - 86 y ) ; 127 CCTA , 17 PVCT , 53 CCS . No significant difference in heart rate , radiation dose , image quality , metoprolol dose and anxiety scores . 86 % of patients enjoyed the music . 90 % of patients in the music group expressed a strong preference to have music for future examinations . The patient cohort demonstrated low anxiety levels prior to CT . Conclusion Relaxation music in CCTA , PVCT and CCS does not reduce heart rate or IV metoprolol use . Patients showed low levels of anxiety indicating that anxiolytics may not have a significant role in lowering heart rate . Music can be used in cardiac CT to improve patient experience . Key Points• Relaxation music does not reduce heart rate in cardiac CT • Relaxation music does not reduce beta-blocker use in cardiac CT • Relaxation music has no effect on cardiac CT image quality • Low levels of anxiety are present in patients prior to cardiac CT • Patients enjoyed the relaxation music and this results in improved patient BACKGROUND AND PURPOSE Optimizing communication between radiotherapy team members and patients and between colleagues requires training . This study applies a r and omized controlled design to assess the efficacy of a 38-h communication skills training program . MATERIAL AND METHODS Four radiotherapy teams were r and omly assigned either to a training program or to a waiting list . Team members ' communication skills and their self-efficacy to communicate in the context of an encounter with a simulated patient were the primary endpoints . These encounters were scheduled at the baseline and after training for the training group , and at the baseline and four months later for the waiting list group . Encounters were audiotaped and transcribed . Transcripts were analyzed with content analysis software ( LaComm ) and by an independent rater . RESULTS Eighty team members were included in the study . Compared to untrained team members , trained team members used more turns of speech with content oriented toward available re sources in the team ( relative rate [RR]=1.38 ; p=0.023 ) , more assessment utterances ( RR=1.69 ; p<0.001 ) , more empathy ( RR=4.05 ; p=0.037 ) , more negotiation ( RR=2.34 ; p=0.021 ) and more emotional words ( RR=1.32 ; p=0.030 ) , and their self-efficacy to communicate increased ( p=0.024 and p=0.008 , respectively ) . CONCLUSIONS The training program was effective in improving team members ' communication skills and their self-efficacy to communicate in the context of an encounter with a simulated patient . Future study should assess the effect of this training program on communication with actual patients and their satisfaction . Moreover a cost-benefit analysis is needed , before implementing such an intensive training program on a broader scale Breast cancer radiotherapy can be an emotionally difficult experience . Despite this , few studies have examined the effectiveness of psychological interventions to reduce negative affect , and none to date have explicitly examined interventions to improve positive affect among breast cancer radiotherapy patients . The present study examined the effectiveness of a multimodal psychotherapeutic approach , combining cognitive-behavioral therapy and hypnosis ( CBTH ) , to reduce negative affect and increase positive affect in 40 women undergoing breast cancer radiotherapy . Participants were r and omly assigned to receive either CBTH or st and ard care . Participants completed weekly self-report measures of positive and negative affect . Repeated and univariate analyses of variance revealed that the CBTH approach reduced levels of negative affect [ F(1 , 38)=13.49 ; p=.0007 , omega(2)=.56 ] , and increased levels of positive affect [ F(1 , 38)=9.67 ; p=.0035 , omega(2)=.48 ] , during the course of radiotherapy . Additionally , relative to the control group , the CBTH group demonstrated significantly more intense positive affect [ F(1 , 38)=7.09 ; p=.0113 , d=.71 ] and significantly less intense negative affect [ F(1 , 38)=10.30 ; p=.0027 , d=.90 ] during radiotherapy . The CBTH group also had a significantly higher frequency of days where positive affect was greater than negative affect ( 85 % of days assessed for the CBTH group versus 43 % of the Control group ) [ F(1 , 38)=18.16 ; p=.0001 , d=1.16 ] . Therefore , the CBTH intervention has the potential to improve the affective experience of women undergoing breast cancer radiotherapy The objective of this study was to evaluate the effect of immersive virtual reality ( IVR ) distraction therapy during painful wound care procedures in adults on the amount of opioid medications required to manage pain . A convenience sample of consenting , adult in patients requiring recurrent painful wound care procedures was studied . Using a within-subject , r and omized controlled trial study design , 2 sequential wound procedures were compared , 1 with IVR distraction therapy and 1 without IVR .  Total opioid medications administered before and during the wound procedures were recorded and pain and anxiety were rated before and after the 2 wound procedures . The IVR intervention included the wearing of virtual reality goggles and participation in an immersive , computer generated , interactive , 3-dimensional virtual world program . Data were analyzed with Student 's t test and chi-square analysis , with P < 0.05 considered significant . A total of 18 patients were studied , with 12 completing both study wound procedures and 6 completing a single wound procedure . The amount of opioid administered before each of the 2 wound procedures was similar with and without IVR . Total opioid administration during the dressing procedures with IVR was significantly less than when no IVR was used , 17.9 ± 6.0 and 29.2 ± 4.5 mcg/kg fentanyl , respectively ( t = -2.7 ; df = 14 ; P = 0.02 ) . Two of 15 patients ( 11 % ) requested more than 1 opioid rescue dose with IVR and 9 of 15 patients ( 60 % ) requested more than 1 rescue dose without IVR . Seventy-five percentage of participants stated that they would want to use IVR with future dressing changes . Pain and anxiety scores were similar for the wound procedures with and without IVR ( P > 0.05 ) . IVR significantly reduced the amount of opioid medication administered during painful wound care procedures when IVR was used compared with no IVR . Since pain scores were similar before and after the wound procedures with IVR and without IVR , the 39 % reduction in opioid medication during IVR supports its use as a pain distraction therapy during painful procedures AIMS AND OBJECTIVES To evaluate the effect of video information given before cardiovascular magnetic resonance imaging on  patient anxiety  and to compare patient experiences of cardiovascular magnetic resonance imaging versus myocardial perfusion scintigraphy . To evaluate whether additional information has an impact on motion artefacts . BACKGROUND Cardiovascular magnetic resonance imaging and myocardial perfusion scintigraphy are technically advanced methods for the evaluation of heart diseases . Although cardiovascular magnetic resonance imaging is considered to be painless , patients may experience anxiety due to the closed environment . DESIGN A prospect i ve r and omised intervention study , not registered . METHODS The sample ( n = 148 ) consisted of 97 patients referred for cardiovascular magnetic resonance imaging , r and omised to receive either video information in addition to st and ard text-information ( CMR-video/n = 49 ) or st and ard text-information alone ( CMR-st and ard/n = 48 ) . A third group undergoing myocardial perfusion scintigraphy ( n = 51 ) was compared with the cardiovascular magnetic resonance imaging-st and ard group . Anxiety was evaluated before , immediately after the procedure and 1 week later . Five question naires were used : Cardiac Anxiety Question naire , State-Trait Anxiety Inventory , Hospital Anxiety and Depression scale , MRI Fear Survey Schedule and the MRI-Anxiety Question naire . Motion artefacts were evaluated by three observers , blinded to the information given . Data were collected between April 2015-April 2016 . The study followed the CONSORT guidelines . RESULT The CMR-video group scored lower ( better ) than the cardiovascular magnetic resonance imaging-st and ard group in the factor Relaxation ( p = .039 ) but not in the factor Anxiety . Anxiety levels were lower during scintigraphic examinations compared to the CMR-st and ard group ( p < .001 ) . No difference was found regarding motion artefacts between CMR-video and CMR-st and ard . CONCLUSION Patient ability to relax during cardiovascular magnetic resonance imaging increased by adding video information prior the exam , which is important in relation to perceived quality in nursing . No effect was seen on motion artefacts . RELEVANCE TO CLINICAL PRACTICE Video information prior to examinations can be an easy and time effective method to help patients cooperate in imaging procedures BACKGROUND AND AIMS Colonoscopy can be painful and uncomfortable . Aromatherapy is often used for the relief of anxiety or discomfort . Recently , it has been reported that olfactory stimulation induces various physiological effects . We investigated the effects of aromatherapy on anxiety and abdominal discomfort during colonoscopy . METHODS The investigation was carried out using a r and omized controlled study . Aromatherapy was performed by vapor diffusion , and each patient was given one of the following treatments : no inhalation ( control group ) , essential-oil-less vapor ( vehicle group ) , lavender oil ( lavender group ) , grapefruit oil ( grapefruit group ) , or Osmanthus fragrans oil ( Osmanthus fragrans group ) . Following total colonoscopy procedures , each patient estimated their anxiety and abdominal discomfort using the Numeric Rating Scale . RESULTS Total colonoscopy was performed on 361 patients . No complications caused by colonoscopy or aromatherapy were experienced . In the Osmanthus fragrans group , anxiety was significantly attenuated . The abdominal discomfort of patients who reported strong anxiety during colonoscopy was significantly attenuated in the grapefruit group and the Osmanthus fragrans group . CONCLUSION Aromatherapies using Osmanthus fragrans oil and grapefruit oil are effective complementary treatments for anxious patients undergoing colonoscopy AIMS AND OBJECTIVES To evaluate the effectiveness of an accessibility-enhanced multimedia informational educational programme in reducing anxiety and increasing satisfaction with the information and material s received by patients undergoing cardiac catheterisation . BACKGROUND Cardiac catheterisation is one of the most anxiety-provoking invasive procedures for patients . However , informational education using multimedia to inform patients undergoing cardiac catheterisation has not been extensively explored . DESIGN A r and omised experimental design with three-cohort prospect i ve comparisons . METHODS In total , 123 consecutive patients were r and omly assigned to one of three groups : regular education ; ( group 1 ) , accessibility-enhanced multimedia informational education ( group 2 ) and instructional digital videodisc education ( group 3 ) . Anxiety was measured with Spielberger 's State Anxiety Inventory , which was administered at four time intervals : before education ( T0 ) , immediately after education ( T1 ) , before cardiac catheterisation ( T2 ) and one day after cardiac catheterisation ( T3 ) . A satisfaction question naire was administrated one day after cardiac catheterisation . Data were collected from May 2009-September 2010 and analysed using descriptive statistics , chi-squared tests , one-way analysis of variance , Scheffe 's post hoc test and generalised estimating equations . RESULTS All patients experienced moderate anxiety at T0 to low anxiety at T3 . Accessibility-enhanced multimedia informational education patients had significantly lower anxiety levels and felt the most satisfied with the information and material s received compared with patients in groups 1 and 3 . A statistically significant difference in anxiety levels was only found at T2 among the three groups ( p = 0·004 ) . CONCLUSIONS The findings demonstrate that the accessibility-enhanced multimedia informational education was the most effective informational educational module for informing patients about their upcoming cardiac catheterisation , to reduce anxiety and improve satisfaction with the information and material s received compared with the regular education and instructional digital videodisc education . RELEVANCE TO CLINICAL PRACTICE As the accessibility-enhanced multimedia informational education reduced patient anxiety and improved satisfaction with the information and material s received , it can be adapted to complement patient education in future regular cardiac care BACKGROUND High levels of anxiety during surgery are associated with poorer post-surgical outcomes . This prospect i ve , non-blinded r and omized controlled trial aim ed to compare the effectiveness of four intraoperative distraction interventions for anxiety and pain management during minimally invasive venous surgery under local anaesthetic . METHODS 407 patients presenting with varicose veins at a private clinic , were r and omized to one of four intraoperative distraction interventions or treatment as usual .  All participants received endovenous thermoablation and /or phlebectomies of varicose veins .  After losses to follow-up , 398 participants were entered into the analysis . Participants were r and omly allocated to one of the following intraoperative distraction techniques : patient selected music ( n = 85 ) , patient selected DVD ( n = 85 ) , interaction with nurses ( n = 81 ) , touch ( stress balls ) ( n = 80 ) or treatment as usual ( TAU , n = 76 ) . The state scale of the STAI , the Short-form McGill pain question naire and numeric rating scales were used to assess intraoperative pain and anxiety . RESULTS Intraoperative anxiety ratings were significantly lower when participants interacted with nurses , used stress balls or watched a DVD during surgery compared to treatment as usual . Intraoperative pain ratings were significantly lower than treatment as usual when participants interacted with nurses or used stress balls during surgery . Patients ' satisfaction was not significantly impacted by intraoperative distractions . CONCLUSIONS The use of simple intraoperative distraction techniques , particularly interacting with nurses , using stress balls or watching a DVD during surgery conducted under local anaesthetic can significantly improve patients ' experiences BACKGROUND Anxiety is a relevant but still underscored perioperative problem . The Visual Analogue Scale for Anxiety ( VAS-A ) seems to be effective , fast and manageable , but has not been fully vali date d yet . The aim of this study is to vali date VAS-A comparing it to , Corah 's Dental Anxiety Scale ( CDAS ) Spielberger 's State Trait Anxiety Inventory ( STAI ) and Beck Depression Inventory ( BDI ) . METHODS One hundred consecutive patients ( 38 males and 62 females , median age 49 years ) su bmi tted to oral surgery filled out the VAS-A , CDAS , STAI forms Y1 and Y2 , and BDI at preoperative examination ; the order of administration of tests was r and omized . RESULTS VAS-A score was significantly correlated to CDAS ( P<0.0001 ) , STAI-Y1 ( P<0.0001 ) , STAI-Y2 ( P<0.002 ) but not to BDI ( P=0.18 ) . ROC curve analysis suggested VAS-A equal to 46 mm as threshold for anxiety when using STAI Y1 equal to 40 as reference cutoff . CONCLUSION Our study confirms that VAS-A is a reliable indicator of preoperative anxiety and may detect patients with depressive symptoms also . Values of VAS-A around 50 mm are a reliable threshold for a clinical ly meaningful level of preoperative anxiety OBJECTIVE Assessment of virtual reality ( VR ) distraction for alleviating pain and anxiety during flexible cystoscopy . Cystoscopy is a common ambulatory procedure performed in Urology and can be associated with moderate pain and anxiety . Sophisticated distraction techniques are not used with cystoscopy and VR has not been studied for this procedure . We design ed a prospect i ve , r and omized , controlled trial assessing the efficacy of VR for alleviating pain and anxiety during flexible cystoscopy . METHODS Adult men referred for cystoscopy were r and omized into a  control or VR group . Subjects were given preprocedure and postprocedure question naires addressing anxiety , pain , and time spent thinking about pain . Vitals signs and galvanic skin monitors were used as objective measures . The control group underwent routine cystoscopy and the VR group underwent cystoscopy with VR . Physicians answered a postprocedure question naire assessing the difficulty of the exam . All question naires used a visual analog score for assessment . RESULTS 23 patients enrolled in the control group and 22 in the VR group .  Mean scores and Student 's t-test were employed to analyze the data . No data endpoints showed a statistically significant difference between the 2 groups . CONCLUSIONS We concluded no benefit to VR distraction mitigating pain in male patients during cystoscopy Background Thresholds for statistical significance are insufficiently demonstrated by 95 % confidence intervals or P-values when assessing results from r and omised clinical trials . First , a P-value only shows the probability of getting a result assuming that the null hypothesis is true and does not reflect the probability of getting a result assuming an alternative hypothesis to the null hypothesis is true . Second , a confidence interval or a P-value showing significance may be caused by multiplicity . Third , statistical significance does not necessarily result in clinical significance . Therefore , assessment of intervention effects in r and omised clinical trials deserves more rigour in order to become more valid . Methods Several method ologies for assessing the statistical and clinical  significance of intervention effects in r and omised clinical trials were considered . Balancing simplicity and comprehensiveness , a simple five-step procedure was developed . Results For a more valid assessment of results from a r and omised clinical trial we propose the following five-steps : ( 1 ) report the confidence intervals and the exact P-values ; ( 2 ) report Bayes factor for the primary outcome , being the ratio of the probability that a given trial result is compatible with a ‘ null ’ effect ( corresponding to the P-value ) divided by the probability that the trial result is compatible with the intervention effect hypothesised in the sample size calculation ; ( 3 ) adjust the confidence intervals and the statistical significance threshold if the trial is stopped early or if interim analyses have been conducted ; ( 4 ) adjust the confidence intervals and the P-values for multiplicity due to number of outcome comparisons ; and ( 5 ) assess clinical significance of the trial results . Conclusions If the proposed five-step procedure is followed , this may increase the validity of assessment s of intervention effects in r and omised clinical trials STUDY OBJECTIVES To determine whether distraction therapy with nature sights and sounds during flexible bronchoscopy ( FB ) reduces pain and anxiety . DESIGN R and omized controlled trial . SETTING Teaching hospital in Baltimore , MD . PATIENTS Consecutive adult patients ( n = 80 ) undergoing FB with conscious sedation . INTERVENTION Nature scene murals were placed at the bedside , and patients were provided a tape of nature sounds to listen to before , during , and after the procedure . Patients assigned to the control group were not offered either the nature scene or the sounds . MEASUREMENTS AND RESULTS The primary outcomes were patient ratings of pain control ( a 5-point scale ranging from poor to excellent ) and anxiety . In a multivariate ordinal logistic regression model , the odds of better pain control were greater in the intervention patients than in the control patients ( odds ratio [ OR ] , 4.76 ; 95 % confidence interval [ CI ] , 1.35 to 16.7 ) , after adjustment for age , gender , race , education , health status , and dose of narcotic medication . Older patients and patients with better health status reported significantly less pain . There was no difference in patient-reported anxiety between the two groups ( OR , 0.87 ; 95 % CI , 0.39 to 1.96 ) . CONCLUSIONS Distraction therapy with nature sights and sounds significantly reduces pain in patients undergoing FB . Although the precise mechanism of this beneficial effect requires further investigation , clinicians should consider this nonintrusive strategy in addition to st and ard analgesic medications in patients undergoing painful , invasive procedures Background : A high level of preoperative anxiety is common among patients undergoing medical and surgical procedures . Anxiety impacts of gastroenterological procedures on psychological and physiological responses are worth consideration . Aims and Objectives : To analyze the effect of listening to Vedic chants and Indian classical instrumental music on anxiety levels and on blood pressure ( BP ) , heart rate ( HR ) , and oxygen saturation in patients undergoing upper gastrointestinal ( GI ) endoscopy . Material s and Methods : A prospect i ve , r and omized controlled trial was done on 199 patients undergoing upper GI endoscopy .  On arrival , their anxiety levels were assessed using state and trait scores and various physiological parameters such as HR , BP , and SpO2 . Patients were r and omly divided into three groups : Group I of 67 patients who were made to listen prerecorded Vedic chants for 10 min , Group II consisting of 66 patients who listened to Indian classical instrumental music for 10 min , and Group III of 66 controls who remained seated for same period in the same environment . Thereafter , their anxiety state scores and physiological parameters were reassessed . Results : A significant reduction in anxiety state scores was observed in the patients in Group I ( from 40.4 ± 8.9 to 38.5 ± 10.7 ; P < 0.05 ) and Group II ( from 41.8 ± 9.9 to 38.0 ± 8.6 ; P < 0.001 ) while Group III controls showed no significant change in the anxiety scores . A significant decrease in systolic BP ( P < 0.001 ) , diastolic BP ( P < 0.05 ) , and SpO2 ( P < 0.05 was also observed in Group II . Conclusion : Listening to Vedic chants and Indian classical instrumental music has beneficial effects on alleviating anxiety levels induced by apprehension of invasive procedures and can be of therapeutic use OBJECTIVE The purpose of this study was to determine effect of three different types of music on patients ' preoperative anxiety .  METHOD This r and omized controlled trial included 180 patients who were r and omly divided into four groups . While the control group did n't listen to music , the experimental groups respectively listened to natural sounds , Classical Turkish or Western Music for 30 min . The State Anxiety Inventory ( STAI-S ) , systolic blood pressure ( SBP ) , diastolic blood pressure ( DBP ) , heart rate ( HR ) and cortisol levels were checked . FINDINGS The post-music STAI-S , SBP , DBP , HR and cortisol levels of the patients in music groups were significantly lower than pre-music time . All types of music decreased STAI-S , SBP , and cortisol levels ; additionally natural sounds reduced DBP ;  Classical Turkish Music also decreased DBP , and HR . CONCLUSIONS All types of music had an effect on reducing patients ' preoperative anxiety , and listening to Classical Turkish Music was particularly the most effective one Background Breast cancer is the most common cancer in women , and the second leading cause of cancer deaths . The detection and treatment of this cancer may create mental pressure and lower mood levels , causing anxiety , depression , stress , and pain for the patients . Objectives The aim of this study was to determine the effects of Swedish massage on mood disorders in breast cancer patients undergoing radiotherapy at the cancer institute of the Imam Khomeini hospital at the Tehran University of Medical Sciences . Patients and Methods This study consisted of a clinical trial including 100 patients with breast cancer . The participants were chosen r and omly , with their consent , by the use of polling , to be included in the intervention group ( which received a Swedish massage three times a week , for 30 minutes , over five weeks ) and control group ( which received routine care ) . At the beginning of the intervention and after 5 weeks , the mood disorders of the patients , including anger , anxiety , depression , and any positive affect , were assessed using the affective control scale ( ACS ) question naire . Results Before the intervention , there was no significant difference in the average of the overall scale between the intervention and control groups in the subscales of anger , anxiety , depression , and positive affect ( P = 0.469 ) . The average of the overall scale  in the Swedish massage group decreased from 3.52 ± 0.65 to 2.42 ± 0.76 when compared to the pre-intervention conditions , and to ( P < 0.001 ) after the intervention . Moreover , the values for the control group were 3.41 ± 0.94 for the pre-intervention and 3.38 ± 0.9 after the intervention ( P = 0.620 ) . Conclusions When compared to the control group , the Swedish massage showed an improvement in the mood disorders of women with breast cancer Machine learning ( ML ) algorithms have proven highly accurate for identifying R and omized Controlled Trials ( RCTs ) but are not used much in practice , in part because the best way to make use of the technology in a typical workflow is unclear . In this work , we evaluate ML models for RCT classification ( support vector machines , convolutional neural networks , and ensemble approaches ) . We trained and optimized support vector machine and convolutional neural network models on the titles and abstract s of the Cochrane Crowd RCT set . We evaluated the models on an external data set ( Clinical Hedges ) , allowing direct comparison with traditional data base search filters . We estimated area under receiver operating characteristics ( AUROC ) using the Clinical Hedges data set . We demonstrate that  ML approaches better discriminate between RCTs and non‐ RCTs than widely used traditional data base search filters at all sensitivity levels ; our best‐performing model also achieved the best results to date for ML in this task ( AUROC 0.987 , 95 % CI , 0.984‐0.989 ) . We provide practical guidance on the role of ML in ( 1 ) systematic review s ( high‐sensitivity strategies ) and ( 2 ) rapid review s and clinical question answering ( high‐precision strategies ) together with recommended probability cutoffs for each use case . Finally , we provide open‐ source software to enable these approaches to be used in practice OBJECTIVE To investigate the effect of ambient music on anxiety and pain in men undergoing prostate biopsies . MATERIAL S AND METHODS Between September 2015 and June 2016 , men undergoing office transrectal prostate biopsy at our institution were r and omly assigned to music ( n = 85 ) or control ( n = 97 ) groups . We examined clinical characteristics , pathologic variables , and baseline anxiety using the Trait Instrument of State-Trait Anxiety Inventory . Primary outcomes included anxiety assessed by State Instrument of STAI ( STAI-S ) and pain using a visual analog scale . RESULTS There were no significant differences in baseline characteristics between the music and control groups , including median age , prostate-specific antigen , use of magnetic resonance imaging-guided biopsies , or Trait Instrument of State-Trait Anxiety Inventory . The majority ( 93 % ) of patients indicated they desired music in their prebiopsy survey . There were no significant differences in STAI-S ( 33.7 ± 8.9 vs 34.4 ± 9.9 , P = .6 ) , pain score ( 2.3 ± 2.1 vs 2.0 ± 2.1 , P = .3 ) , or vital signs between the music and control groups , respectively . There were also no differences in STAI-S , visual analog scale , or vital signs between groups when stratified by age , prostate-specific antigen , or number of previous biopsies . Men who received music were more likely to request music for future prostate biopsy , compared to men who did not ( 93 % vs 83 % , P = .07 , respectively ) . CONCLUSION This r and omized study showed no difference in anxiety or pain scores for patients who had ambient music during transrectal prostate biopsy . Future studies are needed to discern the influence of details including method of music delivery , music type , and utilization of adjunct relaxation tools OBJECTIVE The purpose of this study was to investigate the music therapy ( MT ) effect in levels of intraoperative anxiety in patients undergoing crossectomy with stripping of the great saphenous vein and to assess the efficacy , safety , and feasibility of this alternative therapy as a complement of st and ard intraoperative care . MATERIAL AND METHODS The study is a simple blind , controlled , parallel groups , prospect i ve r and omized clinical trial . Patients were allocated by means of r and omized controlled sampling . The study was performed in the surgery room of Getafe University Hospital in Madrid . The study was carried out in 40 patients , 20 r and omized to the experimental group and 20 r and omized to the control group , with an age range from 27 to 70 years . The control group was given intraoperative routine attention , and the experimental group was given an MT passive intervention that consisted of audition of musical fragments during varicose veins surgery . These pieces previously showed relaxing actions on the cardiovascular system . The anxiety levels were measured by means of pre- and postsurgical question naires by a blinded investigator for the study arm to which the patients had been r and omized . Heart rate and systolic and diastolic blood pressures were determined during the intervention , and adrenaline and noradrenaline plasma levels were determined before and after the surgical procedure . RESULTS The majority of the patients in the MT group ( 95 % ) and st and ard care group ( 90 % ) completed the study . There were no statistical differences between the control and experimental groups in heart rate gradient or systolic and diastolic blood pressures measured after the intervention . The anxiety state and the stress feeling scale score after surgery were significantly inferior in the MT group ( 94.7 % vs 57.9 % decrease in anxiety levels , P < .05 , and stress score of 1.31 vs 2.36 , P < .05 , respectively ) . The adverse events ratio was low and occurred with similar frequency in both groups . CONCLUSIONS The MT intervention was easily implemented in the context of nursing care received during varicose vein surgery and was positively accepted and valued by the majority of the patients . MT is a safe procedure that is proved to reduce anxiety and stress in the study patients PURPOSE / OBJECTIVES To measure the effectiveness of customized guided imagery for increasing comfort in women with early stage breast cancer . DESIGN Experimental longitudinal , r and om assignment to groups . SETTING Two urban radiation oncology departments . SAMPLE 53 women ( 26 in the experimental group , 27 in the control group ) aged 37 - 81 ; 80 % European and 10 % African American with stage I or II breast cancer about to begin radiation therapy . METHODS The experimental group was to listen to a guided imagery audiotape once a day for the duration of the study . The  Radiation Therapy Comfort Question naire was self-administered at three time points : prior to the introduction of intervention and the beginning of radiation therapy ( Time 1 ) , three weeks later ( Time 2 ) , and three weeks after completing radiation therapy ( Time 3 ) . The  State Anxiety Inventory  was administered at Time 1 only . MAIN RESEARCH VARIABLES The effect of use of guided imagery on comfort with anxiety as a control variable . FINDINGS Pooled data indicated a significant overall increase in differences in comfort between the treatment and control group , with the treatment group having higher comfort over time . The data also revealed a significant linear trend in differences between groups . No significant interaction of group and time existed . CONCLUSIONS Guided imagery is an effective intervention for enhancing comfort of women undergoing radiation therapy for early stage breast cancer . The intervention was especially salient in the first three weeks of therapy . IMPLICATION S FOR NURSING PRACTICE Guided imagery audiotapes specifically design ed for this population were re source effective in terms of cost , personnel , and time PURPOSE To evaluate the clinical efficacy , safety , and feasibility of implementing video glasses in a variety of interventional radiologic ( IR ) procedures . MATERIAL S AND METHODS Between August 2012 and August 2013 , 83 patients undergoing outpatient IR procedures were r and omized to a control group ( n = 44 ) or an experimental group outfitted with video glasses ( n = 39 ) . State-Trait Anxiety Inventory ( STAI ) scores , sedation and analgesia doses , mean arterial pressure ( MAP ) , heart rate ( HR ) , respiratory rate ( RR ) , pain scores , and procedure times were obtained . Complications and adverse events related to the use of video glasses were recorded . Postprocedural staff surveys and patient satisfaction surveys were completed . RESULTS Women had greater preprocedural anxiety than men ( P = .0056 ) , and patients undergoing vascular interventions had greater preprocedural anxiety than those undergoing nonvascular interventions ( P = .0396 ) . When assessed after the procedure , patients who wore video glasses had significantly reduced levels of anxiety ( -7.7 vs -4.4 , respectively ; P = .0335 ) and average MAP ( -6.3 vs 2.1 , respectively ; P = .0486 ) compared with control patients . There was no significant difference in amount of sedation and analgesia , HR , RR , pain score , or procedure time between groups . No significant adverse events related to the use of video glasses were observed . Postprocedural surveys showed that video glasses were not distracting and did not interfere or pose a safety issue during procedures . Patients enjoyed using the video glasses and would use them again for a future procedure . CONCLUSIONS Video glasses can be safely implemented during IR procedures to reduce anxiety and improve a patient 's overall experience PURPOSE To assess how patients ' underlying anxiety affects their experience of distress , use of re sources , and responsiveness toward nonpharmacologic analgesia adjunct therapies during invasive procedures . MATERIAL S AND METHODS Two hundred thirty-six patients undergoing vascular and renal interventions , who had been r and omized to receive during st and ard care treatment , structured empathic attention , or self-hypnotic relaxation  , were divided into two groups : those with low state anxiety scores on the State-Trait Anxiety Inventory ( STAI , scores < 43 ; n = 116 ) and those with high state anxiety scores ( > or = 43 ; n = 120 ) . All had access to patient-controlled analgesia with fentanyl and midazolam . Every 15 minutes during the procedure , patients rated their anxiety and pain on a scale of 0 - 10 ( 0 , no pain/anxiety at all ; 10 , worst possible pain/anxiety ) . Effects were assessed by analysis of variance and repeated- measures analysis . RESULTS Patients with high state anxiety levels required significantly greater procedure time and medication . Empathic attention as well as hypnosis treatment reduced procedure time and medication use for all patients . These nonpharmacologic analgesia adjunct treatments also provided significantly better pain control than st and ard care for patients with low anxiety levels . Anxiety decreased over the time of the procedure ; patients with high state anxiety levels experienced the most significant decreases in anxiety with nonpharmacologic adjuncts whereas patients with low state anxiety levels coped relatively well under all conditions . CONCLUSION Patients ' state anxiety level  is a predictor of trends in procedural pain and anxiety , need for medication , and procedure duration . Low and high state anxiety groups profit from the use of nonpharmacologic analgesia adjuncts but those with high state anxiety levels have the most to gain BACKGROUND / AIMS Colonoscopy is generally tolerated , some patients regarding the procedure as unpleasant and painful and generally performed with the patient se date d and receiving analgesics . The effect of sedation and analgesia for colonoscopy is limited . Aromatherapy is also applied to gastrointestinal endoscopy to reduce procedural anxiety . There is lack of information about aromatherapy specific for colonoscopy . In this study , we aim ed to performed a r and omized controlled study to investigate the effect of aromatherapy on relieve anxiety , stress and physiological parameters of colonoscopy . METHODOLOGY A r and omized controlled trail was carried out and collected in 2009 and 2010 . The participants were r and omized in two groups .  Aromatherapy was then carried out by inhalation of Sunflower oil ( control group ) and Neroli oil ( Experimental group ) . The anxiety index was evaluated by State Trait Anxiety Inventory-state ( STAI-S ) score before aromatherapy and after colonoscopy as well as the pain index for post-procedural by visual analogue scale ( VAS ) . Physiological indicators , such as blood pressure ( systolic and diastolic blood pressure ) , heart rate and respiratory rate were evaluated before and after aromatherapy . RESULTS Participates in this study were 27 subjects , 13 in control group and 14 in Neroli group with average age 52.26 + /- 17.79 years . There was no significance of procedural anxiety by STAI-S score and procedural pain by VAS . The physiological parameters showed a significant lower pre- and post-procedural systolic blood pressure in Neroli group than control group . CONCLUSIONS Aromatic care for colonoscopy , although with no significant effect on procedural anxiety , is an inexpensive , effective and safe pre-procedural technique that could decrease systolic blood pressure Patients scheduled for gastrointestinal procedures such as colonoscopy or esophagogastroduodenoscopy are often anxious and frightened . High levels of anxiety may result in more difficult and painful procedures . Past research has reported education , coping skills , relaxation techniques , and combinations of these including music , have decreased anxiety in patients across many setting s. Self-selected music therapy for preprocedural anxiety has not been studied . A r and omized controlled trial of 198 patients was undertaken to determine whether 15 minutes of self-selected music reduced preprocedure anxiety . The State Trait Anxiety Inventory was used to measure patients ’ anxiety .  One-hundred ninety-three men and 5 women comprised the sample with an average age of 61 ( SD 10.5 ) . Patients who listened to music ( n = 100 ) reduced their anxiety score from 36.7 ( SD 9.1 ) to 32.3 ( SD 10.4 ) , while those who did not listen to music ( n = 98 ) reduced their anxiety score from 36.1 ( SD 8.3 ) to 34.6 ( SD 11.5 ) . These differences were statistically significant ( F = 7.5 , p = .007 ) after controlling for trait anxiety . There were no significant vital sign changes premusic and postmusic . Music is a noninvasive nursing intervention that can significantly reduce patients ’ anxiety prior to gastrointestinal procedures . Further research should address using music to reduce anxiety in other procedure areas and testing effectiveness of self-selected versus investigator-selected music in reducing anxiety BACKGROUND Non-pharmacological behavioural adjuncts have been suggested as efficient safe means in reducing discomfort and adverse effects during medical procedures . We tested this assumption for patients undergoing percutaneous vascular and renal procedures in a prospect i ve , r and omised , single-centre study . METHODS 241 patients were r and omised to receive intraoperatively st and ard care ( n=79 ) , structured attention  ( n=80 ) ,  or self-hypnotic relaxation  ( n=82 ) . All had access to patient-controlled intravenous analgesia with fentanyl and midazolam . Patients rated their pain and anxiety on 0 - 10 scales before , every 15 min during and after the procedures . FINDINGS Pain increased linearly with procedure time in the st and ard group ( slope 0.09 in pain score/15 min , p<0.0001 ) , and the attention group ( slope 0.04/15 min ; p=0.0425 ) , but remained flat in the hypnosis group . Anxiety decreased over time in all three groups with slopes of -0.04 ( st and ard ) , -0.07 ( attention ) , and -0.11 ( hypnosis ) . Drug use in the st and ard group ( 1.9 units ) was significantly higher than in the attention and hypnosis groups ( 0.8 and 0.9 units , respectively ) . One hypnosis patient became haemodynamically unstable compared with ten attention patients ( p=0.0041 ) , and 12 st and ard patients ( p=0.0009 ) . Procedure times were significantly shorter in the hypnosis group ( 61 min ) than in the st and ard group ( 78 min , p=0.0016 ) with procedure duration of the attention group in between ( 67 min ) . INTERPRETATION Structured attention and self-hypnotic relaxation proved beneficial during invasive medical procedures . Hypnosis had more pronounced effects on pain and anxiety reduction , and is superior , in that it also improves haemodynamic stability Summary Background Intracardiac catheterization is a routine physical examination . Due to psychological strains , several psychosocial interventions , including music therapy , have been proposed . The aim of the present study was to examine whether the preventive or adjuvant use of music therapy results in a reduction in both subjective and objective anxiety and thus leads to a reduction in sedative medication . Methods of assessment N=83 patients ( 48 male , 35 female , 66±11 yrs ) waiting for scheduled cardiac catheterization were r and omly allocated to one of three groups : control group ( st and ard care ) , exposure group ( music stimulation during the procedure ) , or coaching group ( additional music therapeutic coaching ) . Target variables were subjective anxiety and physiological parameters . Results Music intervention did effectively reduce subjective anxiety ( STAI-S reduction pre-post : exposure 11 pt , coaching : 4 pt , control : 6 pt ; p=0.033 ) . Physiological values and medication did not differ between groups . Conclusion The use of music stimulation during the catheterization has a relaxing and calming effect on patients . It seems to be especially beneficial in a subgroup of patients with higher-than-average psychological strains This research study evaluates the effectiveness of distraction interventions on subject perceptions of discomfort or pain and anxiety during the ocular anesthetic injection prior to cataract surgery . Eighty subjects received either usual care , usual care with massage , usual care with verbal coaching and slow breathing , or usual care with massage and verbal coaching and slow breathing combined as different types of distraction interventions . After the ocular anesthetic injection(s ) , the subjects rated their level of experienced discomfort or pain and anxiety on a Likert scale of 0 to 10 . The statistical analyses revealed a significant reduction of discomfort or pain and anxiety when the distraction interventions were implemented during the ocular anesthetic injections . Because the different distraction interventions are effective , inexpensive , and easy to implement , routine use during ocular anesthetic injections , prior to cataract surgery , is recommended OBJECTIVE This paper describes a r and omized controlled single blind study testing the effects of a patient education intervention combined with positive therapeutic suggestions on anxiety for cataract surgery patients . METHODS 84 patients participated in the study .  Physiological and behavioral indicators of anxiety were compared between a regularly treated control and an intervention group receiving an audio CD containing information , relaxation , and positive imagery . RESULTS We found that the intervention group was calmer throughout the four measurement points of the study ( p=.004 ; d=0.71 ) and they were more cooperative ( p=.01 ; d=0.60 ) during the operation . The groups did not differ in sleep quality before the day of the operation , heart rate during the procedure , and subjective Well-being . CONCLUSION Findings indicate that preoperative information combined with positive suggestions and anxiety management techniques might reduce patient anxiety in the perioperative period of cataract surgery , but further research is needed to investigate the benefits of such interventions and to uncover the underlying mechanisms . PRACTICE IMPLICATION S Patient education interventions providing additional anxiety management techniques are recommended for use prior to cataract surgery Abstract Introduction Several studies evaluating the tolerance of transrectal ultrasound (TRUS)-guided needle biopsies showed that moderate-to-severe pain was associated with the procedure . Additionally , prebiopsy anxiety or rebiopsy as a result of a prior biopsy procedure is mentioned as factors predisposing to higher pain intensity . Thus , in this study , we investigated the effects of hypnotherapy during transrectal ultrasound-guided prostate needle biopsy for pain and anxiety . Material s and methods Sixty-four patients presenting for TRUS-guided prostate needle biopsy were r and omly assigned to receive either 10-min presurgery hypnosis session ( n = 32 , mean age 63.5 ± 6.1 , p = 0.289 ) or a presurgery control session ( n = 32 , mean age 61.8 ± 6.8 , p = 0.289 ) . The hypnosis session involved suggestions for increased relaxation and decreased anxiety . Presurgery pain and anxiety were measured using visual analog scales ( VAS ) , Beck Anxiety Inventory ( BAI ) , and Hamilton Anxiety Scale ( HAS ) , respectively . In our statistics , p < 0.05 was considered statistically significant . Results Postintervention , and before surgery , patients in the hypnosis group had significantly lower mean values for presurgery VAS [ mean 1 ( 0–8 ) ; p = 0.011 ] , BAI ( 6.0 vs 2.0 ; p < 0.001 ) , and HAS ( 11.0 vs 6.0 ; p < 0.001 ) . Conclusion The study results indicate that a brief presurgery hypnosis intervention can be an effective means of controlling presurgical anxiety , and therefore pain , in patients awaiting diagnostic prostate cancer surgery Patients scheduled for vascular angiography are often anxious and frightened . High levels of anxiety may result in more difficult and painful procedures . Past research has reported mixed results for anxiety reduction techniques in other procedures setting s , such as education , cognitive-behavioral skills , coping and relaxation skills , combinations of techniques , and music . Music as an intervention for pre-procedural anxiety prior to vascular angiography has not been studied . A r and omized controlled trial of 170 patients was undertaken to determine whether 15 minutes of self-selected music reduced pre-procedure anxiety . The State Trait Anxiety Inventory was used to measure patients ' anxiety .  One-hundred sixty-six men and 4 women comprised the sample with an average age of 66.8 years ( SD 9.95 , range 37 to 85 years ) . Patients who listened to music ( n=89 ) reduced their anxiety score from 38.57 ( SD 10.46 ) to 35.2 ( SD 9.7 ) , while those who did not listen to music ( n=81 ) reduced their anxiety score from 36.23 ( SD 10.54 ) to 35.1 ( SD 10.59 ) ; the difference between the groups was statistically significant ( t=1.95 , df 161 , p=0.05 ) . Pulse achieved a statistically significant reduction in the music group ( t=2.45 , df 167 , p=0.02 ) . Music is a noninvasive nursing intervention that patients enjoy and reduces their anxiety and their pulse rate . Further research should address using music to reduce anxiety in other interventional vascular angiography setting s with equal numbers of men and women and comparing self-selected versus investigator-selected music BACKGROUND Aromatherapy has been used to reduce anxiety in a variety of setting s , but usefulness associated with breast biopsies has not been documented . AIMS This study was conducted in women undergoing image-guided breast biopsy . We explored the use of two different aromatherapy scents , compared to placebo , aim ed at reducing anxiety with the intent of generating new knowledge . METHODS This was a r and omized , placebo-controlled study of two different types of external aromatherapy tabs ( lavender-s and alwood and orange-peppermint ) compared with a matched placebo-control delivery system .  Anxiety was self-reported before and after undergoing a breast biopsy using the Spielberger State Anxiety Inventory Scale . RESULTS AND FINDINGS Eighty-seven women participated in this study . There was a statistically significant reduction in self-reported anxiety with the use of the lavender-s and alwood aromatherapy tab compared with the placebo group ( p = .032 ) . Aromatherapy tabs reduced anxiety during image-guided breast biopsy . LINKING EVIDENCE TO ACTION The completion of the biopsy provided some relief from anxiety in all groups . The use of aromatherapy tabs offers an evidence -based nursing intervention to improve adaptation and reduce anxiety for women undergoing breast biopsy . Lavender-s and alwood aromatherapy reduced anxiety and promoted adaptation more than orange-peppermint aromatherapy or placebo The purpose was to investigate if women with high pre-procedural anxiety reported higher degree of relaxation and comfort if listening to music during coronary angiographic procedures . A prospect i ve r and omized controlled trial was used included 68 patients undergoing coronary angiography and /or PCI . The women were allocated to receive calming music and st and ard care or st and ard care only .  Relaxation , environmental sound and discomfort associated with lying still were assessed . There was significantly more positive impression of the sound environment and less discomfort associated with lying still in women listening to music in comparison to women who received only st and ard care . No effect in relaxation was found BACKGROUND AND PURPOSE The optimal treatment position for patients receiving radical radiation therapy for prostate cancer has been a source of controversy . To resolve this issue , we conducted a r and omized trial to evaluate the effects of supine and prone positioning on organ motion , positioning errors , and dose to critical organs during escalated dose conformal irradiation for localized prostate cancer and patient and therapist satisfaction with setup technique . PATIENTS AND METHODS Twenty eight patients were r and omized to commence treatment immobilized in the supine or prone position and were subsequently changed to the alternate positioning for the latter half of their treatment . Patients underwent CT simulation and conformal radiotherapy planning and treatment in both positions . The clinical target volume encompassed the prostate gl and . Alternate day lateral port films were compared to corresponding simulator radiographs to measure the isocentre positioning errors ( IPE ) . Prostate motion ( PM ) and total positioning error ( TPE ) were measured from the same films by the displacements of three implanted fiducial markers . Dose volume histograms ( DVHs ) for the two treatment positions were compared at the 95 , 80 and 50 % dose ( D% ) levels . The patients and radiation therapists completed weekly question naires regarding patient comfort and ease of setup . RESULTS Seven patients , who started in the supine position , subsequently refused prone position and received their whole treatment supine . Small bowel in the treatment volume , not present in the supine position , prevented one patient from being treated prone . PM in anterior posterior direction was statistically significantly less in the supine position ( P<0.05 ) . There was no significant difference in superior inferior PM for the two treatment positions . No statistically significant difference between supine and prone positioning was observed in isocentre positioning error ( IPE ) or total positioning error ( TPE ) due to a policy of daily pre-treatment correction . However , more pre-treatment corrections were required for patients in the prone position . The DVH analysis demonstrated larger volumes of the bladder wall , rectal wall and small bowel within the D95 , D80 and D50 % when comparing the planning target volumes ( PTVs ) actually treated for prone positioning . When the prone PTV was exp and ed to account for the greater PM encountered in that position , a statistically significant difference ( P<0.007 ) was observed in favour of the supine position at all dose levels . In the prone position , four patients had small bowel within the 60 Gray ( Gy ) isodose and in the supine position , no patients had small bowel in the 60 or 38Gy volumes . Supine position was significantly more comfortable for the patients and setup was significantly easier for the radiation therapists . The median patient comfort score was 0.79 ( St and ard deviation ( SD ) 0.03 ) supine and 0.45 ( SD 0.05 ) prone ( P<0.001 ) The therapist convenience of setup was 0.80 ( SD 0.016 ) supine and 0.54 ( SD 0.025 ) prone ( P<0.005 ) . No statistically significant difference was seen for the other parameters studied . CONCLUSIONS We demonstrated significantly less PM in the supine treatment position . There was no difference for either treatment position in IPE or TPE , however , more pre-treatment corrections were required in the prone position . Prone position required a larger PTV with result ing increased dose to critical organs . There were statistically significant improvements at all dose levels for small bowel , rectal wall and bladder wall doses in the supine position once corrections were made for differences in organ motion . Linear analogue scores of patient comfort and radiation therapist convenience demonstrated statistically significant improvement in favour of the supine position . Supine positioning has been adopted as the st and ard for conformal prostatic irradiation at our centre Background : A cardiac catheterization laboratory can be a frightening environment and music can be a supportive source of environmental sound that stimulates and maintains relaxation . Aim : To test the effects of patient focused music versus loudspeaker music versus st and ard sound on patient 's experiences of anxiety and well-being during coronary angiographic procedures . Methods : A prospect i ve , r and omized , controlled trial of 98 subjects undergoing elective coronary angiogram and /or percutaneous coronary intervention . The subjects were r and omly allocated to three different groups of sound environments : a control group ( the usual sound environment ) , a patient focused music group ( audio pillow ) or to a loudspeaker music group . Results : Anxiety decreased significantly and well-being increased significantly in the two music groups compared to the control group . There was a significantly more positive impression of the sound environment in the patient focused music group compared to the two other groups . Conclusion : This study showed that the use of a specially design ed music reduced anxiety and increased well-being in patients during coronary angiographic procedures . However , patient focused music seemed to be more preferable . The sound environment was rated more positively by the subjects listening to music via audio pillow . The music delivered via loudspeakers seemed to distract the staff during the examination at the cardiac catheterization laboratory OBJECTIVE To determine whether therapeutic touch administered at the time of stereotactic core biopsy of suspicious breast lesions results in a reduction in anxiety and pain . DESIGN R and omized , patient-blinded , controlled trial of either Krieger-Kunz therapeutic touch administered by a trained practitioner or a sham intervention mimicking therapeutic touch delivered during core biopsy . SETTING Stereotactic breast biopsy unit of a comprehensive breast center . PATIENTS Women with mammographically detected , nonpalpable breast lesions requiring biopsy . OUTCOME MEASURES Changes in pain and anxiety measured by visual analog scales immediately before and after stereotactic core biopsy . RESULTS A total of 82 patients were accrued : 42 received actual therapeutic touch and 40 sham therapeutic touch . No significant differences were found between the arms for age , ethnicity , educational background , or other demographic data . The sham arm had a preponderance of left breast biopsies ( 48 % vs 58 % ; P = 0.07 ) and received a slightly higher volume of epinephrine-containing local anesthetic ( 6.5 + /- 6.1 vs 4.5 + /- 4.5 mL ; P = 0.09 ) . Therapeutic touch patients were more likely to have an upper breast lesion location ( 57 % vs 53 % ; P = 0.022 ) . No significant differences between the arms were seen regarding postbiopsy pain ( P = 0.95 ) , anxiety ( P = 0.66 ) , fearfulness , or physiological parameters . Similarly , no differences were seen between the arms when change in parameters from prebiopsy to postbiopsy was considered for any of the psychological or physiological variables measured . These findings persisted when confounding variables were controlled for . CONCLUSIONS Women undergoing stereotactic core breast biopsy received no significant benefit from therapeutic touch administered during the procedure . Therapeutic touch can not be routinely recommended for patients in this setting Abstract Many patients experience some degree of anxiety during dermatologic procedures . A prospect i ve , r and omized-control trial of hypnotic induction followed by self-guided imagery was conducted with patients in 3 groups : live induction , recorded induction , or control . By 20 minutes into the procedure , there was significantly reduced anxiety reported in the live-induction group compared with the control , whereas reported anxiety in the recorded-induction group was similar to that of the control group . All 13 in the live induction , 11 of the 13 in the recorded induction , and none of the 13 in the control group imagined scenes . The findings of this study suggest that live hypnotic induction followed by self-guided imagery can help to reduce anxiety experienced by many patients during dermatologic procedures OBJECTIVES To determine the impact of music intervention on endothelial function , hemodynamics , and patient anxiety before , during , and after cardiac catheterization . BACKGROUND The effect of music therapy during cardiac catheterization on endothelial function and patient satisfaction has received limited study . METHODS Seventy patients undergoing elective cardiac catheterization were r and omized to music therapy ( n=36 ) or no music therapy ( n=34 ) . Peripheral arterial tonometry was performed before and after catheterization . A 6 item ( 24-point scale ) question naire evaluating patient anxiety and discomfort levels was also administered after the procedure . RESULTS Both study groups had similar baseline characteristics , fluoroscopy time , and contrast administration . Reactive hyperemia index ( RHI ) change was 0.14 ± 0.72 in the music group and 0.30 ± 0.58 in the control group ( P=.35 ) . Systolic and diastolic blood pressure ( BP ) changes did not significantly differ between the two groups ( systolic BP change -3.3 ± 17.3 mm Hg vs -2.3 ± 19.4 mm Hg ; P=.83 and diastolic BP change -1.9 ± 12.2 mm Hg vs. 2.0 ± 13.4 mm Hg ; P=.23 ) . Heart rate changes were also comparable between the two groups ( -1 ± 6 beats/ min vs -1 ± 7 beats/min ; P=.22 ) . Patient satisfaction question naire measurements were found to be similar in patients with and without music therapy ( 8 [ 7 - 11 ] vs 9 [ 8 - 12 ] ; P=.36 ) . CONCLUSIONS In this study , music intervention did not elicit a vasodilator response , did not lower blood pressure or heart rate , and did not relieve anxiety or stress discomfort in patients who underwent coronary angiography Several studies have evaluated music interventions prior and after coronary angiography and percutaneous coronary intervention ( PCI ) , but there is no clear evidence showing that music has an effect on patients during these procedures . The purpose was to investigate the effects of music on anxiety , angina , pain , relaxation , and comfort in patients during angiographic procedures and to evaluate gender differences . The study was a four-armed , prospect i ve r and omized controlled trial included 240 patients undergoing coronary angiography and /or PCI . Patients were allocated to receive relaxing music , MusiCure ® or st and ard care during the procedure . Outcome measures were ; puncture pain and the discomfort related to it , angina and the discomfort related to it , anxiety , experience of the sound environment , discomfort of lying still , and the doses of anxiolytics and analgesics during the procedure . No differences were found between the music and control groups regarding any of the trial endpoints or gender-related differences . The overall rating of the sound environment and feeling of relaxation was high . In conclusion , music intervention in patients undergoing angiographic procedures was highly feasible , but not effective in this study though the delivery of music went smoothly and did not disturb the examination and patients and staff alike looked favorably on it Screening flexible sigmoidoscopy ( FS ) is an effective tool for the detection of colon cancer . Nonetheless , persons are reluctant to undergo FS for a variety of reasons such as anxiety , discomfort , and the possibility of abnormal findings . Nurses caring for FS patients can implement interventions to allay anxiety and promote comfort in an effort to enhance satisfaction and future compliance . Music therapy is one nonpharmacologic intervention that has been shown to be effective in allaying anxiety , reducing discomfort , and promoting satisfaction in other patient population s. A two-group pretest , posttest experimental design with repeated measures study recruited 64 subjects undergoing FS from one Midwestern tertiary care center . Subjects were r and omly assigned to a control condition of usual procedural care or to an experimental condition of music therapy during the examination .  State and trait anxieties were measured at pretest . State anxiety , discomfort , satisfaction , and perceived compliance with future screening were measured after the procedure . Subjects in the music group reported less anxiety and discomfort than subjects in the control group . There were no differences on satisfaction ratings or perceived compliance with screening guidelines . Nurses caring for patients undergoing screening FS  can offer music therapy as one nonpharmacologic intervention to ameliorate anxiety and reduce discomfort BACKGROUND Minor surgery for ingrown toenails can provoke anxiety and the anaesthetic injection can be acutely painful . Distraction techniques may reduce the associated pain and anxiety . OBJECTIVE To investigate an audiovisual distraction ( Bedscapes ) on pain and anxiety during  minor surgery  for the correction of ingrown toenail . METHOD In a r and omised controlled trial , patients ( N=152 ) with ingrown toenails requiring surgical correction under local anaesthesia were allocated  to receive Bedscapes+st and ard care or st and ard care alone .  Pain levels due to local anaesthetic injection were assessed post-procedure , and anxiety levels were assessed pre- and post-procedure in both groups . Follow-up focus groups were conducted with 14 patients allocated to the Bedscapes group , and one-to-one interviews were held with four podiatrists . RESULTS Participants with high pre-procedure anxiety scores experienced greater pain on injection , and older patients reported lower pain than younger patients , regardless of group allocation . Bedscapes did not reduce pain or anxiety , and was apparently no more effective than interpersonal interaction between podiatry staff and the patient . CONCLUSIONS Pain of injected anaesthesia correlates closely with pre-operative anxiety . Formal audiovisual distraction has no added benefit over interpersonal interaction in the alleviation of pain and anxiety in patients undergoing nail surgery Background : Patients undergoing flexible bronchoscopy  usually experience anxiety before and during the procedure . Objectives : We performed this study to investigate whether verbal empathy and intentional touch from a bronchoscopist could reduce anxiety in patients undergoing flexible bronchoscopy .  Methods : We conducted a prospect i ve r and omized trial in a university-affiliated hospital . Participants were r and omly assigned to one of the following groups : a control group , a verbal empathy group , or a verbal empathy and touch group . The staff pulmonologist performing bronchoscopy expressed verbal empathy and used touch by speaking to the patient ( using predefined short statements ) and making eye contact , and by laying his/her left h and on the patient 's right shoulder . We assessed the level of patient anxiety with a visual analog scale before and after the intervention . Results : Participants were 267 patients with a median age of 65 years ; 62.2 % were men . Although there were no differences in changes in anxiety between the three groups , subgroup analysis of the visual analog scale including participants with higher baseline anxiety ( empathy and touch group participants with anxiety ≥60 mm ; empathy group and empathy and touch group participants with anxiety ≥70 mm ) showed a larger reduction in anxiety than the control group . Conclusions : Verbal empathy and touch given by a bronchoscopist before bronchoscopy reduced anxiety in patients with high baseline anxiety levels CONTEXT Despite major advances in cancer treatment , many patients undergo painful procedures during treatment and suffer debilitating side effects as well as report a decrease in quality of life ( QOL ) . This problem is exacerbated for low-income , racial , and ethnic minorities with cancer . Minority cancer patients often enter care with larger tumors and with a more aggressive disease , increasing the risk of debilitating symptoms , such as pain and anxiety . Research ers have never assessed the feasibility and effectiveness of offering massage therapy for low-income , underserved cancer patients who are undergoing port insertion . OBJECTIVE This study examined the feasibility of conducting a r and omized , controlled trial ( RCT ) that would assess the use of massage therapy to reduce pain and anxiety in urban patients with cancer who undergo surgical placement of a vascular access device ( port ) . The study also assessed the effectiveness of the intervention in reducing perioperative pain and anxiety . DESIGN The research team conducted a 9-month RC T of 60 cancer patients undergoing port placement . The research team r and omly assigned patients in a 2:1 ratio to usual care with massage therapy ( intervention group ) versus usual care with structured attention ( control group ) . SETTING The study took place at Boston Medical Center ( BMC ) , which is an urban , tertiary-referral , safety-net hospital . PARTICIPANTS Participants were cancer patients undergoing port placement . Sixty-seven percent were racial or ethnic minorities , and the majority were female and unemployed , with annual household incomes < $ 30 000 and publicly funded health insurance coverage . INTERVENTION For the intervention , an expert panel developed a reproducible , st and ardized massage therapy intended for individuals undergoing surgical port insertion . Both groups received 20-minute interventions immediately pre- and postsurgery . The research team collected data on pain and anxiety before and after the preoperative and postoperative interventions as well as 1 day after the surgery . OUTCOME MEASURES With respect to feasibility , the study examined ( 1 ) data about recruitment -- time to complete enrollment and proportion of racial and ethnic minorities enrolled ; ( 2 ) participants ' retention ; and ( 3 ) adherence to treatment allocation . The efficacy outcomes included measuring ( 1 ) participants ' average pain level using an 11-point numerical rating scale ( 0 = no pain to 10 = worst possible pain ) and ( 2 ) participants ' situational anxiety using the State-Trait Anxiety Inventory ( STAI ) . RESULTS The research team assigned the 60 patients to the groups over 53 weeks . Sixty-seven percent of the participants were racial or ethnic minorities . A majority were female and unemployed , with annual household incomes < $ 30 000 and publicly funded health insurance coverage . Of the 40 patients allocated to massage therapy , the majority ( n = 33 ) received both the pre- and postoperative interventions . Massage therapy participants had a statistically significant , greater reduction in anxiety after the first intervention compared with individuals receiving structured attention ( -10.27 vs -5.21 , P = .0037 ) . CONCLUSIONS Recruitment of low-income , minority patients into an RCT of massage therapy for perioperative pain and anxiety is feasible . Both massage therapy and structured attention proved beneficial for alleviating preoperative anxiety in cancer patients undergoing port placement Abstract Introduction Distress related to wearing an immobilisation mask for radiotherapy treatment ( RT ) is a common experience for the person undergoing RT for head and neck cancer ( HNC ) . Described as ‘ mask anxiety ’ , there is little known about the patterns of this distress through the course of the treatment or what strategies are being used by people to help alleviate mask anxiety . Methods The study used a prospect i ve cohort design to examine the patterns of patient – reported mask anxiety during the course of RT , using a modified Distress Thermometer ( DT ) and a survey to explore strategies patients used to assist their mask anxiety . Results Thirty‐five participants , who identified as experiencing mask anxiety , were followed throughout RT treatment . At baseline , females were more likely to experience higher mask anxiety ( P = 0.03 ) . Across the course of treatment , mask anxiety significantly ( P < 0.001 ) reduced within the total cohort . In 72 % of participants , the level of initial distress was found to reduce over time . Only 22 % experienced mask anxiety that remained constant . Few ( 6 % ) experienced an increase in mask anxiety across the course of RT . Participants reported relying on intervention from health professionals , self – taught strategies , music , visualisation and medication to manage their mask anxiety . Conclusions Due to its high prevalence and variable patterns over time , it is recommended that routine screening for mask anxiety be implemented as st and ard care throughout the course of RT for HNC . Multiple , diverse strategies are being used by patients and studies are needed to develop effective interventions for managing mask anxiety Pain and anxiety are closely associated with bone marrow aspirates and biopsies . To determine whether hypnosis administered concurrently with the procedure can ameliorate these morbidities , the authors r and omly assigned 80 cancer patients undergoing bone marrow aspirates and biopsies to either hypnosis or st and ard of care . The hypnosis intervention reduced the anxiety associated with procedure , but the difference in pain scores between the two groups was not statistically significant . The authors conclude that brief hypnosis concurrently administered reduces patient anxiety during bone marrow aspirates and biopsies but may not adequately control pain . The authors explain this latter finding as indicating that the sensory component of a patient 's pain experience may be of lesser importance than the affective component . The authors describe future studies to clarify their results and address the limitations of this study Bone marrow biopsy and aspiration are commonly used for diagnosing , treating , and following up after treatment for blood disorders and solid tumors . For adults , the infiltration of local anesthesia at the biopsy site has been used as the principal form of analgesia for bone marrow biopsy and aspiration .  Pain relief during these procedures is often incomplete , especially during aspiration of the bone marrow , and pain is likely to contribute to patient anxiety . Research ers at the Tabriz Hematology and Oncology Center in Iran conducted a study to quantify and evaluate the effectiveness of music therapy interventions on pain and anxiety control for 100 patients undergoing bone marrow biopsy and aspiration .  Participants in the study were r and omly assigned to one of two groups : one group listened to music during the procedure , and the other did not . Patients completed the  Spielberger State-Trait Anxiety Inventory  both before and after the procedure and reported pain severity by using a visual analog scale . Results showed that participants who listened to music had lower state anxiety and pain levels than those who did not listen to music The aim of this study was to test the effects of visual and audiovisual distraction on pain , anxiety , and procedure tolerance among patients undergoing colonoscopy . A prospect i ve , r and omized , controlled design was used with 180 consecutive patients who underwent colonoscopy . Subjects were r and omly allocated into 3 groups : Group A received visual distraction , Group B received audiovisual distraction , Group C with routine care . Outcome variables included pain , anxiety , and willingness to undergo colonoscopy again if the procedure was to be repeated . No significant difference was found on the pain scores of the 3 groups . However , when groups A and B were further divided into groups A1 , A2 , A3 ( low- , middle- , high-involvement groups ) , and B1 , B2 , B3 ( low- , middle- , high-involvement groups ) according to the level of distraction involvement , significant differences in pain scores were found between 7 groups ( A1 and A3 , A2 and A3 , A1 and B3 , A2 and B3 , A3 and C , B1 and B3 , B3 and C ) . The pain score of Group A3 was significantly lower than those of groups A1 , A2 , and C , and the pain score of Group B3 was significantly lower than those of groups B1 and C. The reduction of anxiety levels after procedure was insignificant between the 2 intervention groups and control group . The rates of willingness to undergo colonoscopy again if the procedure was to be repeated of the 2 intervention groups were significantly higher than that of the control group . Visual and audiovisual distraction is effective in promoting pain control for patients undergoing colonoscopy and improving their tolerance of the procedure STUDY OBJECTIVE To investigate the effects of music on anxiety and perception of pain  during office hysteroscopy . DESIGN Prospect i ve r and omized trial ( Canadian Task Force classification I ) . SETTING Major university medical center . INTERVENTIONS Three hundred fifty-six patients were enrolled between July 2012 and January 2013 .  Hysteroscopy was performed in a dedicated ambulatory room , using vaginoscopy and without any type of anesthesia . A Bettocchi hysteroscope 5 mm in diameter was used . All procedures were performed by the same surgeon , a gynecologist with special interest in hysteroscopy . MEASUREMENTS AND MAIN RESULTS Data collected included age , body mass index , number of vaginal deliveries , educational achievement level , and history of endometrial surgery ( curettage and /or hysteroscopy )  . For each patient , vital parameters such as blood pressure , heart rate , and respiratory rate were recorded 15 minutes before the procedure and during hysteroscopy after traversing the cervix . Wait time before surgery and the duration of the procedure were also recorded . A completed Italian version of the state anxiety question naire ( State-Trait Anxiety Inventory ) and a visual analog scale ( VAS ) were administered to each patient before and after the procedure . The t test and Mann-Whitney U test was used when appropriate to compare the 2 groups . Statistical significance was accepted at p = .05 . During surgery , systolic blood pressure and heart rate were significantly lower in the music group compared with the no music group . Women in the music group experienced significantly lower anxiety after hysteroscopy and less pain during the procedure , and a significant decrease in both anxiety and pain scores after hysteroscopy . Postoperative State-Trait Anxiety Inventory form Y1 and VAS scores were significantly lower in the music group . CONCLUSION Music can be useful as a complementary method to control anxiety and reduce perception of pain . The patient is more relaxed and experiences less discomfort OBJECTIVE This study examines the effects of listening to meditative music on state anxiety and heart rate variability ( HRV ) of patients during the uptake phase before positron emission tomography ( PET ) scans . METHODS A two-group r and omized experimental design was used . Eligible patients were r and omly assigned to either the experimental or control group . All patients received baseline assessment s of state anxiety using Spielberger State-Trait Anxiety Inventory ( STAI-S ) and HRV before receiving an intravenous injection of radiopharmaceutical fluorine-18 fludeoxyglucose in the uptake room . The experimental group ( n = 35 ) listened individually to 30 min of meditative music , integrating Chinese " Chi " and western frequency resonation in the uptake room . The control group ( n = 37 ) lay on bed quietly for 40 min in the uptake room without music . All patients were assessed for their anxiety level and HRV again , before receiving PET scanning as post-test . RESULTS The results indicated that patients in the experimental group showed a significant reduction in state anxiety and heart rate , and increase on high frequency norm of HRV ( p < 0.001 ) . There was a statistically significant reduction on anxiety level ( p < 0.001 ) , heart rate ( p < 0.001 ) and high frequency norm ( p = 0.001 ) in the experimental group compared with those of the control group . CONCLUSION Listening to meditative music as a non-invasive and cost-effective strategy can help maximize efforts to promote comfort and relaxation for patients awaiting stressful procedures , such as PET scans . Meditative music can be effective in alleviating state anxiety of patients during the uptake phase before PET scans . Advances in knowledge : The study provides scientific evidence of the effects of listening to meditative music for reducing state anxiety in patients during the uptake phase before PET scans . It may have the potential to lower the risk of unwanted false-positive fluorine-18 fludeoxyglucose uptake in normal organs and to further improve image quality and image interpretation . Listening to meditative music is a safe and inexpensive intervention which can be incorporated into routine procedures to reduce anxiety of patients undergoing PET scans PURPOSE To compare mean heart and left anterior descending coronary artery ( LAD ) doses ( NTDmean ) and positional reproducibility in larger-breasted women receiving left breast radiotherapy  using supine voluntary deep-inspiratory breath-hold ( VBH ) and free-breathing prone techniques . MATERIAL S AND METHODS Following surgery for early breast cancer , patients with estimated breast volumes > 750 cm(3 ) underwent  planning-CT scans in supine VBH and free-breathing prone positions . Radiotherapy treatment plans were prepared , and mean heart and LAD doses were calculated . Patients were r and omised to receive one technique for fractions 1 - 7 , before switching techniques for fractions 8 - 15 ( 40 Gy/15 fractions total ) . Daily electronic portal imaging and alternate-day cone-beam CT ( CBCT ) imaging were performed . The primary endpoint was the difference in mean LAD NTDmean between techniques . Population systematic ( Σ ) and r and om errors ( σ ) were estimated . Within-patient comparisons between techniques used Wilcoxon signed-rank tests . RESULTS 34 patients were recruited , with complete dosimetric data available for 28 . Mean heart and LAD NTDmean doses for VBH and prone treatments respectively were 0.4 and 0.7 ( p<0.001 ) and 2.9 and 7.8 ( p<0.001 ) . Clip-based CBCT errors for VBH and prone respectively were ⩽3.0 mm and ⩽6.5 mm ( Σ ) and ⩽3.5 mm and ⩽5.4 mm ( σ ) . CONCLUSIONS In larger-breasted women , supine VBH provided superior cardiac sparing and reproducibility than a free-breathing prone position
OBJECTIVES The aim of this review was to search existing literature to identify comfort interventions that can be used to assist an adult patient to undergo complex radiotherapy requiring positional stability for periods greater than 10 min .
The objectives of this review were to ; 1 ) identify comfort interventions used for clinical procedures that involve sustained inactivity similar to radiotherapy ; 2 ) define characteristics of comfort interventions for future practice ; and 3 ) determine the effectiveness of identified comfort interventions .