***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Pre‐operative anxiety is common and often significant . Ambulatory surgery challenges our pre‐operative goal of an anxiety‐free patient by requiring people to be ‘ street ready ’ within a brief period of time after surgery . Recently , it has been demonstrated that music can be used successfully to relieve patient anxiety before operations , and that audio embedded with tones that create binaural beats within the brain of the listener decreases subjective levels of anxiety in patients with chronic anxiety states . We measured anxiety with the  State‐Trait Anxiety Inventory question naire and compared binaural beat audio ( Binaural Group ) with an identical soundtrack but without these added tones ( Audio Group ) and with a third group who received no specific intervention ( No Intervention Group ) . Mean [ 95 % confidence intervals ] decreases in anxiety scores were 26.3%[19–33 % ] in the Binaural Group ( p = 0.001 vs. Audio Group , p < 0.0001 vs. No Intervention Group ) , 11.1%[6–16 % ] in the Audio Group ( p = 0.15 vs. No Intervention Group ) and 3.8%[0–7 % ] in the No Intervention Group . Binaural beat audio has the potential to decrease acute pre‐operative anxiety significantly Many patients in the Surgical Holding Area become stressed and anxious . In a hospital setting music reduces patients '  anxiety . This study determined that music can reduce the anxiety and stress of patients in the Surgical Holding Area . In this study , one group of subjects listed to music while a second group did not . Subjects who listened to music while in the Surgical Holding Area had significantly less stress and anxiety than did those who did not listen to music . Both groups spent similar lengths of time in the Surgical Holding Area . The results strongly suggest that if music were available to all patients in the Surgical Holding Area , most would select this option , and they would experience less anxiety OBJECTIVE To compare the effects of two pediatric venipuncture distress-management distraction strategies that differed in the degree to which they required children 's interaction . METHODS Eighty-eight 1- to 7-year-old children receiving venipuncture were r and omly assigned to one of three treatment conditions : interactive toy distraction , passive movie distraction , or st and ard care .  Distress was examined via parent , nurse , self-report ( children over 4 years ) , and observational coding . Engagement in distraction was assessed via observational coding . RESULTS Children in the passive condition were more distracted and less distressed than children in the interactive condition . Although children in the interactive condition were more distracted than st and ard care children , there were no differences in distress between these groups . CONCLUSIONS Despite literature that suggests that interactive distraction should lower distress more than passive distraction , results indicate that a passive strategy might be most effective for children 's venipuncture . It is possible that children 's  distress interfered with their ability to interact with the distractor The anticipation of surgery has been recognized as a stressful event that produces anxiety for most patients ( Kapnoullas 1988 ) . Even minor surgical procedures can produce anxiety in patients ; this in turn can affect their postoperative recovery and lead to a risk of physiological complications ( Swindale 1989 ) . Thus , preoperative anxiety is identified as one of the common nursing diagnoses or problems for surgical patients OBJECTIVES Dental anxiety is common in children . This study sought to determine the impact of viewing positive images of dentistry prior to a dental appointment on the anticipatory dental anxiety levels of children attending for dental treatment . METHODS Controlled trial . Assessment of anxiety and analysis of data were conducted blind to experimental condition . Assessment of anxiety was carried out in the waiting room postintervention but before the patient entered the dental surgery for treatment . PARTICIPANTS Thirty-eight children and young adults attending a dental clinic in South West Engl and . INTERVENTION Participants were r and omly assigned to one of two conditions . In both conditions the participant was asked to look at photographs for 2 min in the waiting area prior to their appointment . The intervention consisted of viewing positive images of dentistry and dental treatment , the control condition consisted of dentally neutral images . Positive and neutral images were vali date d independently by four paediatric dentists . The assessment of anticipatory dental anxiety was made blind to experimental condition and statistical analysis was conducted blind to group membership . OUTCOME MEASURE Anticipatory anxiety assessed by the Venham Picture Test . FINDINGS A significant difference in anticipatory dental anxiety was found between the two groups ( median-positive images = 0 , median-neutral images = 3 ; P < 0.001 ) . Anticipatory anxiety was not correlated to age ( rho = 0.04 P > 0.05 ) , there was no difference between male and female participants in their level of anticipatory anxiety ( median-males = 0.5 , median-females = 1 P > 0.05 ) . CONCLUSIONS Viewing positive images of dentistry and dentists results in short-term reductions in anticipatory anxiety in children The aim of this study was to test how distraction influences pain , distress and anxiety in children during wound care . Sixty participants aged 5 - 12 years were r and omized to three groups : serious gaming , the use of lollipops and a control group .  Self-reported pain , distress , anxiety and observed pain behaviour were recorded in conjunction with wound care . Serious gaming , an active distraction , reduced the observed pain behaviour and self-reported distress compared with the other groups . A sense of control and engagement in the distraction , together , may be the explanation for the different pain behaviours when children use serious gaming AIMS AND OBJECTIVES To identify the effect of music on preprocedure anxiety levels of Hong Kong Chinese patients undergoing day procedures in a local community based hospital . DESIGN Pre and post-test quasi experimental design with non-r and om assignment . METHOD A total of 113 participants were assigned to the control group or intervention group depending on the day of their procedure . Participants ' anxiety levels were measured objective ly by comparing their vital signs and subjectively by the Spielberger State Trait Anxiety Scale . Participants ' physiological parameters ( blood pressure , pulse and respiration ) and State Trait Anxiety Scale were measured at two time periods . The control group undertook the usual relaxing activities provided in the waiting room compared with the intervention group who listened to music of their own choice in reclining chairs while waiting for the procedure . RESULTS The physiological parameters for both the control and intervention groups dropped significantly during the waiting period , however , only the intervention group had a significant reduction in reported anxiety levels . CONCLUSIONS These results suggest that providing self-selected music to day procedure patients in the preprocedure period assists in the reduction of physiological parameters and anxiety , yet , a relaxing environment can assist in the reduction of physiological parameters . RELEVANCE TO CLINICAL PRACTICE The administration of self-selected music to day procedure patients in the preprocedure period can be effective in the reduction of physiological parameters and anxiety Background . The induction of anesthesia is one of the most stressful moments for a child who must undergo surgery : it is estimated that 60 % of children suffer anxiety in the preoperative period . Preoperative anxiety is characterized by subjective feelings of tension , apprehension , nervousness , and worry . These reactions reflect the child ’s fear of separation from parents and home environment , as well as of loss of control , unfamiliar routines , surgical instruments , and hospital procedures . High levels of anxiety have been identified as predictors of postoperative troubles that can persist for 6 months after the procedure . Both behavioral and pharmacologic interventions are available to treat preoperative anxiety in children . Objective . The aim of this study was to investigate the effects of the presence of clowns on a child ’s preoperative anxiety during the induction of anesthesia and on the parent who accompanies him/her until he/she is asleep . Methods . The sample was composed of 40 subjects ( 5–12 years of age ) who had to undergo minor day surgery and were assigned r and omly to the clown group ( N = 20 )  , in which the children were accompanied in the preoperative room by the clowns and a parent , or the control group ( N = 20 ) , in which the children were accompanied by only 1 of his/her parents .  The anxiety of the children in the preoperative period was measured through the Modified Yale Preoperative Anxiety Scale instrument ( observational behavioral checklist to measure the state anxiety of young children ) , and the anxiety of the parents was measured with the State-Trait Anxiety Inventory ( Y-1/Y-2 ) instrument ( self-report anxiety behavioral instrument that measures trait/baseline and state/situational anxiety in adults ) . In addition , a question naire for health professionals was developed to obtain their opinion about the presence of clowns during the induction of anesthesia , and a self-evaluation form was developed to be filled out by the clowns themselves about their interactions with the child . Results . The clown group was significantly less anxious during the induction of anesthesia compared with the control group . In the control group there was an increased level of anxiety in the induction room in comparison to in the waiting room ; in the clown group anxiety was not significantly different in the 2 locations . The question naire for health professionals indicated that the clowns were a benefit to the child , but the majority of the staff was opposed to continuing the program because of perceived interference with the procedures of the operating room . The correlation between the scores of the form to self-evaluate the effectiveness of the clowns and of the Modified Yale Preoperative Anxiety Scale is significant for both the waiting room and induction room . Conclusions . This study shows that the presence of clowns during the induction of anesthesia , together with the child ’s parents , was an effective intervention for managing children ’s and parents ’ anxiety during the preoperative period . We would encourage the promotion of this form of distraction therapy in the treatment of children requiring surgery , but the resistance of medical personnel make it very difficult to insert this program in the activity of the operating room It is common clinical experience that anxiety about pain can exacerbate the pain sensation . Using event-related functional magnetic resonance imaging ( FMRI ) , we compared activation responses to noxious thermal stimulation while perceived pain intensity was manipulated by changes in either physical intensity or induced anxiety . One visual signal , which reliably predicted noxious stimulation of moderate intensity , came to evoke low anxiety about the impending pain . Another visual signal was followed by the same , moderate-intensity stimulation on most of the trials , but occasionally by discriminably stronger noxious stimuli , and came to evoke higher anxiety . We found that the entorhinal cortex of the hippocampal formation responded differentially to identical noxious stimuli , dependent on whether the perceived pain intensity was enhanced by pain-relevant anxiety . During this emotional pain modulation , entorhinal responses predicted activity in closely connected , affective ( perigenual cingulate ) , and intensity coding ( mid-insula ) areas . Our finding suggests that accurate preparatory information during medical and dental procedures alleviates pain by disengaging the hippocampus . It supports the proposal that during anxiety , the hippocampal formation amplifies aversive events to prime behavioral responses that are adaptive to the worst possible outcome OBJECTIVES To review the effect of lavender scent on anticipatory anxiety in dental participants . METHODS In a cluster r and omized-controlled trial , patients ' ( N = 340 ) anxiety was assessed while waiting for a scheduled dental appointment , either under the odor of lavender or with no odor .  Current anxiety , assessed by the brief State Trait Anxiety Indicator ( STAI-6 ) , and generalized dental anxiety , assessed by the Modified Dental Anxiety Scale ( MDAS ) were examined . RESULTS Analyses of variance ( anovas ) showed that although both groups showed similar , moderate levels of generalized dental anxiety ( MDAS F((1,338 ) ) = 2.17 , P > 0.05 ) the lavender group reported significantly lower current anxiety ( STAI : F((1,338 ) ) = 74.69 , P < 0.001 ) than the control group . CONCLUSIONS Although anxiety about future dental visits seems to be unaffected , lavender scent reduces state anxiety in dental patients CONTEXT Interest in the use of alternative therapies to reduce anxiety in patients undergoing medical interventions is increasing . We sought to assess the effectiveness of aromatherapy involving essential oils in reducing preoperative anxiety in women undergoing abortions . SETTING An urban , free-st and ing abortion clinic in Vancouver , BC . PATIENTS 66 women waiting for surgical abortions . DESIGN A double blind , r and omized trial . INTERVENTION Ten minutes spent sniffing a numbered container with either a mixture of the essential oils vetivert , bergamot , and geranium ( treatment arm ) or a hair conditioner ( placebo ) . OUTCOME MEASURES Anxiety was measured before and after the intervention by using a verbal anxiety scale from 0 to 10 . RESULTS The anxiety score was reduced by 1.0 point ( 5.0 to 4.0 ) in the aromatherapy group and by 1.1 points ( 6.1 to 5.0 ) in the placebo group ( P = 0.71 ) . The 95 % CI on the 0.1 greater decrease in anxiety for the placebo group extends from 0.55 less ( favors aromatherapy ) to 0.75 greater ( favors placebo ) . CONCLUSION Aromatherapy involving essential oils is no more effective than having patients sniff other pleasant odors in reducing preprocedure anxiety BACKGROUND Stress and anxiety during pregnancy have been associated with premature and low birth weight babies , presumably through fetus over exposion to glucocorticoids . Antenatal stress also seems to have long-term effects upon infant development and adult health . However , medication for stress may carry risks to the expectant mother , therefore the efficacy of non-pharmacological interventions should be investigated . METHODS Pregnant women ( n=15 
    Output:
    
For children , insufficient evidence is available to corroborate the effectiveness of play opportunities , media distractions , and music for mitigating anxiety in children awaiting medical procedures .
CONCLUSIONS : Music is a well-established means of decreasing anxiety in adult patients awaiting medical interventions .
The effect of music on children ’s anxiety  is not known .