***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: AIM To evaluate the effect of a relaxing visual distraction alone on patient pain , anxiety , and satisfaction during colonoscopy . METHODS This study was design ed as an endoscopist-blinded r and omized controlled trial with 60 consecutively enrolled patients who underwent elective colonoscopy at Yokohama City University Hospital , Japan . Patients were r and omly assigned to two groups : group 1 watched a silent movie using a head-mounted display , while group 2 only wore the display . All of the colonoscopies were performed without sedation . We examined pain , anxiety , and the satisfaction of patients before and after the procedure using question naires that included the Visual Analog Scale . Patients were also asked whether they would be willing to use the same method for a repeat procedure . RESULTS A total of 60 patients were allocated to two groups . Two patients assigned to group 1 and one patient assigned to group 2 were excluded after the r and omization . Twenty-eight patients in group 1 and 29 patients in group 2 were entered into the final analysis . The groups were similar in terms of gender , age , history of prior colonoscopy , and pre-procedural anxiety score . The two groups were comparable in terms of the cecal insertion rate , the time to reach the cecum , the time needed for the total procedure , and vital signs . The median anxiety score during the colonoscopy did not differ significantly between the two groups ( median scores , 20 vs 24 ) . The median pain score during the procedure was lower in group 1 , but the difference was not significant ( median scores , 24.5 vs 42 ) . The patients in group 1 reported significantly higher median post-procedural satisfaction levels , compared with the patients in group 2 ( median scores , 89 vs 72 , P = 0.04 ) . Nearly three-quarters of the patients in group 1 wished to use the same method for repeat procedures , and the difference in rates between the two groups was statistically significant ( 75.0 % vs 48.3 % , P = 0.04 ) . Patients with greater levels of anxiety before the procedure tended to feel a painful sensation . Among patients with a pre-procedural anxiety score of 50 or higher , the anxiety score during the procedure was significantly lower in the group that received the visual distraction ( median scores , 20 vs 68 , P = 0.05 ) ; the pain score during the colonoscopy was also lower ( median scores , 23 vs 57 , P = 0.04 ) . No adverse effects arising from the visual distraction were recognized . CONCLUSION Visual distraction alone improves satisfaction in patients undergoing colonoscopy and decreases anxiety and pain during the procedure among patients with a high pre-procedural anxiety score Introduction Anxious patients can cause unexpected increases in healthcare costs that are often overlooked . There are no studies examining the use of an educational pamphlet and its effects on secondary outcomes at colonoscopy . The goal of this study was to determine if the use of an educational pamphlet lowers the anxiety levels before colonoscopy , and if its use has any effect on the quality of the prep or medication or the amount of medication use during the procedure . Methods We prospect ively enrolled 121 patients having a first-time screening colonoscopy . Patients were blinded and r and omized into two groups . One group received st and ard prep instructions only ( group P ) , and the other group received the American Gastroenterological Association colonoscopy educational pamphlet along with their prep instructions ( group I ) . All information was sent by mail 3 weeks before the procedure . The endoscopists were blinded as to which of their patients were in the study and of those , which were in the st and ard prep group or the intervention group . Anxiety was measured immediately before endoscopy using the State portion of the ‘ State Trait Anxiety Index ’ . Procedure-related information was recorded and analyzed at the end of the study using a statistical package looking at primary and secondary endpoints . Results Fifteen patients did not show their examination or were otherwise lost to follow-up . Of the 106 patients who completed the study , there were 55 patients in the P group and 51 in the I group . The average State Anxiety score of the P group was 45.18 , and of the I group was 40.54 ( P=0.014 ) . The use of Midazolam was significantly less in the group . The use of Meperidine was lower in the I group but the difference was not statistically significant . Both the groups took the same amount of time to complete the prep , but the I group fasted longer . The I group also completed or drank more of the prep more often than the P group . The prep quality was found to be superior with less frequency of a poor prep in the I group . Most important , the I group was more likely to have a complete colonoscopy . The I group tended to have fewer questions on the day of the procedure , and less fear about what to expect on the basis of their lower anxiety scores . Conclusion We found that providing the American Gastroenterological Association educational pamphlet to patients before colonoscopy lowers the overall anxiety level , provides a reduction in sedative use during the procedure , and leads to better colon preparation when given in addition to st and ard instructions Aim The aim of this research was to assess how the use of sedation during colonoscopy influences patient anxiety , fear , satisfaction , and acceptance of repeat examinations . Material s and methods A prospect i ve case – control study quantifying the anxiety and fears of patients appointed for colonoscopy  , comparing patients who had undergone previous colonoscopies with sedation ( cases ) with patients who had undergone previous colonoscopies without sedation and patients who had never had a colonoscopy before ( controls ) . Following the examination , patients answered a satisfaction survey and were asked whether they would be willing to undergo future colonoscopies . Results The study included 2016 patients ( average age 50.05±14.44 years ; 47 % men ) . Of these , 1270 patients ( 63 % ) were undergoing colonoscopy for the first time and 746 ( 37 % ) had undergone the procedure before ; in the latter group , 313 patients ( 42 % ) had been provided sedation  , whereas 433 ( 58 % ) had not . Patients who had been se date d for prior colonoscopies assigned significantly lower scores than patients who had undergone previous colonoscopies without sedation and those undergoing the procedure for the first time both in the anxiety survey ( 3.3±2.5 vs. 7.5±2.8 vs. 10.3±3.5 ; P<0.01 ) and in the fears survey ( 7.1±3.0 vs. 14±2.8 vs. 20.3±4.5 ; P<0.01 ) . Satisfaction survey scores were significantly higher among se date d patients than among nonse date d patients ( 22.8±2.7 vs. 18.6±2.3 ) . The percentage of se date d patients who would be willing to undergo colonoscopy again was significantly higher than that of nonse date d patients ( 70 vs. 25 % ; P<0.001 ) . Conclusion Sedation  reduces the anxiety and fear of undergoing a repeat colonoscopy and improves both patient satisfaction and the acceptability of future procedures Background : Participation in cancer screening programmes might cause worries in the population outweighting the benefits of reduced mortality . The present study aim ed to investigate possible psychological harm of participation in a  colorectal cancer ( CRC ) screening pilot in Norway . Methods : In a prospect i ve , r and omised trial participants ( aged 50–74 years ) were invited to either  flexible sigmoidoscopy ( FS ) screening , faecal immunochemical test ( FIT ) , or no screening ( the control group ; 1 : 1 : 1 ) . Three thous and two hundred and thirteen screening participants ( 42 % of screened individuals ) completed the Hospital Anxiety and Depression Scale question naire as well as the SF-12—a health-related quality of life ( HRQOL ) question naire when invited to screening and when receiving the screening result . A control group was invited to complete the question naires only . Two thous and six hundred and eighteen control participants ( 35 % of invited individuals ) completed the question naire . Results : A positive screening result did not increase participants ’ level of anxiety or depression , or decrease participants ’ level of HRQOL . Participants who received a negative result reported decreased anxiety and improvement on some HRQOL dimensions . However , no change was considered to be of clinical relevance . Conclusion : The current study showed no clinical ly relevant psychological harm of receiving a positive CRC screening result or of participating in FS or FIT screening , in a Norwegian population Introduction  Colonoscopy of asymptomatic , healthy individuals for colorectal cancer screening rarely causes complications and adverse events . Thus , quality of life ( QOL ) of the participants should not be affected by the procedure . Aim The aim of the study was to isolate the influence of colonoscopy , by investigation QOL before and after the procedure in a cohort of consecutive patients with different indications . Methods This study is a prospect i ve , longitudinal study , design ed to compare the potential influence of colonoscopy on QOL . For a cohort of consecutive patients undergoing colonoscopy for various reasons and indications , we filled a QOL short form-36 and a short feedback question naire before , immediately after , and a month after the procedure . We also measured the quality of the endoscopy , the outcome in patients , and acceptability among patients . Results There was no significant change before and immediately after colonoscopy in any of the short form-36 parameters . Physical functioning , role limitation physical , pain , general health , vitality , social functioning , role limitation mental , and mental health had very similar scores before and 2–3 h after the procedure . There was a decrease in the physical functioning a month after the procedure ( P=0.01 ) . The same was found for non-inflammatory bowel disease patients , but not for inflammatory bowel disease patients . Conclusion Colonoscopy did not affect QOL in the short or the long duration after the procedure . As such , colonoscopy may be suitable as a part of screening programs . We believe that QOL estimation should be an integral part of assessment of a screening program Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more BACKGROUND Endoscopy is a frequently applied operation in health institutions which may cause  anxiety  in patients . OBJECTIVE The objective of this study is to determine the effects of written educational material related to the endoscopy procedure on the anxiety level of the patient before gastrointestinal endoscopy . DESIGN A r and omised controlled trial design with two groups : case and control groups . PARTICIPANTS 140 patients assigned r and omly who applied for gastrointestinal endoscopy . METHODS INTERVENTION the control group in our study consisted of 70 people who were briefly informed by the relevant unit  about pre-endoscopy preparation . The case group consisted of 70 people who were also given brief information about the pre-endoscopy preparation by the relevant unit . Only the case group were also given written educational material and told orally by the research er about the content . MEASUREMENTS for the collection of the data , a question naire form and Spielberger 's State-Trait Anxiety Inventory were used . RESULTS A significant difference in the average state anxiety scores was found between the case and the control group ( p<0.05 ) . An important difference was found in the average state anxiety scores between the case and the control group who had not undergone endoscopy before our study ( p<0.05 ) . CONCLUSIONS Use of written material including detailed information to inform the patient before endoscopy was useful in lessening their anxiety level . Health professionals should evaluate the anxiety level of patients before endoscopy and educational material should be given to them to read BACKGROUND This study assessed the relationship between patient coping style , precolonoscopy information , and anxiety and pain associated with colonoscopy . METHODS Eighty consecutive adult patients undergoing initial colonoscopy were classified into two groups on the basis of coping style : information seekers or information avoiders . All were given st and ardized information about colonoscopy . Half of each group was r and omly assigned to receive additional sensory information describing what they could expect to feel . Self-report , physiologic , and behavioral indices of anxiety and pain were measured . RESULTS Patients given information congruent with coping style experienced significantly less self-report anxiety immediately after the information intervention and spent less time in recovery . In contrast , patients given information not congruent with coping style maintained their pre-intervention anxiety level . Patients given information congruent with coping style scored lower on behavioral indices of pain , but there were no differences with respect to patient perception of pain or the dosage of sedative drugs . Most patients reported that the bowel preparation was the most distressing part of the colonoscopy . CONCLUSIONS Assessment of coping style and provision of congruent information reduces anxiety , recovery time , and observed behavioral indices of pain of colonoscopy but has no effect on sedation dose or patient perception of pain BACKGROUND / AIMS Anxiety is a common problem in patients undergoing invasive medical procedures .  Colonoscopy is a dem and ing procedure and requires a patient 's good cooperation for successful results . We aim ed to examine the effects of adding an information video to our usual preprocedural information . MATERIAL S AND METHODS A total of 227 patients were assessed in this study ( 120 male , 107 female ) . The patients were divided into two groups as video ( n=124 ) or verbal ( n=103 ) . When the patients in the polyclinic with indications for colonoscopy were selected , a text about the procedure and related complications was given to them . A colonoscopy appointment was scheduled for the patients 3 - 4 weeks following the procedure . On the appointment day , the patients selected r and omly in groups of 10 as either verbal or video sections were taken into the communication room 1 - 5 hours before the procedure . The patients ' anxiety was measured afterwards using the Spielberger State-Trait Anxiety Inventory question naire . In addition , patients answered individual questions . After the colonoscopy , the patients were asked if they would undergo colonoscopy again for health reasons and whether 
    Output:
    
Female gender , higher baseline anxiety , functional abdominal pain , lower education , and lower income were associated with greater anxiety prior to colonoscopy .
: A large proportion of patients undergoing colonoscopy  report anxiety before the procedure .