human
***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: M eeting the anesthesiologist is one of the surgical patient ’s highest priorities preoperatively ( l ) , and several reports document that this interaction reduces patient anxiety ( 2 - 4 ) . High anxiety may be associated with poorer surgical outcome ( 5 ) , whereas improved patient education is associated with increased patient satisfaction ( 6 ) and improved clinical outcome ( 7 ) . Video instruction may supplement conventional instruction techniques for general medical patients ( 8) and aid in obtaining informed consent ( 9 ) . No study has specifically evaluated an instructional video about anesthesia as a tool for educating surgical patients about their upcoming anesthetic and facilitating the anesthesiologist-patient relationship . The hypothesis of this study is that viewing an anesthesia preoperative video will improve patient knowledge and patient perception of the upcoming anesthetic and surgery compared to a st and ard preoperative interview without video instruction Background : The objective of the present study was to develop and evaluate the effects of a preparatory videotape on endocrine stress responses of patients prior to cardiac surgery and to analyze patient acceptance of this video for preoperative preparation We sought to determine whether an extensive behavioral preparation program for children undergoing surgery is more effective than a limited behavioral program . The primary end point was  child and parent anxiety during the preoperative period . Secondary end points included behavior of the child during the induction of anesthesia and the postoperative recovery period . Several days before surgery , children ( n = 75 ) aged 2 - 12 yr r and omly received either an information-based program ( OR tour ) , an information + modeling-based program ( OR tour + videotape ) , or an information + modeling + coping-based program ( OR tour + videotape + child-life preparation ) . Using behavioral and physiological measures of anxiety , we found that children who received the extensive program exhibited less anxiety immediately after the intervention , in the holding area on the day of surgery , and on separation to the operating room . These findings , however , achieved statistical significance only in the holding area on the day of surgery ( 44[10 - 72 ] vs 32[8 - 50 ] vs 9[6 - 33 ] ; P = 0.02 ) . Similarly , parents in the extensive program were significantly less anxious on the day of surgery in the preoperative holding area , as assessed by behavioral ( P = 0.015 ) and physiological measures ( P = 0.01 ) . In contrast , no differences were found among the groups during the induction of anesthesia , recovery room period , or 2 wk postoperatively . We conclude that children and parents who received the extensive preoperative preparation program exhibited lower levels of anxiety during the preoperative period , but not during the intraoperative or postoperative periods . Implication s : The extensive behavioral preoperative program that we undertook had limited anxiolytic effects . These effects were localized to the preoperative period and did not extended to the induction of anesthesia or the postoperative recovery period . ( Anesth Analg 1998;87:1249 - 55 STUDY OBJECTIVE To investigate the effectiveness of a structured preoperative education program in patients receiving patient-controlled analgesia ( PCA ) . DESIGN R and omized controlled trial . SETTING University-affiliated hospital . PATIENTS 60 ASA physical status I and II women undergoing major gynecologic surgery . INTERVENTIONS Patients were r and omly allocated to receive either st and ard information given during routine preanesthetic assessment ( n = 30 ) or additional structured preoperative education on the use of PCA ( n = 30 ) . MEASUREMENTS All patients received st and ard anesthesia and PCA was provided for postoperative analgesia . Patients were review ed bid by an independent team of pain specialists and nurses . Patient satisfaction , severity of postoperative pain , nausea , dizziness , and morphine consumption were measured at discharge from recovery room , 24 , and 48 hours after operation . Recovery characteristics of patients were also measured . MAIN RESULTS Pain scores and morphine consumption decreased over time ( p < 0.01 ) , but there was no significant difference between groups . The overall analgesic efficacy , side effects , and recovery times was not affected by the education program . Patient satisfaction in the education group was better than control during early recovery ( p= 0.03 ) , but there was no additional benefit in the remaining postoperative period . CONCLUSIONS Structured preoperative PCA education did not affect patient outcome . The early improvement in patient satisfaction was minimized by continued education and pain team supervision during the rest of the postoperative period UNLABELLED The purpose of this study was to determine whether larger doses of anesthetics are required in the anxious patient to establish and maintain a clinical ly sufficient hypnotic component of the anesthetic state . Fifty-seven women undergoing bilateral laparoscopic tubal ligation with a propofol-based anesthetic regimen  were enrolled in this cross-sectional study . Trait ( baseline ) and state ( situational ) anxiety were assessed in all patients immediately before surgery , and the propofol doses required for the induction and maintenance of anesthesia were recorded . A  bispectral index monitor was used to assure that the hypnotic component of the anesthetic state was the same in all patients . We found that patients with high trait anxiety required more propofol for both the induction ( 2.1+/-0.4 vs 1.8+/-0.3 mg/kg ; P = 0.01 ) and maintenance of anesthesia ( 170+/-70 vs 110+/-20 microg x kg(-1 ) x min(-1 ) ; P = 0.02 ) , compared with patients with low trait anxiety . State anxiety , however , was not found to affect the propofol doses required for the induction or maintenance of anesthesia . Multiple regression models confirmed that Trait anxiety is an independent predictor for intraoperative propofol requirements ( P = 0.02 ) . We conclude that increased baseline ( i.e. , trait ) anxiety is associated with increased intraoperative anesthetic requirements . Thus , we suggest that the initial dose of anesthetic administered by an anesthesiologist should be modified based on the anxiety level exhibited by the patient . IMPLICATION S The goal of this study was to assess the relationship between preoperative anxiety and intraoperative anesthetic requirements . We found that high baseline anxiety predicts increased intraoperative anesthetic requirements . We suggest that anesthesiologists should modify the initial induction dose based on the anxiety level exhibited by the patient This study examined the effect of structured preoperative teaching  on patients ' underst and ing of patient-controlled analgesia ( PCA ) and their management of pain . The experimental group received a written pamphlet and structured preoperative teaching on the use of PCA to manage their pain . The control group received the usual preoperative preparation normally provided by the physician . Both groups were later asked to complete a posttest to determine how well they understood the use of PCA  and how well they managed their pain . There was no statistically significant evidence that the experimental group 's knowledge of PCA  was different from that of the control group . However , there was significant evidence that the experimental group managed their pain better Fear and anxiety in a child undergoing surgery are correlated positively with the parent 's level of anxiety , and interventions to decrease the parent 's anxiety are appropriate . The purpose of this study was to determine whether viewing a video of an actual pediatric inhalation induction would reduce the level of parental anxiety . Eighty patients requiring an inhalation anesthetic induction were selected and r and omized to 2 groups . Parents in the experimental group ( group 1 ; n = 40 ) viewed a video demonstrating pediatric mask induction . Parents in the control group ( group 2 ; n = 40 ) received an information pamphlet only .  Anxiety was measured perioperatively in the parents and their children . Mean arterial pressure for children in group 1 was significantly lower during preoperative holding and following induction ( P < .05 ) . The level of anxiety postoperatively of children and parents in group 1 was significantly lower than that of children and parents in group 2 ( P < .05 ) . Viewing a preoperative video seems to be beneficial . Decreasing the parent 's level of anxiety preoperatively may have a positive effect on the child 's level of anxiety expressed postoperatively A psychological preparation programme was developed for outpatient surgery in children . The purpose of this study was to determine if the programme could increase retrieval of information and reduce anxiety prior to ENT surgery . After ethical committee approval , 160 children and their parents were included . Eighty children ( group 1 ) received conventional verbal information from an ENT nurse , and another 80 children ( group 2 ) received specific information , including role-play , from a nurse anaesthetist at a preadmission visit . Children 's and parents ' experience of premedication , operation theatre ( OR ) , i.v.-needle insertion and induction of anaesthesia were evaluated from a self-rating question naire . The question naire included ratings for anxiety and satisfaction with information and care . The results indicate a clear improvement of the preoperative acquisition of knowledge in all age groups . When it comes to alleviation of fear , a positive effect of the preparation programme was noticed , especially among the younger children ( < 5 years ) , while preoperative anxiety overall was a significantly smaller problem among the older children . The effects of the programme were also related to previous experience of anaesthesia and most beneficial among young children with such experience . Overall , the most negative procedure reported by the children was the i.m . injection for premedication ( a routine which was ab and oned as a result of the study ) , followed by the insertion of the i.v . -needle . The parents experienced watching their child fall asleep during induction of anaesthesia as most negative , followed by the insertion of the i.v.-needle . Parents also reported more satisfaction and less anxiety after having received specific information and preparation preoperatively . It was concluded that this preoperative preparation programme is useful in all age groups with regard to information , while alleviation of anxiety and fear was seen mainly among the younger children with previous experience of anaesthesia We developed and introduced into clinical practice a leaflet to improve the delivery of information to patients before obtaining their consent to anaesthesia . The amount of information needs to be what a “ reasonable ” patient thinks appropriate ; therefore we tested patients ’ responses to three levels of information : “ full ” disclosure , “ st and ard ” disclosure ( as contained in our leaflet ) and “ minimal ” disclosure .  Forty-five patients scheduled to undergo cardiac surgery were enrolled in the study . None of the information sheets caused a significant change in state anxiety score and only the “ full ” disclosure significantly increased knowledge about anaesthesia ( P=0.016 ) . All leaflets were easy to underst and . When only one leaflet was provided 64–73 % of patients thought the content was “ just right ” , whereas when all three leaflets were viewed together , 63 % of patients thought the “ minimal ” leaflet withheld too much information In a r and omized controlled trial at Duke University and University of North Carolina Hospitals , 143 two to six year old children undergoing elective ambulatory surgery were r and omized into a control group who received routine preoperative teaching or an intervention group who received an interactive teaching book .  Changes in behaviour were measured by a Vernon behavioural question naire preoperatively and again two weeks postoperatively . A Global Mood Score was assessed in the preoperative holding area , at arrival into the operating room , and at the time of mask induction . The children in the control group were significantly more aggressive postoperatively than the intervention group ( P < 0.05 ) . Children who received the interactive teaching book exhibited higher levels of anxiety on the day of surgery , but fewer behavioural changes two weeks following surgery . Parents in the intervention group reported that preoperative teaching helped their child ( 87 % ) and themselves ( 83 % ) UNLABELLED Pediatric pain management often depends on parents recognition and assessment of their child 's pain and their beliefs as to whether the pain should be treated . Parental misconceptions concerning pain assessment and pain management may therefore result in inadequate pain treatment , particularly in patients who are too young or too developmentally h and icapped to self-report their pain . We hypothesized that viewing a concise , educational videotape would provide parents with instructive information that could correct misconceptions concerning pain and pain management in children . To do this , we evaluated the impact of an educational videotape on parental responses to a question naire about pediatric pain management . Parents of children scheduled for inpatient , postoperative hospital care were studied . After answering 30 questions , parents were r and omly assigned to either view ( Group 1 ) or not view ( Group 2 ) a 19-min educational videotape . Immediately after viewing the videotape ( Group 1 ) , or 30 min after taking the first test ( Group 2 ) , parents were asked to answer the same question naire a second time . The effect of seeing the videotape was assessed by comparing post-pre test score differences using paired t-test . One-hundred parents were studied . R and omization was effective in assigning equitable groups . Initial scores of percent answers correct in each group were not different ( [ mean + /- SD ] Group 1 [ n = 50 ] : 68.7 % + /- 18.8 % vs Group 2 [ n = 50 ] : 61.5 % + /- 22.7 % ; P = 0.09 ) . Viewing the videotape effectively increased test scores : paired t-test within groups demonstrated a significant difference in Group 1 ( 22.4 % + /- 16.5 % , P < 0.0001 ) , whereas Group 2 scores changed to a much lesser degree ( 2.7 % + /- 8.3 % , P = 0.0271 ) . All parents who viewed the videotape stated that it was informative regarding their underst and ing of their child 's pain management . This study demonstrates the effectiveness of an educational videotape in changing parental knowledge concerning postoperative pediatric pain . This effective and efficient teaching medium may be useful in improving pain management in postoperative pediatric surgical patients . IMPLICATION S Pediatric pain management often depends on parents recognition and assessment of their child 
    Output:
    
agent
***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: M eeting the anesthesiologist is one of the surgical patient ’s highest priorities preoperatively ( l ) , and several reports document that this interaction reduces patient anxiety ( 2 - 4 ) . High anxiety may be associated with poorer surgical outcome ( 5 ) , whereas improved patient education is associated with increased patient satisfaction ( 6 ) and improved clinical outcome ( 7 ) . Video instruction may supplement conventional instruction techniques for general medical patients ( 8) and aid in obtaining informed consent ( 9 ) . No study has specifically evaluated an instructional video about anesthesia as a tool for educating surgical patients about their upcoming anesthetic and facilitating the anesthesiologist-patient relationship . The hypothesis of this study is that viewing an anesthesia preoperative video will improve patient knowledge and patient perception of the upcoming anesthetic and surgery compared to a st and ard preoperative interview without video instruction Background : The objective of the present study was to develop and evaluate the effects of a preparatory videotape on endocrine stress responses of patients prior to cardiac surgery and to analyze patient acceptance of this video for preoperative preparation We sought to determine whether an extensive behavioral preparation program for children undergoing surgery is more effective than a limited behavioral program . The primary end point was  child and parent anxiety during the preoperative period . Secondary end points included behavior of the child during the induction of anesthesia and the postoperative recovery period . Several days before surgery , children ( n = 75 ) aged 2 - 12 yr r and omly received either an information-based program ( OR tour ) , an information + modeling-based program ( OR tour + videotape ) , or an information + modeling + coping-based program ( OR tour + videotape + child-life preparation ) . Using behavioral and physiological measures of anxiety , we found that children who received the extensive program exhibited less anxiety immediately after the intervention , in the holding area on the day of surgery , and on separation to the operating room . These findings , however , achieved statistical significance only in the holding area on the day of surgery ( 44[10 - 72 ] vs 32[8 - 50 ] vs 9[6 - 33 ] ; P = 0.02 ) . Similarly , parents in the extensive program were significantly less anxious on the day of surgery in the preoperative holding area , as assessed by behavioral ( P = 0.015 ) and physiological measures ( P = 0.01 ) . In contrast , no differences were found among the groups during the induction of anesthesia , recovery room period , or 2 wk postoperatively . We conclude that children and parents who received the extensive preoperative preparation program exhibited lower levels of anxiety during the preoperative period , but not during the intraoperative or postoperative periods . Implication s : The extensive behavioral preoperative program that we undertook had limited anxiolytic effects . These effects were localized to the preoperative period and did not extended to the induction of anesthesia or the postoperative recovery period . ( Anesth Analg 1998;87:1249 - 55 STUDY OBJECTIVE To investigate the effectiveness of a structured preoperative education program in patients receiving patient-controlled analgesia ( PCA ) . DESIGN R and omized controlled trial . SETTING University-affiliated hospital . PATIENTS 60 ASA physical status I and II women undergoing major gynecologic surgery . INTERVENTIONS Patients were r and omly allocated to receive either st and ard information given during routine preanesthetic assessment ( n = 30 ) or additional structured preoperative education on the use of PCA ( n = 30 ) . MEASUREMENTS All patients received st and ard anesthesia and PCA was provided for postoperative analgesia . Patients were review ed bid by an independent team of pain specialists and nurses . Patient satisfaction , severity of postoperative pain , nausea , dizziness , and morphine consumption were measured at discharge from recovery room , 24 , and 48 hours after operation . Recovery characteristics of patients were also measured . MAIN RESULTS Pain scores and morphine consumption decreased over time ( p < 0.01 ) , but there was no significant difference between groups . The overall analgesic efficacy , side effects , and recovery times was not affected by the education program . Patient satisfaction in the education group was better than control during early recovery ( p= 0.03 ) , but there was no additional benefit in the remaining postoperative period . CONCLUSIONS Structured preoperative PCA education did not affect patient outcome . The early improvement in patient satisfaction was minimized by continued education and pain team supervision during the rest of the postoperative period UNLABELLED The purpose of this study was to determine whether larger doses of anesthetics are required in the anxious patient to establish and maintain a clinical ly sufficient hypnotic component of the anesthetic state . Fifty-seven women undergoing bilateral laparoscopic tubal ligation with a propofol-based anesthetic regimen  were enrolled in this cross-sectional study . Trait ( baseline ) and state ( situational ) anxiety were assessed in all patients immediately before surgery , and the propofol doses required for the induction and maintenance of anesthesia were recorded . A  bispectral index monitor was used to assure that the hypnotic component of the anesthetic state was the same in all patients . We found that patients with high trait anxiety required more propofol for both the induction ( 2.1+/-0.4 vs 1.8+/-0.3 mg/kg ; P = 0.01 ) and maintenance of anesthesia ( 170+/-70 vs 110+/-20 microg x kg(-1 ) x min(-1 ) ; P = 0.02 ) , compared with patients with low trait anxiety . State anxiety , however , was not found to affect the propofol doses required for the induction or maintenance of anesthesia . Multiple regression models confirmed that Trait anxiety is an independent predictor for intraoperative propofol requirements ( P = 0.02 ) . We conclude that increased baseline ( i.e. , trait ) anxiety is associated with increased intraoperative anesthetic requirements . Thus , we suggest that the initial dose of anesthetic administered by an anesthesiologist should be modified based on the anxiety level exhibited by the patient . IMPLICATION S The goal of this study was to assess the relationship between preoperative anxiety and intraoperative anesthetic requirements . We found that high baseline anxiety predicts increased intraoperative anesthetic requirements . We suggest that anesthesiologists should modify the initial induction dose based on the anxiety level exhibited by the patient This study examined the effect of structured preoperative teaching  on patients ' underst and ing of patient-controlled analgesia ( PCA ) and their management of pain . The experimental group received a written pamphlet and structured preoperative teaching on the use of PCA to manage their pain . The control group received the usual preoperative preparation normally provided by the physician . Both groups were later asked to complete a posttest to determine how well they understood the use of PCA  and how well they managed their pain . There was no statistically significant evidence that the experimental group 's knowledge of PCA  was different from that of the control group . However , there was significant evidence that the experimental group managed their pain better Fear and anxiety in a child undergoing surgery are correlated positively with the parent 's level of anxiety , and interventions to decrease the parent 's anxiety are appropriate . The purpose of this study was to determine whether viewing a video of an actual pediatric inhalation induction would reduce the level of parental anxiety . Eighty patients requiring an inhalation anesthetic induction were selected and r and omized to 2 groups . Parents in the experimental group ( group 1 ; n = 40 ) viewed a video demonstrating pediatric mask induction . Parents in the control group ( group 2 ; n = 40 ) received an information pamphlet only .  Anxiety was measured perioperatively in the parents and their children . Mean arterial pressure for children in group 1 was significantly lower during preoperative holding and following induction ( P < .05 ) . The level of anxiety postoperatively of children and parents in group 1 was significantly lower than that of children and parents in group 2 ( P < .05 ) . Viewing a preoperative video seems to be beneficial . Decreasing the parent 's level of anxiety preoperatively may have a positive effect on the child 's level of anxiety expressed postoperatively A psychological preparation programme was developed for outpatient surgery in children . The purpose of this study was to determine if the programme could increase retrieval of information and reduce anxiety prior to ENT surgery . After ethical committee approval , 160 children and their parents were included . Eighty children ( group 1 ) received conventional verbal information from an ENT nurse , and another 80 children ( group 2 ) received specific information , including role-play , from a nurse anaesthetist at a preadmission visit . Children 's and parents ' experience of premedication , operation theatre ( OR ) , i.v.-needle insertion and induction of anaesthesia were evaluated from a self-rating question naire . The question naire included ratings for anxiety and satisfaction with information and care . The results indicate a clear improvement of the preoperative acquisition of knowledge in all age groups . When it comes to alleviation of fear , a positive effect of the preparation programme was noticed , especially among the younger children ( < 5 years ) , while preoperative anxiety overall was a significantly smaller problem among the older children . The effects of the programme were also related to previous experience of anaesthesia and most beneficial among young children with such experience . Overall , the most negative procedure reported by the children was the i.m . injection for premedication ( a routine which was ab and oned as a result of the study ) , followed by the insertion of the i.v . -needle . The parents experienced watching their child fall asleep during induction of anaesthesia as most negative , followed by the insertion of the i.v.-needle . Parents also reported more satisfaction and less anxiety after having received specific information and preparation preoperatively . It was concluded that this preoperative preparation programme is useful in all age groups with regard to information , while alleviation of anxiety and fear was seen mainly among the younger children with previous experience of anaesthesia We developed and introduced into clinical practice a leaflet to improve the delivery of information to patients before obtaining their consent to anaesthesia . The amount of information needs to be what a “ reasonable ” patient thinks appropriate ; therefore we tested patients ’ responses to three levels of information : “ full ” disclosure , “ st and ard ” disclosure ( as contained in our leaflet ) and “ minimal ” disclosure .  Forty-five patients scheduled to undergo cardiac surgery were enrolled in the study . None of the information sheets caused a significant change in state anxiety score and only the “ full ” disclosure significantly increased knowledge about anaesthesia ( P=0.016 ) . All leaflets were easy to underst and . When only one leaflet was provided 64–73 % of patients thought the content was “ just right ” , whereas when all three leaflets were viewed together , 63 % of patients thought the “ minimal ” leaflet withheld too much information In a r and omized controlled trial at Duke University and University of North Carolina Hospitals , 143 two to six year old children undergoing elective ambulatory surgery were r and omized into a control group who received routine preoperative teaching or an intervention group who received an interactive teaching book .  Changes in behaviour were measured by a Vernon behavioural question naire preoperatively and again two weeks postoperatively . A Global Mood Score was assessed in the preoperative holding area , at arrival into the operating room , and at the time of mask induction . The children in the control group were significantly more aggressive postoperatively than the intervention group ( P < 0.05 ) . Children who received the interactive teaching book exhibited higher levels of anxiety on the day of surgery , but fewer behavioural changes two weeks following surgery . Parents in the intervention group reported that preoperative teaching helped their child ( 87 % ) and themselves ( 83 % ) UNLABELLED Pediatric pain management often depends on parents recognition and assessment of their child 's pain and their beliefs as to whether the pain should be treated . Parental misconceptions concerning pain assessment and pain management may therefore result in inadequate pain treatment , particularly in patients who are too young or too developmentally h and icapped to self-report their pain . We hypothesized that viewing a concise , educational videotape would provide parents with instructive information that could correct misconceptions concerning pain and pain management in children . To do this , we evaluated the impact of an educational videotape on parental responses to a question naire about pediatric pain management . Parents of children scheduled for inpatient , postoperative hospital care were studied . After answering 30 questions , parents were r and omly assigned to either view ( Group 1 ) or not view ( Group 2 ) a 19-min educational videotape . Immediately after viewing the videotape ( Group 1 ) , or 30 min after taking the first test ( Group 2 ) , parents were asked to answer the same question naire a second time . The effect of seeing the videotape was assessed by comparing post-pre test score differences using paired t-test . One-hundred parents were studied . R and omization was effective in assigning equitable groups . Initial scores of percent answers correct in each group were not different ( [ mean + /- SD ] Group 1 [ n = 50 ] : 68.7 % + /- 18.8 % vs Group 2 [ n = 50 ] : 61.5 % + /- 22.7 % ; P = 0.09 ) . Viewing the videotape effectively increased test scores : paired t-test within groups demonstrated a significant difference in Group 1 ( 22.4 % + /- 16.5 % , P < 0.0001 ) , whereas Group 2 scores changed to a much lesser degree ( 2.7 % + /- 8.3 % , P = 0.0271 ) . All parents who viewed the videotape stated that it was informative regarding their underst and ing of their child 's pain management . This study demonstrates the effectiveness of an educational videotape in changing parental knowledge concerning postoperative pediatric pain . This effective and efficient teaching medium may be useful in improving pain management in postoperative pediatric surgical patients . IMPLICATION S Pediatric pain management often depends on parents recognition and assessment of their child 
    Output:
    