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: 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 Background : Children and parents experience significant anxiety and distress during the preoperative period . Currently available interventions are having limited efficacy . Based on an integration of the literature in both the anesthesia and psychological milieus , the authors developed a behaviorally oriented perioperative preparation program for children undergoing surgery that targets the family as a whole . Methods : Children and their parents ( n = 408 ) were r and omly assigned to one of four groups : ( 1 ) control : received st and ard of care ; ( 2 ) parental presence : received st and ard parental presence during induction of anesthesia ; ( 3 ) ADVANCE : received family-centered behavioral preparation ; and ( 4 ) oral midazolam . The authors assessed the effect of group assignment on preoperative anxiety levels and postoperative outcomes such as analgesic consumption and emergence delirium . Results : Parents and children in the ADVANCE group exhibited significantly lower anxiety in the holding area as compared with all three other groups ( 34.4 ± 16 vs. 39.7 ± 15 ; P = 0.007 ) and were less anxious during induction of anesthesia as compared with the control and parental presence groups ( 44.9 ± 22 vs. 51.6 ± 25 and 53.6 ± 25 , respectively ; P = 0.006 ) . Anxiety and compliance during induction of anesthesia was similar for children in both the ADVANCE and midazolam groups ( 44.9 ± 22 vs. 42.9 ± 24 ; P = 0.904 ) . Children in the ADVANCE group exhibited a lower incidence of emergence delirium after surgery ( P = 0.038 ) , required significantly less analgesia in the recovery room ( P = 0.016 ) , and were discharged from the recovery room earlier ( P = 0.04 ) as compared with children in the three other groups . Conclusion : The family-centered preoperative ADVANCE preparation program is effective in the reduction of preoperative anxiety and improvement in postoperative outcomes 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 We assessed the effectiveness of a behavioral intervention aim ed at reducing the anxiety of children undergoing anesthesia and surgery . The intervention consisted of dimmed operating room ( OR ) lights ( 200 Lx ) and soft background music ( Bach ’s “ Air on a G String , ” 50–60 dB ) . Only one person , the attending anesthesiologist , interacted with the child during the induction of anesthesia . Children undergoing anesthesia and surgery were r and omly assigned either to a low sensory stimulation group ( LSSG , n = 33 ) or to control group ( n = 37 ) . By using vali date d behavioral measures of anxiety ( mYPAS ) and compliance ( ICC ) , children were evaluated at the preoperative holding area and during the induction of anesthesia . On postoperative Days 1 , 2 , 3 , 7 , and 14 , the behavioral recovery of the children was assessed by using the Post Hospitalization Behavior Question naire . We found that the LSSG was significantly less anxious compared with the control group on entrance to the OR ( P = 0.03 ) and on the introduction of the anesthesia mask ( P = 0.003 ) . Also , the compliance during the induction of anesthesia was significantly better in children assigned to the LSSG ( P = 0.02 ) . The incidence of postoperative behavioral changes , however , did not differ significantly between the two groups ( P = ns ) . We conclude that children who are exposed to low-level sensory stimuli during the induction of anesthesia and who are exposed to background music exhibit lower levels of anxiety and increased compliance Background : To compare oral midazolam ( 0.5 mg/kg ) with oral butorphanol ( 0.2 mg/kg ) as a premedication in 60 pediatric patients with regards to sedation , anxiolysis , rescue analgesic requirement , and recovery profile . Material s and Methods : In a double blinded study design , 60 pediatric patients belonging to ASA class I and II between the age group of 2–12 years scheduled for elective surgery were r and omized to receive either oral midazolam ( group I ) or oral butorphanol ( group II ) 30 min before induction of anesthesia . The children were evaluated for levels of sedation and anxiety at the time of separation from the parents , venepuncture , and at the time of facemask application for induction of anesthesia . Rescue analgesic requirement , postoperative recovery , and complications were also recorded . Results : Butorphanol had better sedation potential than oral midazolam with comparable anxiolysis at the time of separation of children from their parents . Midazolam proved to be a better anxiolytic during venepuncture and facemask application . Butorphanol  reduced need for supplemental analgesics perioperatively without an increase in side effects such as nausea , vomiting , or unpleasant postoperative recovery . Conclusion : Oral butorphanol is a better premedication than midazolam in children in view of its excellent sedative and analgesic properties . It does not increase side effects significantly PURPOSE / OBJECTIVES To determine the effects of virtual reality ( VR ) glasses on adolescents with cancer undergoing lumbar punctures ( LPs ) . DESIGN Pilot study using an experimental , control group design . SETTING In-hospital oncology clinic . SAMPLE 30 adolescents with cancer ( 17 in the VR and 13 in the control group ) undergoing frequent LPs . METHODS Subjects were r and omly assigned to groups . Both groups received st and ard intervention during the LP , but the experimental group also wore VR glasses and watched a video . Following the LP , both groups rated their pain using a visual analog scale ( VAS ) and were interviewed to evaluate their experience . MAIN RESEARCH VARIABLES Pain , subjective evaluation of experience . FINDINGS Although VAS pain scores were not statistically different between the two groups ( p = 0.77 ) , VAS scores tended to be lower in the VR group ( median VAS of 7.0 , range 0 - 48 ) than in the control group ( median VAS of 9.0 , range 0 - 59 ) . 77 % of subjects in the experimental group said the VR glasses helped to distract them from the LP . CONCLUSIONS VR glasses are a feasible , age-appropriate , nonpharmacologic adjunct to conventional care in managing the pain associated with LPs in adolescents . IMPLICATION S FOR PRACTICE The clinical application of various age-appropriate distracters to reduce pain in adolescents undergoing painful procedures should be explored Background Children and parents experience significant anxiety and distress during the preoperative period . This is important because preoperative anxiety in children is associated with adverse postoperative outcome . So we suggest behaviorally oriented preoperative anxiety intervention program based on the anesthesia and psychology with smartphone application , world-widely used . Methods A total 120 patients ( aged 1 - 10 years old ) who were scheduled for elective surgery under general anesthesia was included in this r and omized controlled trial . We r and omized the patients into three groups , with using intravenous ( IV ) midazolam sedation ( M group ) , with using smartphone application program ( S group ) , and with using low dose IV midazolam plus smartphone application program ( SM group ) . And the child anxiety was assessed using the modified Yale Preoperative Anxiety Scale ( mYPAS ) at holding area , 5 min after intervention , entrance to operating room . Results In all three groups , mYPAS after intervention were lower than the preoperative holding area ( M group 52.8 ± 11.8 vs 41.0 ± 7.0 , S group 59.2 ± 17.6 vs 36.4 ± 7.3 , SM group 58.3 ± 17.5 vs 26.0 ± 3.4 ) . A comparison of mYPAS scores between each group showed that the S group reduced anxiety lower than M group ( P < 0.01 ) , and the SM group exhibited significantly lower anxiety than the two other groups ( P < 0.01 ) . Conclusions The preoperative preparation program using smartphone application is simple and customized by individual development that effective in the reduction of preoperative anxiety & NA ; This un‐blinded experimental study investigated the effectiveness of imagery , in addition to routine analgesics , in reducing tonsillectomy and /or adenoidectomy pain and anxiety after ambulatory surgery ( AS ) and at home . Seventy‐three children , aged 7–12 , were recruited from five AS setting s. Thirty‐six children r and omly assigned to the treatment group  watched a professionally developed videotape on the use of imagery and then listened to a 30‐min audio tape of imagery approximately 1 week prior to surgery ( T1 ) . They listened to only the audio tape 1–4 h after surgery ( T2 ) , and 22–27 h after discharge from AS ( T3 ) . The 37 children in the attention‐control group received st and ard care . Pain and anxiety were measured at each time‐point in both groups . Measures of sensory pain were the Oucher and amount of analgesics used in AS and home ; affective pain was measured with the Facial Affective Scale ( FAS ) . Anxiety was measured using the State Trait Anxiety Inventory for Children ( STAIC ) . When controlling for trait anxiety and opioid and non‐opioid intake 1–4 h before the pain measures , MANCOVA showed significantly lower pain and anxiety in the treatment group at T2 , but not at T3 . When controlling for trait anxiety , a two‐way RM MANCOVA indicated no significant group differences in combined opioid and non‐opioid use between the groups , or between times . Appropriately trained health care providers should use imagery to reduce post‐operative pain following tonsillectomy and /or adenoidectomy in AS . Teaching parents about adequate home administration of analgesics may increase the effectiveness of imagery at home O 
    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: 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 Background : Children and parents experience significant anxiety and distress during the preoperative period . Currently available interventions are having limited efficacy . Based on an integration of the literature in both the anesthesia and psychological milieus , the authors developed a behaviorally oriented perioperative preparation program for children undergoing surgery that targets the family as a whole . Methods : Children and their parents ( n = 408 ) were r and omly assigned to one of four groups : ( 1 ) control : received st and ard of care ; ( 2 ) parental presence : received st and ard parental presence during induction of anesthesia ; ( 3 ) ADVANCE : received family-centered behavioral preparation ; and ( 4 ) oral midazolam . The authors assessed the effect of group assignment on preoperative anxiety levels and postoperative outcomes such as analgesic consumption and emergence delirium . Results : Parents and children in the ADVANCE group exhibited significantly lower anxiety in the holding area as compared with all three other groups ( 34.4 ± 16 vs. 39.7 ± 15 ; P = 0.007 ) and were less anxious during induction of anesthesia as compared with the control and parental presence groups ( 44.9 ± 22 vs. 51.6 ± 25 and 53.6 ± 25 , respectively ; P = 0.006 ) . Anxiety and compliance during induction of anesthesia was similar for children in both the ADVANCE and midazolam groups ( 44.9 ± 22 vs. 42.9 ± 24 ; P = 0.904 ) . Children in the ADVANCE group exhibited a lower incidence of emergence delirium after surgery ( P = 0.038 ) , required significantly less analgesia in the recovery room ( P = 0.016 ) , and were discharged from the recovery room earlier ( P = 0.04 ) as compared with children in the three other groups . Conclusion : The family-centered preoperative ADVANCE preparation program is effective in the reduction of preoperative anxiety and improvement in postoperative outcomes 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 We assessed the effectiveness of a behavioral intervention aim ed at reducing the anxiety of children undergoing anesthesia and surgery . The intervention consisted of dimmed operating room ( OR ) lights ( 200 Lx ) and soft background music ( Bach ’s “ Air on a G String , ” 50–60 dB ) . Only one person , the attending anesthesiologist , interacted with the child during the induction of anesthesia . Children undergoing anesthesia and surgery were r and omly assigned either to a low sensory stimulation group ( LSSG , n = 33 ) or to control group ( n = 37 ) . By using vali date d behavioral measures of anxiety ( mYPAS ) and compliance ( ICC ) , children were evaluated at the preoperative holding area and during the induction of anesthesia . On postoperative Days 1 , 2 , 3 , 7 , and 14 , the behavioral recovery of the children was assessed by using the Post Hospitalization Behavior Question naire . We found that the LSSG was significantly less anxious compared with the control group on entrance to the OR ( P = 0.03 ) and on the introduction of the anesthesia mask ( P = 0.003 ) . Also , the compliance during the induction of anesthesia was significantly better in children assigned to the LSSG ( P = 0.02 ) . The incidence of postoperative behavioral changes , however , did not differ significantly between the two groups ( P = ns ) . We conclude that children who are exposed to low-level sensory stimuli during the induction of anesthesia and who are exposed to background music exhibit lower levels of anxiety and increased compliance Background : To compare oral midazolam ( 0.5 mg/kg ) with oral butorphanol ( 0.2 mg/kg ) as a premedication in 60 pediatric patients with regards to sedation , anxiolysis , rescue analgesic requirement , and recovery profile . Material s and Methods : In a double blinded study design , 60 pediatric patients belonging to ASA class I and II between the age group of 2–12 years scheduled for elective surgery were r and omized to receive either oral midazolam ( group I ) or oral butorphanol ( group II ) 30 min before induction of anesthesia . The children were evaluated for levels of sedation and anxiety at the time of separation from the parents , venepuncture , and at the time of facemask application for induction of anesthesia . Rescue analgesic requirement , postoperative recovery , and complications were also recorded . Results : Butorphanol had better sedation potential than oral midazolam with comparable anxiolysis at the time of separation of children from their parents . Midazolam proved to be a better anxiolytic during venepuncture and facemask application . Butorphanol  reduced need for supplemental analgesics perioperatively without an increase in side effects such as nausea , vomiting , or unpleasant postoperative recovery . Conclusion : Oral butorphanol is a better premedication than midazolam in children in view of its excellent sedative and analgesic properties . It does not increase side effects significantly PURPOSE / OBJECTIVES To determine the effects of virtual reality ( VR ) glasses on adolescents with cancer undergoing lumbar punctures ( LPs ) . DESIGN Pilot study using an experimental , control group design . SETTING In-hospital oncology clinic . SAMPLE 30 adolescents with cancer ( 17 in the VR and 13 in the control group ) undergoing frequent LPs . METHODS Subjects were r and omly assigned to groups . Both groups received st and ard intervention during the LP , but the experimental group also wore VR glasses and watched a video . Following the LP , both groups rated their pain using a visual analog scale ( VAS ) and were interviewed to evaluate their experience . MAIN RESEARCH VARIABLES Pain , subjective evaluation of experience . FINDINGS Although VAS pain scores were not statistically different between the two groups ( p = 0.77 ) , VAS scores tended to be lower in the VR group ( median VAS of 7.0 , range 0 - 48 ) than in the control group ( median VAS of 9.0 , range 0 - 59 ) . 77 % of subjects in the experimental group said the VR glasses helped to distract them from the LP . CONCLUSIONS VR glasses are a feasible , age-appropriate , nonpharmacologic adjunct to conventional care in managing the pain associated with LPs in adolescents . IMPLICATION S FOR PRACTICE The clinical application of various age-appropriate distracters to reduce pain in adolescents undergoing painful procedures should be explored Background Children and parents experience significant anxiety and distress during the preoperative period . This is important because preoperative anxiety in children is associated with adverse postoperative outcome . So we suggest behaviorally oriented preoperative anxiety intervention program based on the anesthesia and psychology with smartphone application , world-widely used . Methods A total 120 patients ( aged 1 - 10 years old ) who were scheduled for elective surgery under general anesthesia was included in this r and omized controlled trial . We r and omized the patients into three groups , with using intravenous ( IV ) midazolam sedation ( M group ) , with using smartphone application program ( S group ) , and with using low dose IV midazolam plus smartphone application program ( SM group ) . And the child anxiety was assessed using the modified Yale Preoperative Anxiety Scale ( mYPAS ) at holding area , 5 min after intervention , entrance to operating room . Results In all three groups , mYPAS after intervention were lower than the preoperative holding area ( M group 52.8 ± 11.8 vs 41.0 ± 7.0 , S group 59.2 ± 17.6 vs 36.4 ± 7.3 , SM group 58.3 ± 17.5 vs 26.0 ± 3.4 ) . A comparison of mYPAS scores between each group showed that the S group reduced anxiety lower than M group ( P < 0.01 ) , and the SM group exhibited significantly lower anxiety than the two other groups ( P < 0.01 ) . Conclusions The preoperative preparation program using smartphone application is simple and customized by individual development that effective in the reduction of preoperative anxiety & NA ; This un‐blinded experimental study investigated the effectiveness of imagery , in addition to routine analgesics , in reducing tonsillectomy and /or adenoidectomy pain and anxiety after ambulatory surgery ( AS ) and at home . Seventy‐three children , aged 7–12 , were recruited from five AS setting s. Thirty‐six children r and omly assigned to the treatment group  watched a professionally developed videotape on the use of imagery and then listened to a 30‐min audio tape of imagery approximately 1 week prior to surgery ( T1 ) . They listened to only the audio tape 1–4 h after surgery ( T2 ) , and 22–27 h after discharge from AS ( T3 ) . The 37 children in the attention‐control group received st and ard care . Pain and anxiety were measured at each time‐point in both groups . Measures of sensory pain were the Oucher and amount of analgesics used in AS and home ; affective pain was measured with the Facial Affective Scale ( FAS ) . Anxiety was measured using the State Trait Anxiety Inventory for Children ( STAIC ) . When controlling for trait anxiety and opioid and non‐opioid intake 1–4 h before the pain measures , MANCOVA showed significantly lower pain and anxiety in the treatment group at T2 , but not at T3 . When controlling for trait anxiety , a two‐way RM MANCOVA indicated no significant group differences in combined opioid and non‐opioid use between the groups , or between times . Appropriately trained health care providers should use imagery to reduce post‐operative pain following tonsillectomy and /or adenoidectomy in AS . Teaching parents about adequate home administration of analgesics may increase the effectiveness of imagery at home O 
    Output:
    