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: Background : Preoperative anxiety is associated with adverse clinical , behavioral , and psychological outcomes . Various effective interventions targeting preoperative anxiety in children exist . Objectives : The aim of this study was to evaluate the educational intervention by residents on children and maternal anxiety and their satisfaction from anxiety management . Patients and Methods : After obtaining the institutional ethics committee approval and written informed parental consent , 36 ASA-I , II children ( age range , 8 - 10 years ) underwent small operations were included in this prospect i ve r and omized study . The participants were allocated into the intervention ( n = 18 ) and control ( n = 18 ) groups . Children in the first group were prepared routinely . In the second group children and their mothers received data about anesthesia and operation by the booklet .  Children-maternal anxiety was assessed using the anxiety level form , at the night and in the morning before surgery . Few days after surgery mothers , residents , and children experiences and satisfaction from anxiety management were assessed in the focus group discussion . Results : Mean scores and st and ard deviations of state anxiety in the intervention group before and after training were 33.1 ± 5.5 and 30.8 ± 6 , respectively ( P = 0.06 ) . In the control group it was 32 ± 6.5 on the night and 34.1 ± 6.7 in the morning before surgery ( P = 0.00 ) . Comparison between groups was not significant ( P = 0.6 ) and ( P = 0.1 ) . The mean levels of anxiety in the control group mothers on the night before and in the morning of surgery were 39.2 ± 13.1 and 42.8 ± 14 ( P = 0.00 ) , respectively . In the intervention group , mothers ’ anxiety before education was 41 ± 12.7 and after education it was 35.6 ± 9.5 ( P = 0.04 ) . Comparison between groups was not significant ( P = 0.7 ) and ( P = 0.1 ) . According to the focus group discussion s , booklet study , provided education , sympathy of medical team , spiritual issues and beliefs reduced anxiety and fear of surgery . Anesthesia and lack of knowledge of what will happen , crying and restlessness of children increased preoperative anxiety . Conclusions : In this study , the preoperative anxiety was reduced by explaining anesthesia and surgery to the mothers and children ( in mothers it was significant P < 0.05 ) . Since there is a direct relation between mothers ’ and their children ’s anxiety , using an effective method to reduce anxiety in children and their mothers together at the same time would be very useful for children and their mothers Objective The purpose of this study was to examine effects of performing preoperative preparation program on  children 's anxiety .  Methods This study was performed in Amirkola Pediatrics Hospital , Maz and aran . A r and omized controlled trail was performed on 122 children ( 7–12 years of age ) admitted for elective surgery during 15 months . The research er r and omly assigned eligible participants in to the experimental and control groups , after pre-test baseline measurement had been taken . Analyzing was performed through independent t-test and χ2 test . P<0.005 was considered statistically significant . The experimental group received therapeutic play and the control group received routine preoperative information preparation . Findings The mean and st and ard deviation of the state anxiety scores of children in experimental and control groups before intervention were 35.52±6.99 and 34.98±6.78 , after intervention 31.44±5.87 and 38.31±7.44 respectively . The state anxiety score was lower significantly in the experimental group prior to preoperative surgery than in the control group ( P=0.000 ) . Conclusion Performing preoperative program with using therapeutic play intervention is effective for preparing children before surgery and decreases their anxiety 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 OBJECTIVE We evaluated the effects of surgery preparation using a children 's book on pre- and postoperative anxiety and distress in 2 - 10 years old children undergoing tonsillectomy and /or adenoidectomy and their mothers . METHODS Parents of the experimental group were given the preparation book during the preoperative visit at the hospital , whilst control subjects did not receive the book . Data collection was conducted on the evening prior to surgery ( T1 ) , and the evening post surgery ( T2 ) . At these two points in time , mothers completed a self- design ed feeling states checklist and the state anxiety scale of the State and Trait Anxiety Inventory to assess their perceptions of the child 's distress and their own level of anxiety . At T2 , nurses were asked to give ratings of patient-caregiver variables , such as level of anxiety , cooperation with care or level of information . The sample under study consisted of 160 mother/child dyads in the experimental group and 240 controls . RESULTS We found that mothers who received the book exhibited less self-reported state anxiety prior to the operation compared to mothers who did not . Simultaneously , children of the experimental group showed less distress in 4 of 11 feeling states . Nurses assessed the mothers of the experimental group to participate more in the child 's care than control mothers . CONCLUSIONS The results demonstrated that our preparation book can provide educational and anxiety-reducing benefits . Given the relatively low production costs and its easy administration , it can be recommended as a popular , practical and cost-efficient tool to prepare children and parents for surgery and hospitalization 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 This study developed three types of educational preoperative material s and examined their efficacy in preparing children for surgery by analysing children 's preoperative  worries and  parental anxiety .  The sample was recruited from three hospitals in Lisbon and consisted of 125 children , aged 8 - 12 years , scheduled to undergo outpatient surgery . The participants were r and omly assigned to one of the seven independent conditions that were combined into the following three main groups : an experimental group , which received educational material s with information about surgery and hospitalization ( a board game , a video or a booklet ) ; a comparison group , which received entertaining material with the same format type ; and a control group , which did not receive any material .  Children 's preoperative worries and parental anxiety were evaluated after the experimental manipulation . Children who received educational material s were significantly less worried about surgery and hospital procedures than children in the comparison and the control groups , although no statistically differences were found between the type of material s within the experimental group , and no significant effect occurred on parental state anxiety . These results do however support the hypothesis that providing preoperative material s with educational information reduce children 's preoperative worries BACKGROUND : The purpose of this 2-phase project was to conduct a formative evaluation and to test the preliminary efficacy of a newly developed Web-based Tailored Intervention for Preparation of parents and children undergoing Surgery  ( WebTIPS ) . METHODS : Phase 1 enrolled 13 children 2 to 7 years of age undergoing outpatient elective surgery and their parents for formative evaluation of WebTIPS .  Parent participation focus groups are common in qualitative research and are a method of asking research participants about their perceptions and attitudes regarding a product or concept . In phase 2 , children 2 to 7 years of age in 2 medical centers were assigned r and omly to receive the WebTIPS program ( n = 38 ) compared with children receiving the st and ard of care ( n = 44 ) . The primary outcome of phase II was child and parent preoperative anxiety . RESULTS : In phase 2 , parents reported WebTIPS to be both helpful ( P < 0.001 ) and easy to use ( P < 0.001 ) . In phase 2 , children in the WebTIPS group ( 36.2 ± 14.1 ) were less anxious than children in the st and ard of care group ( 46.0 ± 19.0 ) at entrance to the operating room ( P = 0.02 ; Cohen d = 0.59 ) and introduction of the anesthesia mask ( 43.5 ± 21.7 vs 57.0 ± 21.2 , respectively , P = 0.01 ; Cohen d = 0.63 ) . Parents in the WebTIPS group ( 32 
    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: Background : Preoperative anxiety is associated with adverse clinical , behavioral , and psychological outcomes . Various effective interventions targeting preoperative anxiety in children exist . Objectives : The aim of this study was to evaluate the educational intervention by residents on children and maternal anxiety and their satisfaction from anxiety management . Patients and Methods : After obtaining the institutional ethics committee approval and written informed parental consent , 36 ASA-I , II children ( age range , 8 - 10 years ) underwent small operations were included in this prospect i ve r and omized study . The participants were allocated into the intervention ( n = 18 ) and control ( n = 18 ) groups . Children in the first group were prepared routinely . In the second group children and their mothers received data about anesthesia and operation by the booklet .  Children-maternal anxiety was assessed using the anxiety level form , at the night and in the morning before surgery . Few days after surgery mothers , residents , and children experiences and satisfaction from anxiety management were assessed in the focus group discussion . Results : Mean scores and st and ard deviations of state anxiety in the intervention group before and after training were 33.1 ± 5.5 and 30.8 ± 6 , respectively ( P = 0.06 ) . In the control group it was 32 ± 6.5 on the night and 34.1 ± 6.7 in the morning before surgery ( P = 0.00 ) . Comparison between groups was not significant ( P = 0.6 ) and ( P = 0.1 ) . The mean levels of anxiety in the control group mothers on the night before and in the morning of surgery were 39.2 ± 13.1 and 42.8 ± 14 ( P = 0.00 ) , respectively . In the intervention group , mothers ’ anxiety before education was 41 ± 12.7 and after education it was 35.6 ± 9.5 ( P = 0.04 ) . Comparison between groups was not significant ( P = 0.7 ) and ( P = 0.1 ) . According to the focus group discussion s , booklet study , provided education , sympathy of medical team , spiritual issues and beliefs reduced anxiety and fear of surgery . Anesthesia and lack of knowledge of what will happen , crying and restlessness of children increased preoperative anxiety . Conclusions : In this study , the preoperative anxiety was reduced by explaining anesthesia and surgery to the mothers and children ( in mothers it was significant P < 0.05 ) . Since there is a direct relation between mothers ’ and their children ’s anxiety , using an effective method to reduce anxiety in children and their mothers together at the same time would be very useful for children and their mothers Objective The purpose of this study was to examine effects of performing preoperative preparation program on  children 's anxiety .  Methods This study was performed in Amirkola Pediatrics Hospital , Maz and aran . A r and omized controlled trail was performed on 122 children ( 7–12 years of age ) admitted for elective surgery during 15 months . The research er r and omly assigned eligible participants in to the experimental and control groups , after pre-test baseline measurement had been taken . Analyzing was performed through independent t-test and χ2 test . P<0.005 was considered statistically significant . The experimental group received therapeutic play and the control group received routine preoperative information preparation . Findings The mean and st and ard deviation of the state anxiety scores of children in experimental and control groups before intervention were 35.52±6.99 and 34.98±6.78 , after intervention 31.44±5.87 and 38.31±7.44 respectively . The state anxiety score was lower significantly in the experimental group prior to preoperative surgery than in the control group ( P=0.000 ) . Conclusion Performing preoperative program with using therapeutic play intervention is effective for preparing children before surgery and decreases their anxiety 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 OBJECTIVE We evaluated the effects of surgery preparation using a children 's book on pre- and postoperative anxiety and distress in 2 - 10 years old children undergoing tonsillectomy and /or adenoidectomy and their mothers . METHODS Parents of the experimental group were given the preparation book during the preoperative visit at the hospital , whilst control subjects did not receive the book . Data collection was conducted on the evening prior to surgery ( T1 ) , and the evening post surgery ( T2 ) . At these two points in time , mothers completed a self- design ed feeling states checklist and the state anxiety scale of the State and Trait Anxiety Inventory to assess their perceptions of the child 's distress and their own level of anxiety . At T2 , nurses were asked to give ratings of patient-caregiver variables , such as level of anxiety , cooperation with care or level of information . The sample under study consisted of 160 mother/child dyads in the experimental group and 240 controls . RESULTS We found that mothers who received the book exhibited less self-reported state anxiety prior to the operation compared to mothers who did not . Simultaneously , children of the experimental group showed less distress in 4 of 11 feeling states . Nurses assessed the mothers of the experimental group to participate more in the child 's care than control mothers . CONCLUSIONS The results demonstrated that our preparation book can provide educational and anxiety-reducing benefits . Given the relatively low production costs and its easy administration , it can be recommended as a popular , practical and cost-efficient tool to prepare children and parents for surgery and hospitalization 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 This study developed three types of educational preoperative material s and examined their efficacy in preparing children for surgery by analysing children 's preoperative  worries and  parental anxiety .  The sample was recruited from three hospitals in Lisbon and consisted of 125 children , aged 8 - 12 years , scheduled to undergo outpatient surgery . The participants were r and omly assigned to one of the seven independent conditions that were combined into the following three main groups : an experimental group , which received educational material s with information about surgery and hospitalization ( a board game , a video or a booklet ) ; a comparison group , which received entertaining material with the same format type ; and a control group , which did not receive any material .  Children 's preoperative worries and parental anxiety were evaluated after the experimental manipulation . Children who received educational material s were significantly less worried about surgery and hospital procedures than children in the comparison and the control groups , although no statistically differences were found between the type of material s within the experimental group , and no significant effect occurred on parental state anxiety . These results do however support the hypothesis that providing preoperative material s with educational information reduce children 's preoperative worries BACKGROUND : The purpose of this 2-phase project was to conduct a formative evaluation and to test the preliminary efficacy of a newly developed Web-based Tailored Intervention for Preparation of parents and children undergoing Surgery  ( WebTIPS ) . METHODS : Phase 1 enrolled 13 children 2 to 7 years of age undergoing outpatient elective surgery and their parents for formative evaluation of WebTIPS .  Parent participation focus groups are common in qualitative research and are a method of asking research participants about their perceptions and attitudes regarding a product or concept . In phase 2 , children 2 to 7 years of age in 2 medical centers were assigned r and omly to receive the WebTIPS program ( n = 38 ) compared with children receiving the st and ard of care ( n = 44 ) . The primary outcome of phase II was child and parent preoperative anxiety . RESULTS : In phase 2 , parents reported WebTIPS to be both helpful ( P < 0.001 ) and easy to use ( P < 0.001 ) . In phase 2 , children in the WebTIPS group ( 36.2 ± 14.1 ) were less anxious than children in the st and ard of care group ( 46.0 ± 19.0 ) at entrance to the operating room ( P = 0.02 ; Cohen d = 0.59 ) and introduction of the anesthesia mask ( 43.5 ± 21.7 vs 57.0 ± 21.2 , respectively , P = 0.01 ; Cohen d = 0.63 ) . Parents in the WebTIPS group ( 32 
    Output:
    