O-166 A smartphone video clip on the patient journey to reduce patient’s anxiety: a randomized controlled trial

Study question Can a smartphone video clip detailing the patient journey decrease the anxiety of women and men on the day of their first oocyte aspiration? Summary answer The video clip does not affect the anxiety of women but does reduce the anxiety of men on the day of couples’ first oocyte aspiration. What is known already Infertility and in vitro fertilisation (IVF) decrease the personal wellbeing of women and men. Couples shared that this contributed to their IVF discontinuation despite a good prognosis and reimbursement of IVF. Previous longitudinal studies confirmed that pre-IVF anxiety is associated with IVF discontinuation. Limiting treatment anxiety is, therefore, relevant for fertility patients and clinics. Studies from the field of reproductive medicine examining the effect of preparatory information on anxiety suggest that focussed interventions seem more effective than complex interventions. Several randomized controlled trials (RCTs) found that preparatory information movies reduce anxiety for out-patient cardiology procedures in women and men. Study design, size, duration This monocentric RCT randomized (1:1 allocation; computerized) 190 heterosexual couples about to start their first IVF cycle between care as usual (i.e. preparatory information session 1-3 months before IVF) and care as usual combined with a novel intervention during a 24 months recruitment period (2018-2020). The novel intervention is a 5-minute smartphone video clip detailing the patient journey on the day of oocyte aspiration, which was sent to both partners the day before oocyte aspiration. Participants/materials, setting, methods Upon arrival at a private fertility clinic for their first oocyte aspiration women and men independently filled out the ‘STAI-State anxiety inventory’ and the ‘infertility distress scale (IDS)’ and evaluated the novel intervention, if applicable. A minority of randomized couples didn’t comply with the standard IVF trajectory (n = 27) or didn’t fill out the questionnaires (n = 8). The data of 155 couples (76-79/group, a-priori sample size calculation requested minimally 76/group) was subjected to a modified intention-to-treat analysis. Main results and the role of chance Women and men were on average 33 and 35 years old, respectively. Couples had a mean duration of infertility of 27 months and 63 of them (41%) had tried intrauterine insemination. The background variables were equally distributed between the intervention (IG) and control group (CG). The video clip did not affect women’s anxiety on the day of oocyte aspiration (mean STAI-State score IG 42.7±8.1 vs CG 42.1±8.5, p = 0.67). However, men who watched the video clip were significantly less anxious than men who did not watch it (mean STAI-State score IG 35.8±6.4 vs CG 38.2±7.6, p = 0.04). Surprisingly, infertility-specific distress was higher among women and men who watched the video clip (mean IDS scores of 25.8±4.9 and 22.6±5.0, respectively), as compared to women (p = 0.05) and men (p = 0.02) who did not watch the video clip (mean IDS score 24.3±4.6 and 20.8±4.7, respectively). All women and men of the intervention group, except one woman, would recommend the video clip to friends and family going through IVF. The intervention and control group did not differ significantly regarding clinical pregnancy rate (31/76 vs. 29/79, p = 0.60) or miscarriage rate (2/76 vs. 3/79, p = 0.68) 12 weeks after their first oocyte aspiration. Limitations, reasons for caution Patients nor assessors were blinded and there was no attention control group. Selection bias is plausible although the participation rate was 89%. Assessing infertility-specific distress the day after watching the video clip was not optimal, as priming couples to feel infertility-specific distress short term is less problematic than longer term. Wider implications of the findings Providing additional procedural information is interesting for clinics as patients recommended the video clip and as it decreased men’s anxiety. A follow-up study should examine whether the video clip’s priming effect on infertility-specific distress lasts longer than only the day after and whether the video clip affects IVF discontinuation. Trial registration number NCT03717805

P1474IMPACT OF MALNUTRITION ON HEALTH-RELATED QUALITY OF LIFE IN DIALYSIS PATIENTS: A PROSPECTIVE STUDY

Background and Aims Health-related quality of life (HRQoL) is severely impaired in dialysis patients compared to the general population. Previous studies have shown that malnutrition, a frequent complication and independent risk factor for mortality in the dialysis population, is associated with poor HRQoL. However, there is no published evidence regarding the impact of malnutrition on change in HRQoL over time. We sought to determine the most important predictors of poor HRQoL as well as the determinants of change in HRQoL over time in dialysis patients, with a particular focus on malnutrition. Method We enrolled 119 haemodialysis and 31 peritoneal dialysis patients in a 1-year single-centre prospective observational study. HRQoL was assessed using the physical and mental component scores (PCS and MCS, respectively) from the 36-Item Short Form Health Survey and the health state and visual analogue scores from the European Quality of Life 5-Dimensions (EQ5D) questionnaire. The 7-point scale Subjective Global Assessment (SGA) was performed to evaluate nutritional status. Energy, protein and fat intake, biochemical variables, anthropometric measurements and handgrip strength (HGS) were also measured. All study assessments were performed at baseline, 6 and 12 months. Results Mean age was 64±14 years. Malnutrition was present in 37% of the population (as determined by 7-point SGA). Patients with malnutrition and diabetes had significantly lower MCS, PCS and EQ5D scores compared to well-nourished and non-diabetic patients, respectively. At baseline, chronological age, serum albumin, energy and protein intake, and HGS correlated positively with PCS and EQ5D health state score. Multivariable analysis at baseline identified malnutrition as the strongest independent predictor of decreased HRQoL, after adjusting for confounders (Table 1). Patients who stayed or became malnourished during one year showed a significant decrease in MCS, PCS and EQ5D health state score at 12 months compared to baseline. This same group of patients had significantly lower MCS, PCS and EQ5D scores at baseline and 12 months compared to those who stayed or became well-nourished during one year. Prevalent/development of malnutrition was independently and significantly associated with the 1-year decrease in MCS and EQ5D health state score. In addition, a decrease in serum total protein and dietary protein intake (markers of malnutrition) were identified as independent determinants of 1-year decrease in MCS, PCS and EQ5D health state score. Conclusion We observed in this prospective observational study that presence of malnutrition was the most important and strongest independent predictor of decreased HRQoL in this dialysis population. Furthermore, prevalence/development of malnutrition and a decrease in markers of nutritional status were independently associated with a decrease in some HRQoL scores over 1 year. These findings strengthen the importance of undertaking screening to identify malnutrition, and providing specialised, individualised nutritional advice to all dialysis patients in order to prevent and/or improve nutritional status. Future studies with larger sample sizes, longer follow-up, and which include evaluation of barriers to effective nutritional interventions are needed to evaluate the impact of nutritional interventions on HRQoL and other long-term outcomes.

Analgo-Sedative Effects of Oral or Nebulized Ketamine in Preschoolers Undergoing Elective Surgery: A Comparative, Randomized, DoubleBlind Study

Background: Premedication in children with ketamine is useful to produce mild sedation, decrease anxiety, help the child separation from parents, and provide postoperative pain relief with no or little adverse effects. Objectives: The aims of this study were to compare the level of sedation, parental separation, successful venous cannulation, and postoperative analgesia of oral or nebulized ketamine in preschoolers undergoing elective surgery. Study Design: A prospective, comparative, double-blind, randomized study. Setting: Zagazig University Hospitals. Methods: In the preparation room, 30 minutes before induction of anesthesia, 62 children were randomly divided into 2 groups: group O (n = 31) received oral ketamine 10 mg/kg in 2 mL apple juice, and group N (n = 31) received nebulized ketamine 3 mg/kg plus 2 mL isotonic saline solution by a standard hospital jet nebulizer via a mouth mask with a continuous 6 L/min flow of 100% oxygen. Results: At 10 minutes after premedication, sedation score was 3 in group O (34.4%) compared with group N (0%), and at 20 minutes in group O (93.5%) compared with group N (9.6%) (P < 0.001 ). However, at 30 minutes, 51.6% of group O showed a sedation score of 1 versus 0% of group N (P < 0.001 ). There were 70.9% of group O versus 6.4% of group N who showed an Emotional State Score of 1 (P < 0.0001), and 29.03% of group O versus 19.3% of group N who showed an Emotional State Score of 2 (P = 0.37), with statistically nonsignificant adverse effects in both groups. Low mean modified Children’s Hospital of Eastern Ontario Pain Scale score in group O compared with group N at 30, 60, 90 minutes (P < 0.0001). Limitations: In this study, although the dose of nebulized ketamine was 3 mg/kg, which was more than the optimum dose investigated in previous studies, it was not adequate, so we recommend conducting more studies investigating higher doses. Conclusions: Oral ketamine 10 mg/kg as premedication 30 minutes before induction of anesthesia is more effective than 3 mg/kg nebulized ketamine in producing more sedation, satisfactory separation from parents, successful venous cannulation, and effective postoperative analgesia, as it is more tolerable and accepted by preschoolers undergoing elective surgery. Key words: Nebulized ketamine, oral ketamine, preschooler, elective surgery

Conservative Kinematic Alignment Strategies Report Higher Incidence of Mid-Term Pain Following TKA: a Retrospective Study

Kinematic alignment (KA) aims to restore the pre-arthritic geometry of the joint and has been shown to produce similar or improved outcomes compared to mechanical alignment (MA). However, there are significant challenges when attempting to restore outlier joint anatomy. This study sought to investigate how achieved TKA alignment correlates with 12 month patient outcomes. The study considered three categories of achieved TKA alignments: KA, MA, or conservative KA (restricting coronal component alignments to within 5° and combined coronal alignment to within 3° of neutral). 369 patients were analysed; each patient had pre- and post-operative CT scans and a 12-month postoperative Knee Osteoarthritis &amp; Outcome Score (KOOS). From CT scans, component positions were measured, and patients were categorized to one of the three categories. The conservative KA group were least likely (76%) to reach the threshold KOOS Pain score set by the Patient Acceptable State Score (PASS); the full KA group was most likely (95%) to reach the threshold, whilst the MA group was in between these two groups (88%). These results demonstrated an increase in pain when the achieved alignment formed a compromise between a restorative and a reconstructive approach, and further suggests that conservative approaches to kinematic alignment may require a high level of discretion.

Parental anxiety among children undergoing cardiac catheterisation

BackgroundParents may experience anxiety and stress when their children undergo cardiac catheterisation. The goal of this study was to assess the level of anxiety in parents of children undergoing cardiac catheterisation and to identify factors that were associated with level of anxiety.MethodsThis was a cross-sectional survey of parents of children who underwent cardiac catheterisation. Anxiety levels were measured using a validated self-report questionnaire – State-Trait Anxiety Inventory, which generates state anxiety scores on the current state of anxiety and trait anxiety scores on the stable aspects of anxiety proneness. One sample t-test was used to compare the data with normative data. Multiple linear regression was used to assess the factors associated with the state score.ResultsA total of 113 parents completed the survey. The mean age of parents was 34.0±7.7 years and the mean age of children undergoing catheterisation was 6.7±5.7 years. Compared with normative data, mean state score was significantly higher in our cohort (p<0.05) despite no difference in the trait score. Final multivariate model showed that the state score was significantly associated with child age group (<1 year [coefficient β 7.2] and 10–18 years [6.3], compared to 1 to <10 years of age [reference]) and history of previous catheterisation (−5.2) (p<0.05).ConclusionsConcurrent state anxiety level was high among parents of children undergoing cardiac catheterisation, whereas trait anxiety level was not. Higher anxiety was experienced by parents of infants and adolescents without a history of previous catheterisation.

Effect of a Special Examination Gown and Nature-Based Sounds on Anxiety in Women Undergoing a Gynecological Examination

Many women feel anxiety about gynecological examination. The purpose of this semi-experimental study was to investigate the effect of a special examination gown and nature-based sounds on anxiety in women undergoing a gynecological examination. This study was conducted with three experimental groups and one control group. The randomized sampling method was used. The sample size was determined as 30 women for each group. Data were collected over 4 months from February 2015 to May 2015. Anxiety levels were assessed using the Status Anxiety Inventory Form (STAI, A-State). The STAI (A-State) score after the gynecological examination was quite low in the women in the experimental groups in comparison with the women in the control group ( F = 3.672, p = .001). It is remarkable that the anxiety levels of the women in the special examination gown + nature-based sounds group were especially lower than the women in the control group.