Reviewer ’s report  
 
Title: Effects of audio and visual distraction on patients ’ vital signs and tolerance during 
esophagogastroduodenoscopy: a randomized controlled trial  
 
Version: 0 Date: 29 Jan 2020  
 
Reviewer: Research Square Reviewer 1  
 
Reviewer's report:  
 
PEER REVIEWER ASSESSMENTS:  
 
OBJECTIVE - Full research articles: is there a clear objective that addresses a testable research 
question(s) (brief or other article types: is there a clear objective)?  
Yes - there is a clear objective  
 
DESIGN - Is the current  approach (including controls and analysis protocols) appropriate for the 
objective?  
No - there are minor issues  
 
EXECUTION - Are the experiments and analyses performed with technical rigor to allow 
confidence in the results?  
Yes - experiments and analyses  were performed appropriately  
 
STATISTICS - Is the use of statistics in the manuscript appropriate?  
Yes - appropriate statistical analyses have been used in the study  
 
INTERPRETATION - Is the current interpretation/discussion of the results reasonable and not 
overstated?  
Yes - the author's interpretation is reasonable  
 
OVERALL MANUSCRIPT POTENTIAL - Is the current version of this work technically 
sound? If not, can revisions be made to make the work technically sound?  
Probably - with minor revisions  
 
PEER R EVIEWER COMMENTS:  
 
GENERAL COMMENTS: The present study examined whether the audiovisual distraction 
influence 1) vital signs (pulse rate, arterial blood pressure, SpO2), 2) autonomic function by 
heart rate variability, 3) psychological assessment. The mer it of the present study was the authors 
assessed the effect of audiovisual distraction, in other words, healing effect, by examining the 
physiological variables, since assessment by the psychological influence has already been 
reported previously. However,  there are several concerns in the present manuscript before 
publication.  
 
REQUESTED REVISIONS:  
General Points  
 
The first concern is that there were still concerns on the techniques of 5 endoscopy specialists. 
Differences among these five specialists shou ld be assessed according to the difference in vital 
signs and heart rate variability.  
 
The second concern is about the word usage. Authors used several words meaning one 
definition. For example, the reviewer suggests that the authors should use Control, Audio, 
Visual, and Audiovisual instead of Groups 1, 2, 3, and 4. Please do not use the po int 1, 2, 3, etc. 
but pre -EGD, post -EGD, by defining these words previously.  
 
Where is SpO2? The authors measured SpO2 in the Methods section, but have not mentioned it 
in the Results section.  
 
The way of writing should be checked by the English medical wr iters since the authors wrote 
sometimes redundant way, but sometimes omitted way, and sometimes using different 
terminology on the same matters. Please be consistent.  
 
Please use heart rate variability instead of autonomic nervous function. HRV is a part o f ANS 
function.  
 
The authors should explain the effect of gastroduodenal inflation. The volume of the inflated air 
into the stomach may influence the heart rate variability. This should be described.  
 
The Abstract is very difficult to read. Please check ag ain and make an easy abstract for reading.  
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
No 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
No 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to th e authors.  
 
Yes 
 
 
 
 
 
 
Are you able to assess any statistics in the manuscript or would you recommend an  
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects require further  
assessment in your comments to t he editors.  
 
I am able to assess the statistics  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Needs some language corrections before being published  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimbursements, f ees, funding, or salary from an 
organisation that may in any way gain or lose financially from the publi cation of this 
manuscript, either now or in the future?  
2. Do you hold any stocks or shares in an organisation t hat may in any way gain or lose 
financially from the publication of this manuscript, either now or in the future?  
3. Do you hold or are you curr ently applying for any patents  relating to the content of the 
manuscript?  
4. Have you received reimbursements, fees, funding, or salary from an organization that 
holds or has applied for patents relating to the content of the manuscript?  
5. Do you have any  other financial competing interests?  
6. Do you have any non -financial competing interests in relation to this paper?  
 
If you can answer no to all of the above, write 'I declare that I have  no competing interests' 
below. If your reply is yes to any, please give details below.  
 
This reviewer has been recruited by a partner organization, Research  Square. Reviewers with 
declared or apparent competing interests are not utilized for t hese reviews. This reviewer has 
agreed to publication of their comments online under a Creat ive Commons Attribution License 
attributed to Research Square and was paid a small honorarium for  completing the review within 
a specified timeframe. Honoraria for reviews such as this are paid regardless of the review er 
recommendation.  
 
I agree to the open peer review policy of the journal. I understan d that my name will be included 
on my report to the authors and, if the manuscript is accepted f or publication, my named report 
including any attachments I upload will be posted on the website along  with the authors' 
responses. I agree for my report to be made available under an Open Access Creative Commons  
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I understand that any comments 
which I do not wish to be included in my named report  can be in cluded as confidential comments 
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
 
Reviewer ’s report  
 
Title: Effects of audio and visual distraction on patients ’ vital signs and tolerance during 
esophagogastroduodenoscopy: a randomized controlled trial  
 
Version: 0 Date: 29 Jan 2020  
 
Reviewer: Research Square Reviewer 1  
 
Reviewer's report:  
 
PEER REVIEWER ASSESSMENTS:  
 
OBJECTIVE - Full research articles: is there a clear objective that addresses a testable research 
question(s) (brief or other article types: is there a clear objective)?  
Yes - there is a clear objective  
 
DESIGN - Is the current  approach (including controls and analysis protocols) appropriate for the 
objective?  
No - there are minor issues  
 
EXECUTION - Are the experiments and analyses performed with technical rigor to allow 
confidence in the results?  
Yes - experiments and analyses  were performed appropriately  
 
STATISTICS - Is the use of statistics in the manuscript appropriate?  
Yes - appropriate statistical analyses have been used in the study  
 
INTERPRETATION - Is the current interpretation/discussion of the results reasonable and not 
overstated?  
Yes - the author's interpretation is reasonable  
 
OVERALL MANUSCRIPT POTENTIAL - Is the current version of this work technically 
sound? If not, can revisions be made to make the work technically sound?  
Probably - with minor revisions  
 
PEER R EVIEWER COMMENTS:  
 
GENERAL COMMENTS: The present study examined whether the audiovisual distraction 
influence 1) vital signs (pulse rate, arterial blood pressure, SpO2), 2) autonomic function by 
heart rate variability, 3) psychological assessment. The mer it of the present study was the authors 
assessed the effect of audiovisual distraction, in other words, healing effect, by examining the 
physiological variables, since assessment by the psychological influence has already been 
reported previously. However,  there are several concerns in the present manuscript before 
publication.  
 
REQUESTED REVISIONS:  
General Points  
 
The first concern is that there were still concerns on the techniques of 5 endoscopy specialists. 
Differences among these five specialists shou ld be assessed according to the difference in vital 
signs and heart rate variability.  
 
The second concern is about the word usage. Authors used several words meaning one 
definition. For example, the reviewer suggests that the authors should use Control, Audio, 
Visual, and Audiovisual instead of Groups 1, 2, 3, and 4. Please do not use the po int 1, 2, 3, etc. 
but pre -EGD, post -EGD, by defining these words previously.  
 
Where is SpO2? The authors measured SpO2 in the Methods section, but have not mentioned it 
in the Results section.  
 
The way of writing should be checked by the English medical wr iters since the authors wrote 
sometimes redundant way, but sometimes omitted way, and sometimes using different 
terminology on the same matters. Please be consistent.  
 
Please use heart rate variability instead of autonomic nervous function. HRV is a part o f ANS 
function.  
 
The authors should explain the effect of gastroduodenal inflation. The volume of the inflated air 
into the stomach may influence the heart rate variability. This should be described.  
 
The Abstract is very difficult to read. Please check ag ain and make an easy abstract for reading.  
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
No 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
No 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to th e authors.  
 
Yes 
 
 
 
 
 
 
Are you able to assess any statistics in the manuscript or would you recommend an  
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects require further  
assessment in your comments to t he editors.  
 
I am able to assess the statistics  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Needs some language corrections before being published  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimbursements, f ees, funding, or salary from an 
organisation that may in any way gain or lose financially from the publi cation of this 
manuscript, either now or in the future?  
2. Do you hold any stocks or shares in an organisation t hat may in any way gain or lose 
financially from the publication of this manuscript, either now or in the future?  
3. Do you hold or are you curr ently applying for any patents  relating to the content of the 
manuscript?  
4. Have you received reimbursements, fees, funding, or salary from an organization that 
holds or has applied for patents relating to the content of the manuscript?  
5. Do you have any  other financial competing interests?  
6. Do you have any non -financial competing interests in relation to this paper?  
 
If you can answer no to all of the above, write 'I declare that I have  no competing interests' 
below. If your reply is yes to any, please give details below.  
 
This reviewer has been recruited by a partner organization, Research  Square. Reviewers with 
declared or apparent competing interests are not utilized for t hese reviews. This reviewer has 
agreed to publication of their comments online under a Creat ive Commons Attribution License 
attributed to Research Square and was paid a small honorarium for  completing the review within 
a specified timeframe. Honoraria for reviews such as this are paid regardless of the review er 
recommendation.  
 
I agree to the open peer review policy of the journal. I understan d that my name will be included 
on my report to the authors and, if the manuscript is accepted f or publication, my named report 
including any attachments I upload will be posted on the website along  with the authors' 
responses. I agree for my report to be made available under an Open Access Creative Commons  
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I understand that any comments 
which I do not wish to be included in my named report  can be in cluded as confidential comments 
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
 
Please review this paper.
user
Reviewer ’s report  
 
Title: Effects of audio and visual distraction on patients ’ vital signs and tolerance during 
esophagogastroduodenoscopy: a randomized controlled trial  
 
Version: 0 Date: 29 Jan 2020  
 
Reviewer: Research Square Reviewer 1  
 
Reviewer's report:  
 
PEER REVIEWER ASSESSMENTS:  
 
OBJECTIVE - Full research articles: is there a clear objective that addresses a testable research 
question(s) (brief or other article types: is there a clear objective)?  
Yes - there is a clear objective  
 
DESIGN - Is the current  approach (including controls and analysis protocols) appropriate for the 
objective?  
No - there are minor issues  
 
EXECUTION - Are the experiments and analyses performed with technical rigor to allow 
confidence in the results?  
Yes - experiments and analyses  were performed appropriately  
 
STATISTICS - Is the use of statistics in the manuscript appropriate?  
Yes - appropriate statistical analyses have been used in the study  
 
INTERPRETATION - Is the current interpretation/discussion of the results reasonable and not 
overstated?  
Yes - the author's interpretation is reasonable  
 
OVERALL MANUSCRIPT POTENTIAL - Is the current version of this work technically 
sound? If not, can revisions be made to make the work technically sound?  
Probably - with minor revisions  
 
PEER R EVIEWER COMMENTS:  
 
GENERAL COMMENTS: The present study examined whether the audiovisual distraction 
influence 1) vital signs (pulse rate, arterial blood pressure, SpO2), 2) autonomic function by 
heart rate variability, 3) psychological assessment. The mer it of the present study was the authors 
assessed the effect of audiovisual distraction, in other words, healing effect, by examining the 
physiological variables, since assessment by the psychological influence has already been 
reported previously. However,  there are several concerns in the present manuscript before 
publication.  
 
REQUESTED REVISIONS:  
General Points  
 
The first concern is that there were still concerns on the techniques of 5 endoscopy specialists. 
Differences among these five specialists shou ld be assessed according to the difference in vital 
signs and heart rate variability.  
 
The second concern is about the word usage. Authors used several words meaning one 
definition. For example, the reviewer suggests that the authors should use Control, Audio, 
Visual, and Audiovisual instead of Groups 1, 2, 3, and 4. Please do not use the po int 1, 2, 3, etc. 
but pre -EGD, post -EGD, by defining these words previously.  
 
Where is SpO2? The authors measured SpO2 in the Methods section, but have not mentioned it 
in the Results section.  
 
The way of writing should be checked by the English medical wr iters since the authors wrote 
sometimes redundant way, but sometimes omitted way, and sometimes using different 
terminology on the same matters. Please be consistent.  
 
Please use heart rate variability instead of autonomic nervous function. HRV is a part o f ANS 
function.  
 
The authors should explain the effect of gastroduodenal inflation. The volume of the inflated air 
into the stomach may influence the heart rate variability. This should be described.  
 
The Abstract is very difficult to read. Please check ag ain and make an easy abstract for reading.  
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
No 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
No 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to th e authors.  
 
Yes 
 
 
 
 
 
 
Are you able to assess any statistics in the manuscript or would you recommend an  
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects require further  
assessment in your comments to t he editors.  
 
I am able to assess the statistics  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Needs some language corrections before being published  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimbursements, f ees, funding, or salary from an 
organisation that may in any way gain or lose financially from the publi cation of this 
manuscript, either now or in the future?  
2. Do you hold any stocks or shares in an organisation t hat may in any way gain or lose 
financially from the publication of this manuscript, either now or in the future?  
3. Do you hold or are you curr ently applying for any patents  relating to the content of the 
manuscript?  
4. Have you received reimbursements, fees, funding, or salary from an organization that 
holds or has applied for patents relating to the content of the manuscript?  
5. Do you have any  other financial competing interests?  
6. Do you have any non -financial competing interests in relation to this paper?  
 
If you can answer no to all of the above, write 'I declare that I have  no competing interests' 
below. If your reply is yes to any, please give details below.  
 
This reviewer has been recruited by a partner organization, Research  Square. Reviewers with 
declared or apparent competing interests are not utilized for t hese reviews. This reviewer has 
agreed to publication of their comments online under a Creat ive Commons Attribution License 
attributed to Research Square and was paid a small honorarium for  completing the review within 
a specified timeframe. Honoraria for reviews such as this are paid regardless of the review er 
recommendation.  
 
I agree to the open peer review policy of the journal. I understan d that my name will be included 
on my report to the authors and, if the manuscript is accepted f or publication, my named report 
including any attachments I upload will be posted on the website along  with the authors' 
responses. I agree for my report to be made available under an Open Access Creative Commons  
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I understand that any comments 
which I do not wish to be included in my named report  can be in cluded as confidential comments 
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
 
assistant