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Patient Anxiety (patient + anxiety)
Selected AbstractsUse of Hyaluronidase in the Treatment of Granulomatous Hyaluronic Acid Reactions or Unwanted Hyaluronic Acid MisplacementDERMATOLOGIC SURGERY, Issue 8 2005Harold J. Brody MD Background. In the past, reactions or misplacement of soft tissue fillers has been fraught with anxiety because time has been the main thrust for improvement in spite of ancillary treatments. Hyaluronidase is an enzyme that dissolves hyaluronic acid in the skin and also assists in the management of granulomatous foreign-body reactions to hyaluronic acid. These reactions may be caused by allergy to the material or immunologic response to the protein contaminants in the hyaluronic acid preparations. Dissolution of material in erroneous placement of material and in allergic reactions can be a time saver and a deterrent to patient dissatisfaction. Objective. To evaluate the use of hyaluronidase in the treatment of both allergic reactions and the erroneous misplacement of hyaluronic acid in the skin. Methods. A case of persistent granulomatous reaction to injectable hyaluronic acid and a case of hyaluronic acid erroneous misplacement with their successful subsequent treatments using intracutaneous hyaluronidase are reported, along with illustrative examples of hyaluronidase use. Results. The use of hyaluronidase reduced the patient discomfort within 24 to 48 hours, deterring any patient anxiety or patient dissatisfaction. Conclusions. Hyaluronidase has a place in the treatment of allergic reactions to hyaluronidase and in the erroneous misplacement of the material. [source] Fine-needle aspiration of the testis in azoospermic men: The value of measuring serum follicle stimulating hormone and testicular sizeDIAGNOSTIC CYTOPATHOLOGY, Issue 4 2005W.A. Mourad M.D. Abstract Testicular fine-needle aspiration biopsy (FNAB) is used as a primary tool in assessing azoospermic infertile men in our institution. If the FNA is negative for sperm, a subsequent testicular biopsy specimen and wet preparation are obtained with possible immediate fertilization. To our knowledge, the value of these techniques in the context of testicular size and serum levels of follicle stimulating hormone (FSH) has not been explored. We reviewed 453 FNA biopsies of the testis performed for the identification of sperm in infertile azoospermic males between 1999 and 2000. We identified cases that had all three procedures (FNA, wet preparation and biopsy) performed. These were the patients that were compared for testicular size using Seager orchiometry and serum levels of FSH. Of the 453 FNAs reviewed, 128 (21%) had all three procedures performed. Seventy-two cases (56%) were negative in all three tests, 26 (20%) cases were positive in all tests, and 30 cases (23%) had different results. These 30 cases were excluded. The testicular size in the negative group ranged from 4 to 16 ml (median, 10 ml) and the positive group had testicular sizes ranging from 10 to 25 ml (median, 15 ml; P = 0.0001). The negative group had serum FSH levels ranging from 3 to 52 IU/l (median, 19 IU/l) whereas the positive group had serum levels ranging from 3 to 26 IU/l (median, 10 IU/l; P = 0.0001). Our findings suggest that in infertile azoospermic men, a testicular size of <10 ml combined with a serum FSH level of >19 IU/l, the chances of retrieving sperm are minimal using all three diagnostic modalities. The use of this cutoff point would lead to a 30,50% reduction in the number of procedures performed. This reduction would have a significant impact on the management of these patients with a significant decrease in cost, logistics, and patient anxiety. Diagn. Cytopathol. 2005;32:185,188. © 2005 Wiley-Liss, Inc. [source] A course of treatment of binge eating disorder: a time series approachEUROPEAN EATING DISORDERS REVIEW, Issue 2 2006Beate Wild Abstract Objective The aim of the study was an analysis of the therapeutic course of treatment of a patient with binge eating disorder (BED), who participated in the multi-modal intervention programme at the Medical University Hospital of Heidelberg. Method Throughout the course of the treatment period, the patient answered questions daily on a handheld computer about her eating behaviour as well as her psychological and physical state. Diary data was analysed with a time series analysis method. Results Multiple regression analysis revealed that both depression and distress were same-day predictors for eating behaviour. Delayed predictors were both the eating behaviour and the anxiety of the previous day, as well as the activity 2 days earlier. The model accounts for 55% of the total variance. Discussion The findings of this study expand upon the evidence of previous cross-sectional studies, suggesting that the development process of the eating behaviour during treatment is strongly associated with affective variables. The study demonstrates that changes that occur during the treatment occur simultaneously on multiple levels. The causal interpretation of the delayed predictors shows that for this patient anxiety is a trigger of binge eating episodes. Copyright © 2006 John Wiley & Sons, Ltd and Eating Disorders Association. [source] Achieving long-term compliance with colonoscopic surveillance guidelines for patients at increased risk of colorectal cancer in AustraliaINTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 3 2007P. A. Bampton Summary We have previously demonstrated that we could improve colonoscopic surveillance practice for patients at increased risk of colorectal cancer by the adoption of guidelines, facilitated by a nurse co-ordinator. This study was to determine whether we could sustain this improvement over a longer period (4 years). All colonoscopic surveillance decisions made by the co-ordinated colorectal screening programme of our hospital between 2000 and April 2004 were reviewed. Reasons for variance were recorded, and surveillance decisions made in the last 4 months of the study time were compared with decisions made 4 years previously, both before and after the introduction of the co-ordinated programme. Between 2000 and 2004, 1794 surveillance decisions were made with variance occurring in 100. In the last 4 months of the period of study, 98% of decisions matched guidelines, suggesting that the improvement made following the adoption of the guidelines (45,96% p < 0.05) could be maintained. Reasons for variance from guidelines included a belief that the particular clinical scenario was not covered in the guidelines, disagreement with the guidelines or patient anxiety. Adherence to evidence based medicine guidelines for colonoscopy surveillance can be maintained over time at a high level. A number of clinical scenarios are not covered adequately by the existing guidelines and continue to generate disagreement amongst clinicians. [source] Literature Review and suggested protocol for managing ultrasound soft markers for Down syndrome: Thickened nuchal fold, echogenic bowel, shortened femur, shortened humerus, pyelectasis and absent or hypoplastic nasal boneJOURNAL OF MEDICAL IMAGING AND RADIATION ONCOLOGY, Issue 3 2007Article first published online: 10 MAY 200, M Bethune Summary Mid-trimester soft markers have been linked with Down syndrome and other aneuploidies. There are many other prenatal screening tests available with better detection rates for Down syndrome than the mid-trimester ultrasound. Many patients confronted with the diagnosis of a soft marker become anxious and may request a diagnostic test (amniocentesis) despite the associated risk of miscarriage. This is also despite the fact that most fetuses with an isolated soft marker are chromosomally normal. The management of a pregnancy with a soft marker must therefore be planned in a manner designed to minimize patient anxiety. Likelihood ratios can be used to modify a patient's ,prior risk' (based on age or prior screening tests) and create a new risk. This calculation may help identify a subset of patients suitable for further investigation. It has been proposed that ,negative' likelihood ratios can be used to reduce a patient's risk if no soft marker is found at a mid-trimester ultrasound. There remain concerns about this approach and further research is required before this approach enters common practice. The published work surrounding the management of thickened nuchal fold, echogenic bowel, shortened femur, shortened humerus, pyelectasis (renal pelvis dilatation) and hypoplastic nasal bone is reviewed. Each soft marker has different associations and individual management plans for each of these soft markers are presented. Although isolated single umbilical artery is not usually considered a soft marker of aneuploidy, a management plan for this common finding is also included. [source] Atraumatic Restorative Treatment and Dental Anxiety in Outpatients Attending Public Oral Health Clinics in South AfricaJOURNAL OF PUBLIC HEALTH DENTISTRY, Issue 3 2007Steffen Mickenautsch BDS Abstract Objectives: This study was undertaken to test the hypotheses that using the atraumatic restorative treatment (ART) approach results in lower patient anxiety and that lower anxiety leads to higher restoration/extraction ratios. Methods: The test group of dental operators (n=9) was trained in ART. The control group (n=11) was not, and did not apply ART. The Short Form of the Dental Subscale of the Children's Fear Survey Schedule (CFSS-SF) and Corah's Dental Anxiety Scale (DAS) were used to assess patient anxiety after ART (test group) and after traditional restorations (control group). The restoration/extraction ratio calculated for primary (children) and permanent dentitions (adults) per operator was based on 12-month treatment statistics. Dental anxiety assessments were analysed using ANOVA. Differences were compared using the t -test and corrected for confounding factors (ANCOVA). The Pearson correlation coefficient was used to measure the correlation between dental anxiety levels and restoration/extraction ratios. Results: The mean CFSS-SF score for test-group children was statistically significantly lower than for the control-group children. The mean DAS score for test-group adults was statistically significant lower than the control. No significant correlation was observed between dental anxiety level and restoration/extraction ratio per operator for both dentitions in both groups. Conclusion: The first hypothesis was accepted; the second, rejected. Although dental anxiety scores were lower both in child and in adult patients treated by ART than in those who received traditional restorative treatments, this positive effect had not resulted in higher restoration/extraction ratios. [source] Reducing admission times in the endoscopy unitINTERNATIONAL JOURNAL OF NURSING PRACTICE, Issue 4 2006Deborah Dobree-Carey RGN Pre-procedural admission of outpatients to a day-case endoscopy facility is time-consuming. Collecting and recording routine but necessary information distracts nurses from spending time that could be used to counsel patients. This study assessed whether patients can record some pre-procedural details and whether such self-recording quickens nurse admission times. A new admission document was devised and posted to patients. Patients completed personal/administrative details and information about drugs and allergies and brought the document with them when attending for outpatient endoscopy. Endoscopy nurses anonymously timed 100 admissions, 50 using the new admission form and 50 using the old admission form. Overall, the median (range) time to admit using the old form was 6 (3,15.5) min. Using the new form, the median time to admit was lower at 4 (0.5,10) min. No patient completing the new form reported any particular difficulties. An admission document that patients partially complete at home leads to a faster pre-procedural admission in the endoscopy unit. This allows more nursing time to discuss patients' anxieties and answer patient queries, helps to prevent delays and facilitates increased capacity in the endoscopy unit. [source] Does the experimental design capture the effects of complementary therapy?JOURNAL OF CLINICAL NURSING, Issue 4 2007A study using reflexology for patients undergoing coronary artery bypass graft surgery Aim., Our purpose was to pilot test whether reflexology may reduce anxiety in patients undergoing Coronary Artery Bypass Graft Surgery in Iceland. Background., Nurses need to study the effects of complementary therapies in general and particularly those that may be beneficial to decrease patients' anxiety. It has been assumed that reflexology lessens anxiety, but research is needed to substantiate such expectations. Design., A pilot study using randomized design with experimental and control groups. Methods., Nine patients were recruited and randomly assigned into groups with five patients assigned into an experimental group receiving reflexology for 30 minutes and four patients into control group which rested for 30 minutes. Anxiety and physiological variables were measured pre- and post-reflexology sessions once a day over five days. Results., The anxiety scores were lower for patients in the control group on all measures. Systolic blood pressure lowered significantly more in the control group than in the treatment group. No significant changes were observed for other variables. Patients' comments and responses overwhelmingly suggested increased well-being due to both experimental and control intervention. Conclusion., This study showed little evidence to support reflexology as a mean of reducing anxiety in CABG patients. Several methodological problems were identified that need to be considered further. Relevance to clinical practice., It is suggested that reflexology should be tailored to individual needs and research methods used that allow for capturing its holistic nature. Further scholarly work is warranted to explore several methodological issues in studying complementary therapies in a highly complex treatment situation. [source] | ||||||||||