Small bowel capsule biopsy in children: parents' opinions on children's discomfort

This questionnaire study asked the parents of 62 children undergoing small bowel capsule biopsy for their reactions to the discomfort experienced by their children. The children were randomized to receive sedation with midazolam either intravenously or intranasally. With regard to the biopsy procedure the parents of 94% of the children had no objections. The parents of 3% of the children found the biopsy very unpleasant and another 3% suggested that the biopsy should be performed under general anaesthesia. The proportion of parents with negative reactions to the biopsy procedure did not differ significantly between the intravenously and intranasally sedated children. With regard to the sedation given, the parents of 79% of the children did not think that their children were in any discomfort at all. Ten percent of the children had obvious signs of nasal discomfort using the intranasal administration. In the remaining 11% of the children the parents reported various symptoms.

CONCLUSION

The vast majority of parents of children undergoing small bowel capsule biopsy found the procedure satisfactory providing that the sedative medication was given intravenously rather than intranasally.

Women's lived experience of breast biopsy: a phenomenological study

This study aimed to explore Irish women's lived experience of breast biopsy with a view to gaining a deeper understanding of their individual experiences and the meanings that it holds for them. A phenomenological approach from a Heideggerian hermeneutical perspective was used. Study participants were eight women aged 22-54 years who had experienced a recent breast biopsy with benign diagnosis. Data were collected using in-depth interviewing. The work of Benner (1994), together with guidelines from Morse & Field (1996) and Burnard (1991) were used to guide the process of data analysis. Themes which emerged from the data were: 'Finding the lump', 'Waiting, not knowing', 'knowing', 'Getting back to normal' and 'Reflections'. Women's feelings of initial distress followed by relief permeate these themes.

Increased patient satisfaction from transrectal ultrasonography and biopsy under sedation

OBJECTIVE

To determine the acceptability and patient satisfaction of transrectal biopsy undertaken with the patient under sedation. Patients and methods A retrospective questionnaire was sent to 100 patients who had undergone transrectal biopsy between January and August 1998. Levels of patient acceptability and satisfaction were assessed using visual analogue scales (VAS, with a maximum score of 10 being the least satisfactory or acceptable) and direct questions about the side-effects of the procedure. A subsequent prospective study was undertaken on 130 patients undergoing transrectal biopsy with sedation between January 1999 and January 2000.

RESULTS

The mean score for patient discomfort with sedation was 1.5, compared with 3.5 with no sedation. The overall satisfaction score improved from 3.1 to 0.9 with sedation. Complication rates were comparable, although slightly higher overall in the prospective group. Conclusion Sedation can significantly reduce patient discomfort and make the transrectal biopsy a more satisfactory experience for the patient. This is particularly important in the proportion of men who need to be considered for repeat biopsies.

Legal aspects of consent 2: the different forms of consent

Mary, following preoperative medication, was taken to theatre for a biopsy for possible breast cancer. When the theatre staff went through their checklist they could not find a consent form. The consultant surgeon said that he had seen her in the outpatients' department 2 weeks before and she had given a clear consent, not only for the biopsy but also for a radical mastectomy should the results show that to be necessary. He said that he had no problems with continuing the operation. The theatre sister was unsure of the legal position.

Aberrant nuclear expression of AP-1 and NFkappaB in lymphocytes of women stressed by the experience of breast biopsy

We have investigated the expression of AP-1 and NFkappaB in peripheral blood lymphocytes of women scheduled for breast biopsy. Samples were collected when women were informed of the need for biopsy (prebiopsy, T1, 5-7 days prior to the actual biopsy) and 7-10 days after they learned the result of their biopsy (postbiopsy, T2). At the time of blood collection, psychological stress was evaluated using Speilberger's State Trait Anxiety Inventory (STAI) and the Profile of Mood States (POMS). Women scheduled to undergo breast biopsy reported significant increases in anxiety (STAI) and mood disturbance (POMS). Gel shift mobility assays showed that mitogen stimulated peripheral blood lymphocytes of these women were less capable of the nuclear expression of AP-1 or NFkappaB at T1. Similar assessments, 7-10 days after the women learned of the results of their breast biopsy, showed these same women to have a marked reduction in anxiety and mood disturbance and an increased nuclear translocation of AP-1 and NFkappaB. These results show a significant decrease in nuclear AP-1 and NFkappaB expression during the period of emotional distress prior to biopsy with a return of nuclear transcription activity to normal levels when distress was relieved. Several studies have correlated increased psychological stress with decreased immune function. The results of this study suggest that psychological stress may mediate immunosuppression by altering the expression of the transcription factors, AP-1 and NFkappaB.

Experience with the advanced breast biopsy instrumentation system

OBJECTIVES

To report early experience with the advanced breast biopsy instrumentation (ABBI) system and to compare the results with those of other published studies.

DESIGN

A nonrandomized case series.

SETTING

An outpatient breast diagnostic centre at a large urban community hospital.

PATIENTS

Thirty-four women; 27 had suspicious calcifications, 2 had a nonpalpable mass and 5 had both.

INTERVENTION

The ABBI procedure to excise a breast lesion or obtain a representative sample for histologic examination.

MAIN OUTCOME MEASURES

Success of the procedure with respect to diagnosis, sample quality, technical problems, margins of tumour free tissue and patient satisfaction.

RESULTS

Malignant tissue was diagnosed in 7 women (21%) and atypical ductal hyperplasia in 2 (6%). In all cancers, the obtained samples had malignant cells present at the margins or less than 1 mm away. Technical problems were encountered in 32% of cases. Manual extraction of the specimen was required in 21% of cases.

CONCLUSIONS

The preliminary data correlate well with those of other published results. Although it is possible that a small number of cases and a relatively high proportion of technical difficulties may represent a normal learning curve, there is a definite need for improvement of some ABBI components. ABBI does not appear to provide adequate margins of uninvolved tissue in patients with cancer and thus should not be used with curative intent. ABBI provides excellent quality samples for pathological study and good patient satisfaction. There are not yet enough data for meaningful comparison of ABBI with stereotactic core biopsy and excisional biopsy with needle localization.

Practices of liver biopsy in France: results of a prospective nationwide survey. For the Group of Epidemiology of the French Association for the Study of the Liver (AFEF)

A nationwide prospective study was conducted in France in 89 university and primary referral hospitals' liver units to evaluate practices of liver biopsy and the occurrence of complications. A total of 2,084 biopsies were analyzed, recording the indication, hemostasis parameters, experience of operator, route of biopsy, use of ultrasonography (US), type of hospitalization, side effects, and complications. Pain, anxiety, and discomfort were evaluated by patients by visual analogue scale (VAS). Biopsies were performed by experienced physicians (>150 procedures performed) in 72%, and hepato-gastroenterologists in 89% of the cases. Hepatitis C was the indication in 54%. Sedation or premedication (atropine) was given in 46%. US-guidance was used in 56% of the cases. A day-care procedure was used in 27%. No deaths occurred, but severe complications were observed in 0.57% and increased with the number of passes and decreased with experience of operator, use of atropine, and US-guidance. Pain was independently related to general anesthesia, experience of the operator, female sex, and hepatitis C. Anxiety was increased in women. Discomfort was increased by venous access and decreased with an experienced operator. Acceptance of additional biopsies was related to a day-care procedure and independently related to general anesthesia and multiples passes. This study showed that (1) liver biopsy procedures vary greatly in France, (2) hepatitis C is the main indication for liver biopsy at present, (3) US-guidance should be developed to reduce severe complications, and (4) day-care procedures increase acceptance of a future biopsy and should also be used more often.

Improving nursing care through mentored research: a paper within a paper

In 1995 Western Sydney Area Health Service (WSAHS) and University of Western Sydney Nepean (UWSN) entered a strategic alliance to develop a nursing research culture in Western Sydney. As a result, the WSAHS/UWSN Professorial Nursing Unit (PNU) was established in 1996: Its mandate was to develop a variety of strategies to promote a nursing research culture in the area. One of these strategies was to encourage mentored research projects between personnel in the PNU and inexperienced clinical nurses. This paper describes one such project. In addition, it contextualizes the study in relevant literature relating to mentored research and outlines both the issues and the benefits associated with such projects.

[Psychopathological factors of surgical biopsy within the scope of bone tumors]

Some particularities of cancerous conditions in bone surgery have profound psychological implications for the patients involved: their angst of death is compounded by the fear of mutilation or physical impairment. All medical treatment is undertaken to save the patient's life, but at what cost? The reactions of some patients at different stages of the process, before the diagnosis is established--during a brief stay at the hospital, when biopsy is performed--, when the diagnosis is disclosed and later, during the period of treatment, affect the medical team and are apt to seriously undermine the relationship between doctors and patients. The emergence of a tumor is a major event in a patient's life, even if this tumor eventually turns out to be of the non-malicious kind. Psychological counseling and even the prescription of psychotropic medication may prove necessary: the patient must be helped to cope with a newly acquired sense of powerlessness and the awareness of his or her own mortality. At every step of this personal experience, whether before, during or after the performance of the biopsy, the patient is likely to need help to cope with a sense of anxiety, uncertainty, loneliness, or the consequences of a brutal disclosure of his or her medical condition. Some psychic reactions may take us by surprise. In the first place, we have been puzzled by the discrepancy between the simplicity of the biopsy in operative, surgical terms and the highly emotional reaction it elicited among some patients. To the surgeon, biopsy often amounts to a quick surgical gesture. During their brief stay at the hospital, patients whose condition commands no particular attention are likely to suffer a sense of loneliness while they expect the verdict of the biopsy, and these emotions may be harder to cope with than the implications of serious surgery, should the preliminary analysis require it. Even if it turns out that surgery is not necessary, the anxiety just won't go away and a reactive depression may settle in, oddly enough, one could think. Occasionally, some patients may become aggressive in their dealings with the surgeon, who must remain calm and amenable to have them accept the terms of the treatment. Once the treatment options are reviewed (most of which are stereotypical and codified, a fact that is barely belied by the detailed explanations patiently provided by the medical staff), the patient is left alone to ponder the course and the meaning of life. At this point, life cannot go on under the best possible terms if patients are not offered the opportunity to discuss their physical and moral suffering and if no one is there to listen to complaints that transcend the scope their physical condition.

A multidisciplinary approach to breast biopsy

The explosion in technological advances has provided physicians and patients more options in the diagnostic breast biopsy arena. Successful collaborative relationships between nurses, physicians, and all health care workers and detailed patient education are essential to provide optimum patient care. Survival in health care today mandates that perioperative nurses and their colleagues move outside traditional environments to provide quality, cost-effective care to patients and their family members. The aim of this collaborative approach to breast biopsy is to provide patients with the most expedient, accurate, cost-effective diagnoses with the least amount of physical and psychological trauma.

Do women who undergo further investigation for breast screening suffer adverse psychological consequences? A multi-centre follow-up study comparing different breast screening result groups five months after their last breast screening appointment

BACKGROUND

In 1995-1996 about 53500 women aged 50-64 attending for routine breast screening were called back for further investigation after an initial mammogram. Even when women were found to be clear after further investigation, significant adverse psychological consequences (PCs) can remain one month later. This follow-up study investigates whether residual emotional effects persisted five months after women received a clear result.

METHODS

Women who had previously completed a questionnaire one month after their last breast screening appointment, at which they had a clear result, were invited to complete a further postal questionnaire four months later (five months after their last appointment). We compare women who received a clear result after assessment without fine needle aspiration cytology (FNAC), after assessment with FNAC, after a benign biopsy, and those who had been placed on early recall, with those who received a clear result after mammography (reference group).

RESULTS

The response rate was 76 per cent (215/284). All groups of women who went on for further investigation suffered significantly greater adverse psychological consequences (PCs) at five months than women who were given a clear result after mammography. Compared with 10 per cent (5/52) of women who received a clear result after a basic mammogram, adverse psychological consequences were experienced by 59 per cent (27/46, p<0.00001) of the women who were placed on six month early recall, 61 per cent (14/23, p<0.0001) of women who had benign surgical biopsy, 44 per cent (18/41, p<0.0001) of women who received a clear result after assessment (with FNAC), and 45 per cent (23/51, p<0.0001) of women who received a clear result after assessment (without FNAC). Whereas all groups who had gone on for further investigations had experienced a significant decrease in PCs between one month and five months, those who were placed on six month early recall showed no significant difference in PCs between these two time periods. Other factors relating to adverse experiences as a result of breast screening are reported.

CONCLUSION

Despite receiving a clear final result, women who undergo further investigation suffer significantly greater adverse psychological consequences five months after their last screening appointment than women who receive a clear result after mammography.

Information needs, uncertainty, and anxiety in women who had a breast biopsy with benign outcome

A retrospective, descriptive study to determine the information needs of women who underwent a breast biopsy with a benign outcome and to ascertain the levels of uncertainty and anxiety they experienced was conducted in two community health care sites in Winnipeg, Manitoba. A sample of 70 women completed a four-part survey after learning the benign breast biopsy diagnosis. The survey consisted of an Information Needs Questionnaire, Mishel Uncertainty in Illness Scale--Community Form, State-Trait Anxiety Inventory, and a Demographic Questionnaire. Before the study, nine information needs were identified in a focus group composed of women (n = 9) who had a benign breast biopsy. The nine information needs were arranged in 36 pairs in the Information Needs Questionnaire. Profiles of information needs were developed through Statistical Analysis Systems analysis using Thurstone's Law of Comparative Judgement--Case V. The most important information need of women who underwent a benign breast biopsy was knowing when they would learn the diagnosis. The next four information needs were categorized as information about the risks of developing breast cancer. Information about follow-up and diagnostic tests were less important than information about the threat of breast cancer. Women experienced heightened uncertainty and anxiety levels related to the benign breast biopsy experience. Profiles of information needs were developed for women experiencing various levels of uncertainty and anxiety, women of different age groups, and women who experienced with a loved one with breast cancer.

[Effects of a written consent for liver biopsy on information and anxiety of patients]

INTRODUCTION

The present study gathers information on the influence of a consent form for liver biopsy on the information and anxiety of patients.

METHODS

The study had two phases, which included 30 patients each: before the consent form was started and the second once it was started. Two questionnaires were administered to every patient: one to evaluate the degree of patient's information, and the other to evaluate the patient's anxiety.

RESULTS

Patients who received the consent form were more informed on the obtention (p < 0.001) and complications (p < 0.0001) of the biopsy, more satisfied with the information (p < 0.0001) and showed no increased anxiety.

CONCLUSIONS

While apparently changes observed are not exclusively accounted for by consent form, this seems to be helpful and encouraging to improve patient's information.

The role of the breast clinic nurse

Women scheduled for breast biopsy procedures experience heightened anxiety about the outcomes of their diagnostic procedures. Perioperative nurses have unique opportunities to provide quality nursing care for patients awaiting breast biopsy procedures and their definitive diagnoses. The prevalence (ie, 50%) of benign breast disease in women of reproductive age and the anxiety related to the threat of breast cancer are important nursing concerns. This article addresses the breast clinic nurse's role in meeting the emotional and informational needs of women scheduled for breast biopsy procedures. The human response to illness (HRI) model is used as a framework for understanding the phenomenon of anxiety within this context. The HRI model provides a basis for delivering quality nursing care through the development of an enhanced role for the breast clinic nurse.

Self-reported locus of control is based on feelings of depression as well as on asymmetry in activation of cerebral hemispheres

In a sample of 50 patients with primary breast cancer we obtained interviews, answers to questionnaires, blood samples, and reaction times on two stimulus discrimination tests on the day of admission to the hospital for a biopsy. Locus of control scores on Rotter's I-E Locus of Control Scale seemed to be directly associated with an indicator of depressed mood and one of relative activation of the right cerebral hemisphere. Other variables of which one might have expected a mediating role did not show significant partial relationships with the dependent variable.

Coping with a breast biopsy: how healthcare professionals can help women and their husbands

PURPOSE/OBJECTIVE

To examine the type of information women received from their physicians prior to breast biopsy, to describe women's and their husbands' levels of concern during this time, and to determine the type of help they want from healthcare professionals.

DESIGN

Descriptive.

SETTING

Homes of couples in the midwestern United States.

SAMPLE

300 women and 265 of their husbands interviewed approximately one week prior to biopsy.

METHODS

Interviews using a semistructured questionnaire.

MAIN RESEARCH VARIABLES

The type of information women and their husbands receive prior to biopsy, their levels of concern, and the type of help they want from healthcare professionals.

FINDINGS

Most women were told prior to biopsy that their breast problem needed further assessment (56%) or was probably not cancer (36%). Only a small group of women were told prior to biopsy that they definitely had cancer (2%) or that their breast problem was suspicious (5%). The majority of women and their husbands reported high levels of concern awaiting the biopsy. Women identified several ways healthcare professionals could help, including providing educational materials, shortening the time between detection and biopsy, offering support, using a personalized approach, and involving family members. Husbands identified many of these interventions but also wanted information on how to help their wives.

CONCLUSIONS

Breast biopsy generated a high degree of concern in women and their husbands. Their concerns remained high even though many women were told that they probably did not have cancer.

IMPLICATIONS FOR NURSING PRACTICE

To minimize the adverse effects of a biopsy, healthcare professionals need to provide information and support, involve husbands, and shorten the biopsy waiting period.

Social support, stress, and age in women undergoing breast biopsies

The relationship among stress, age, and social support was explored in 30 women scheduled for a breast biopsy. Stress was determined using the State Trait Anxiety Inventory. Social support strength and network size were measured using the Norbeck Social Support Questionnaire in this correlational study. Findings demonstrated that women do experience stress before their biopsies. Stress was also found to have a negative correlation with social support strength. Moreover, although statistically insignificant, these women tended to have increased stress with aging until age 40, then stress decreased with increasing age. Additional research should replicate the natural age division of < or = 40 years and > 40 years in a larger sample of women. Advanced practitioners are ideally suited to affect patient outcomes by providing social support. This social support could consist of facilitated support groups or access to the information needed by women during this stressful diagnostic experience.