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.

Health inequalities in the early years: is there equalisation in youth?

In the light of a still prevalent view that health inequalities are an invariant feature of the life-course, this paper re-examines the thesis that youth, in contrast to childhood, is characterised by relative equality in health, and proposes a process of equalisation to account for changes in the social class patterning of certain dimensions of health between these life stages. The evidence relating to the relationship between class of background and health over the early years is first reviewed, focusing on seven dimensions of health: mortality, chronic illness, specific conditions, self-rated health, symptoms of acute illness, accidents and injuries, and mental health. The overall picture is consistent with a conclusion of relative equality of health in youth with one major exception, severe chronic illness, which particularly on the evidence of the 1991 British Census is class differentiated from infancy. In respect of other dimensions of health, notably symptoms, non-fatal accidents and (probably) mental health, there is evidence of a change in class patterning between childhood and youth consistent with a hypothesis of equalisation. Within a theoretical perspective that juxtaposes class and age (youth) based influences, it is suggested that this could occur when effects associated with the secondary (high) school, the peer group and youth culture cut across those of the family, home background and neighbourhood in such a way as to reduce or remove class differences in health. In later youth, in the post-school period, the relative balance of class and age based shifts once more to produce a "re-emergence" of class gradients in adulthood. Youth may be a barometer of the relative power of post-modern consumer culture and traditional class based structures to shape the pattern of health inequalities over the early years into adulthood.

Emotional expectancy: brain electrical activity associated with an emotional bias in interpreting life events

University students in either an optimistic or pessimistic mood state read brief stories of daily life events as event-related brain potentials were collected during the final word of each story. For subjects in a pessimistic mood, a bias to expect negative outcomes was seen as an N400/P300 effect over posterior scalp regions. For subjects in an optimistic mood, a differentiation between good and bad outcomes was also observed, but it was specific to medial frontal areas. Analysis of single-trial P300 latencies suggested that semantically incongruent and mood-incongruent outcome words resulted in increased median latency of the late positive complex (LPC) and resulted in increased variability of LPC latency across trials.

Establishing an interdisciplinary patient care team: collaboration at the bedside and beyond

The authors describe how an interdisciplinary team used skills in communication and collaboration to improve patient care on a busy surgical service. A major goal was to establish and maintain continuity of care in the face of decreasing lengths of stay and increasing patient acuity. The authors share their insight about designing and supporting a successful interdisciplinary patient care team and discuss how their experiences relate to concepts such as case management and career development.

Nurse practitioners: the South Thames RHA experience

Nurses are a key resource in primary and community care, but their effectiveness and efficiency is not easily evaluated. In this paper the authors describe a major project undertaken in England to demonstrate the outcomes of nursing practised at an advanced level. The key lessons learnt from this study are explained, together with some pointers for the way forward for nurse practitioners in primary care.

Family life and health in adolescence: a role for culture in the health inequalities debate?

Until recently, the role of the family in the 'health inequalities' debate has been largely ignored. Using data from the youngest cohort in the West of Scotland Twenty-07 Study, three dimensions of family life (family structure, culture and conflict) are examined in respect of their association both with health when respondents were aged 15 and 18, and with labour market position at 18. Despite a strong association between family structure and material deprivation, those from intact, reconstituted and single parent families were largely undifferentiated in terms of health. By contrast, aspects of family functioning, particularly a poorer relationship and conflict with parent(s), were independently associated with lower self-esteem, poorer psychological well-being and (among females) more physical symptoms at both ages. In addition, both family culture and conflict were associated with labour market position over and above the effects of material deprivation, with those from family centred and lower conflict homes having a greater likelihood of being in tertiary education. While the relationships between the family and psychological well-being and, to a lesser extent, physical symptoms appeared to be mediated by self-esteem, those between the family and labour market position did not. These findings suggest that in adolescence family life may have more direct effects on health than material factors and, through social mobility, may be indirectly linked to health inequalities in adulthood. These family processes, we argue, are expressions of cultural influences, the scope of which to date has been too narrowly focused on health behaviours.

Necrotizing fasciitis following postpartum tubal ligation. A case report and review of the literature

Necrotizing fasciitis is a rare, but devastating subcutaneous bacterial infection which occurs following breaks in skin integrity, either natural, post traumatic or post surgical. Although it has been described following many surgical procedures, necrotizing fasciitis has not been previously described following postpartum tubal ligation. Necrotizing fasciitis was diagnosed four days after an uncomplicated postpartum tubal ligation via an infraumbilical incision. Rapid surgical debridement with broad spectrum antibiotic coverage provided successful therapy. Postpartum tubal ligation is one of the most common surgical procedures in obstetrics and gynecology, thus reports of complications resulting from this procedure are quite relevant to clinical practice. We present here the first reported case of necrotizing fasciitis following postpartum tubal ligation through an infraumbilical incision.

Improving a rural hospital's peer review process

Quality monitoring in a small rural hospital is a challenge on many fronts. The case study presented here illustrates a quality monitoring failure and analyzes the contributing factors. Based on their experience, the authors suggest methods to improve small rural hospital quality monitoring.

Patterns of class inequality in health through the lifespan: class gradients at 15, 35 and 55 years in the west of Scotland

Data confirming the existence of social inequalities in health have continued to accumulate since the Black Report reported class inequalities across a broad range of causes of mortality, with an increasing emphasis on indicators of morbidity and current health status. Although evidence of continuing inequalities mounts, elucidation of underlying mechanisms generating and maintaining such inequalities has been more elusive, and much of the debate has oscillated from the very broad to the very specific. In this paper, the class patterning of a range of non-fatal indicators of health are modelled in an attempt to outline first the adequacy of models of linear relationships for this range of measures, and secondly, the extent to which these are generalizable across a series of age/sex subgroups and across different domains of health. Data are presented here for representative community samples of men and women in adolescence, early- and late-midlife. While orderly relationships between social class and health were seen for the majority of the measures considered; the detailed patterns show considerable diversity. Thus for some aspects of health, notably height (itself often heralded as a broad indicator of health and early life experience), common class gradients were observed for both sexes at each of the stages of the life course examined. For others (notably mental health and presence of chronic illness), gradients were evident in later life but not in adolescence. Others still showed sex but not age differences in class patterning (typically measures of body shape), or no clear patterns (notably blood pressure and consultations with general practitioners). The current analysis draws attention to the consistency of gradients in early- and late-midlife, which are apparent despite the marked increase in the burden of poorer health which manifests between these life stages for almost all indicators of health (an exception being mental health). The challenges which this presents for understanding the mechanisms and processes which have been candidate explanations for social inequalities in health are discussed.

Socio-demographic correlates of dietary habits in mid to late adolescence

OBJECTIVE

To examine socio-demographic correlates of dietary habits at 15 and 18 years.

DESIGN

First and second sweeps of a longitudinal survey, based on a two-stage stratified clustered random sample.

SETTING

Central Clydeside Conurbation, in the West of Scotland.

SUBJECTS

A random sample of 1682 households containing 15-year-olds was approached by Strathclyde Regional Council, 70% of whom agreed to have their names passed on to the MRC. 1009 (86%) of this target sample were interviewed at baseline. 908 (90%) were re-interviewed at age 18. Analyses are restricted to respondents who took part in both data collection sweeps.

MEASURES

Questions on meal patterns and food choices were included in the interviews: self-complete questionnaires included a dietary inventory. Social class was measured by reference to the head of household at baseline: information on own labour market position and place of residence was obtained at 18.

RESULTS

At 18 there was clear differentiation in food choices and meal patterns according to sex and both parental social class and own current labour market position. Controlling for class, dietary habits at 15 were independently related to future labour market position. Overall changes in eating habits between 15 and 18 were slight, though females were more likely to have increased consumption of foods consistent with current recommendations, while the un/non-employed reduced their consumption of a midday meal.

CONCLUSIONS

Dietary habits are established in mid-teens and closely associated with lifestyle, facts which need to be taken into consideration in designing effective nutrition education programmes.

How sick is the West of Scotland? Age specific comparisons with national datasets on a range of health measures

The Central Clydeside Conurbation (CCC) has relatively high mortality rates. This paper examines whether it also has relatively high rates of ill health, using data from three cohorts (aged 15, 35 and 55 in 1987/88) in the West of Scotland. Comparisons on a range of self-reported physical and mental health indicators, anthropometric measures, blood pressure, and respiratory function were made with comparable age groups in ten British or Scottish national studies. The older two cohorts in the CCC exhibited relatively high rates of longstanding and limiting longstanding illness and the youngest cohort had relatively poor psychosocial health, compared to their age peers elsewhere. Fewer differences were found in blood pressure, anthropometric measures or respiratory function although older CCC residents were slightly shorter than in Britain as a whole and had slightly poorer respiratory function. Central Clydesiders in the late 1980s were generally in poorer health than those of the same sex and similar age elsewhere in the UK, but the extent of the disadvantage varied across different dimensions of health, and was not as marked as some stereotypes of the West of Scotland would suggest.

Idiopathic right ventricular tachycardia: electrophysiology and response to catheter ablation

BACKGROUND

Ventricular tachycardia (VT) originating in the right ventricle may be seen in the absence of structural heart disease. Although this is thought to be associated with a benign course, it may cause intolerable symptoms and be difficult to control with antiarrhythmic drugs.

AIMS

To assess the value of radiofrequency ablation of right ventricular tachycardia and to characterise the clinical and electrophysiologic features predictive of successful ablation.

METHODS

Nine patients (aged 20-49 years) with clinical VT underwent cardiac mapping which localised the site of origin of VT in the right ventricle. At least three separate areas of VT origin were identified in these patients. Ablation of VT was defined as suppression of VT at the time of hospital discharge.

RESULTS

Five patients had successful ablation of the tachycardia focus with long term suppression of the arrhythmia. Patients with successful ablation were characterised by inability to induce VT with extrastimuli, a distinct VT morphology with a rS pattern in lead 1, right axis deviation, facilitation of VT with isoprenaline and site of origin in the lateral outflow tract. During VT, an earlier site of presystolic activation was found in successful patients compared with unsuccessful ablations. Right ventricular tachycardia in patients without structural heart disease is a heterogeneous disorder with varied clinical and electrophysiologic features. Successful ablation of VT may be predicted by consideration of these variables.

Dietary patterns among adolescents in the west of Scotland

Dietary data from 15-year-old adolescents participating in the West of Scotland Twenty-07 study were examined in order to describe current eating patterns and food habits. Comparison of the data with a 'healthy eating' index showed that less than one-third of the sample were eating a diet similar to that promoted by local health education campaigns. Multivariate analysis showed that adolescents from non-manual and wealthier families, non-smokers, and females were more likely to be classified as 'healthy eaters'. Comparison of the data with that collected from a 35-year-old cohort in the same study showed that significantly fewer 15-year-olds were likely to consume diets associated with long-term health.

Heterosexual behaviour of 18-year-olds in the Glasgow area

This paper describes heterosexual behaviour, and protection against pregnancy and sexually transmitted diseases, among 908 18-year-olds in the Glasgow area in 1990. The proportion who reported having experienced sexual intercourse was similar to, though slightly lower than, that reported in most recent studies elsewhere. There were marked sex differences, with males reporting being significantly younger at first intercourse and having had more sexual partners than females. The reported prevalence of unprotected sex (without any contraception) and of "unsafe" sex (without a condom) was high. Being male, of no religious affiliation, an early school leaver, and not in higher education were independently associated with sexual experience. Among the sexually experienced, lower education was also associated with "unsafe" sex, and Catholicism with unprotected sex. The overall pattern of findings, particularly in relation to sex differences, suggests that young people in the Glasgow area may be subject to more traditional influences than those elsewhere.

Factors associated with the dental visiting habits of adolescents in the west of Scotland

Although little detailed research has been conducted into the factors affecting the dental visiting habits of adolescents, there is evidence that the utilisation of dental services is related to social class background. Amongst the data collected for the 15-year-old cohort of the 'West of Scotland Twenty-07 Study' is information relating to dental visiting and the utilisation of dental services. The results show that while there is an independent adolescent dimension, including gender and smoking, which influences dental visiting, the most important influence is that resulting from the parents' own dental visiting habits. Combined with smoking, this accounts for the social class difference found. It is clearly the case that parents continue to exert an influence on their children well into the adolescent period.

Bridging the gap between research and clinical practice: a collaborative approach

In nursing, a gap sometimes exists between research and practice. This paper discusses how a group of 11 nurses successfully bridged this gap. The group was composed of nurses from a large teaching hospital, a regional outpatient cancer center, and a university. The result of the group's work over a two-year period was an externally funded research proposal. This paper discusses the strategies that led to the group's success and provides specific recommendations for nurses who want to form similar groups.

Adolescent meal patterns: grazing habits in the west of Scotland

Concern is frequently expressed that young people are increasingly taking a 'grazing' approach to eating, rather than eating 'proper meals', and that this may have undesirable nutritional and social consequences. As part of a wide ranging study of health and well-being, 1,009 fifteen year olds in the Central Clydeside Conurbation were questioned in 1987 about their eating patterns. They reported an average of 5.5 eating occasions per day (2.7 main meals and 2.8 snacks), these eating occasions being concentrated towards the end of the day. Over 40% reported eating crisps, confectionery or biscuits at least once a day, a much higher proportion than among a cohort of 35 year olds in the same study. We discuss the implications for nutrition education and suggest that the picture is not as bad as is sometimes painted.

Reporting by parents of longstanding illness in their adolescent children

Parents' proxy reports of longstanding illness in their 15 year children are compared with the young people's own reports, both overall and between different reporting contexts; mother alone, father alone and both parents together. Parents over-report longstanding, but not limiting longstanding, illness in comparison to self report. There is no evidence of differential over-reporting by reporting context, but a number of differences are found in the likelihood of disagreement between these reporting contexts. The gender of the young person influences the relationship between proxy and self reports.

'What does the phrase "safer sex" mean to you?' Understanding among Glaswegian 18-year-olds in 1990

OBJECTIVE

To ascertain what young people in western Scotland understand by the phrase 'safer sex', and the social correlates of this knowledge.

DESIGN

Face-to-face interviews with 18-year-olds participating in the third stage of a longitudinal study of the social patterning of health and illness.

SETTING

The Central Clydeside Conurbation in western Scotland.

PARTICIPANTS

Eight hundred and seventy-nine 18-year-olds (416 men and 463 women).

MAIN OUTCOME MEASURES

Reported understanding of the term 'safer sex'.

RESULTS

Eighty-four per cent mentioned condoms, 68% some aspect of choice of partner, and only 2% abstaining from specific sexual activities. Those in more advantaged socio-economic circumstances and with higher levels of education were more likely to have 'better' knowledge (defined as mentioning condom use plus one or more other risk-reduction strategy).

CONCLUSIONS

Although knowledge of the routes of transmission of HIV may be reasonably good among the young, knowledge of what professionals mean by 'safer sex' appears less so, particularly among the more deprived sections of the community.

Hodgkin's disease presenting as an enlarged thyroid gland. Report of a case diagnosed by fine needle aspiration

An unusual case of Hodgkin's disease (HD) in a 36-year-old woman that was diagnosed by fine needle aspiration (FNA) biopsy of a neck mass believed clinically to be diffuse goiter is reported. The aspirate was composed mainly of dispersed lymphocytes; admixed with these were occasional large mononuclear cells with round-to-oval nuclei and prominent nucleoli. Binucleated variants of the large cells were interpreted as Reed-Sternberg cells, suggesting the diagnosis of HD. Subsequent to the FNA biopsy, radiologic examinations demonstrated an enlarged mediastinum, and incisional biopsy of the neck mass confirmed the diagnosis of HD. This case emphasizes the value of FNA biopsy as a rapid and reliable procedure, even in the unusual but established clinical presentation of HD as a diffuse neck mass.