Psychological Reaction to Potential Malfunctioning of Implantable Defibrillators

BACKGROUND

Psychological problems following implantable cardioverter defibrillators (ICD) implantation are diverse and include increased levels of anxiety. Anxiety may even rise further when possible malfunctioning of an ICD is announced, with a higher risk of serious ventricular arrhythmias and death as a consequence. Following the public statement of Medtronic, all patients in the Netherlands with the specific Medtronic ICD were contacted for extra device evaluation. The aim of this exploratory study was to determine whether the proportion of ICD patients with high levels of anxiety would increase after this extra device evaluation.

METHODS

Patients were recruited from an ongoing prospective study on psychological effects of ICD implantation. Thirty-three patients completed the State subscale of the State-Trait Anxiety Inventory (STAI) before and after extra device evaluation. The STAI can identify patients with high levels of anxiety.

RESULTS

A high level of anxiety was experienced by two patients (6.1%) at baseline and eight patients (24.2%) at follow-up (P=0.031). Hence, ICD patients were significantly more likely to experience high levels of anxiety following the public statement of potential malfunctioning of their device.

CONCLUSION

A public statement regarding device safety may increase levels of anxiety among ICD patients. Given the potential triggering effect of high levels of anxiety on arrhythmias, psychological support may be considered for some of the ICD patients after such public statement.

Innoxious removal of suction drains

Suction drains are commonly used in orthopedic elective and trauma surgery; however, drain tube removal causes pain, discomfort, and anxiety. A method of drain tube removal is described in patients who underwent total hip replacement and in adolescents who underwent lower extremity surgery. Ten milliliters of lidocaine was injected through the skin wound around the drain tube. The efficiency of this practice was evaluated using a visual analog scale score in two patient groups. Pain during tube removal and pain on post-removal were significantly decreased in the study group compared to the placebo group. Using this technique drain tube removal was painless, comfortable, and safe.

The duration of use, causes of discontinuation, and problems during removal in women admitted for removal of IUD

OBJECTIVE

Our aim was to determine the duration of intrauterine device (IUD) use, reasons for discontinuation, and problems encountered during removal in patients who were admitted to our clinic for removal of IUD.

MATERIALS AND METHODS

We studied 321 cases of IUD removal with respect to duration of use, cause of removal, type of IUD used, and sociodemographic characteristics. The relationships among duration of use, patient's level of education, medical facility where the IUD was inserted, and number of children were analyzed. The reasons for removal and their relationship to duration of use were investigated. We also investigated the problems encountered during removal.

FINDINGS

The mean age of cases included in the study was 34.8+/-1 years, mean number of children was 2.3+/-1.5, and mean duration of use was 5.8+/-3.9 years. The type of IUD most frequently removed was TCu-380A (86.3%). Although there was no correlation between the duration of use and the type of medical facility where the IUD was inserted, we observed that women with more children used IUDs for longer periods. When cases were evaluated for level of education, there was a statistically significant difference between university graduates and illiterate/primary school graduate women (p = .032 and .029, respectively). The reasons for removal were frequently side effects related to IUD use, expired date of use, and desire for conception. Pregnancy during IUD use was observed in 16 cases (5%). Removal of IUD was achieved without problems in 263 cases (81.9%), whereas alligator forceps needed to be used in 44 cases (13.7%).

CONCLUSION

IUD is the most frequently used contraceptive method in our country. We have observed a long duration of use in the women studied, with minimal problems during removal.

Discontinuation pattern among IUCD users at the family planning clinic, University College Hospital, Ibadan

Despite the high popularity of the intrauterine contraceptive device (IUCD) among family planning clients at University College Hospital, Ibadan, some users discontinued its use for a variety of reasons. This study was to determine the discontinuation rate among IUCD users at UCH, Ibadan. It was a 5-year retrospective analytical study. The records of patients using an IUCD seen at the Family Planning Clinic between 1 January, 1998 and 31 December, 2003 were analysed. A total of 867 clients were seen during the study period; 258(29.8%) clients discontinued within 5 years with the highest rate at 1 year 10.1% and least after 5 years 2.8%. The most common reason for discontinuation was the desire for pregnancy (57.0%). Other reasons included: side-effects (28.3%), husband's views (7.0%) and the menopause (8.0%). The reason for discontinuation varied significantly with the age of the clients (92.5% of clients that discontinued were less than 35 years), educational status, husband coercion, number of living children and religion. The discontinuation rate for the IUCD is high inspite of the high initial acceptability of the method in Nigeria. In a country experiencing a very rapid population growth where the prevalence of contraceptive use hardly attains double figures, it is imperative that policy makers double their efforts at ensuring an appreciable continuation rate of contraceptive use in general and IUCD in particular, among Nigerian women.

Medical and bioethical considerations in elective cochlear implant array removal

OBJECTIVE

Cochlear explantation for purely elective (e.g. psychological and emotional) reasons is not well studied. Herein, we aim to provide data and expert commentary about elective cochlear implant (CI) removal that may help to guide clinical decision-making and formulate guidelines related to CI explantation.

DATA SOURCES

We address these objectives via three approaches: case report of a patient who desired elective CI removal; review of literature and expert discussion by surgeon, audiologist, bioethicist, CI user and member of Deaf community.

REVIEW METHODS

A systematic review using three scientific online databases was performed. Included articles addressed the benefits and/or complications of cochlear implantation in young children, CI explantation with or without revision surgery and the ethical debate between the medical and Deaf communities on cochlear implantation and explantation.

CONCLUSIONS

The medical and audiological perspectives identify a host of risks related to implant removal without reimplantation, including risk from surgery, general anaesthesia, cochlear ossification and poor audiometric outcomes. The member of the deaf community and bioethicist argue that physicians need to guide the principles of beneficence, non-maleficence and patient autonomy. Taken together, patient desires should be seen as paramount, if the patient is otherwise fit for surgery and well informed.

IMPLICATIONS FOR PRACTICE

Similar to the case of device implantation, device explantation should be a multidisciplinary and collaborative decision with the patient and the family's desires at the centre. While every case is different, we offer a CI explantation discussion to assist in clinical decision-making, patient counselling and education.

[Treating ICD patients at the end of their lives: attitudes, knowledge, and behavior of doctors and patients. A critical literature analysis]

BACKGROUND

The implantable cardioverter-defibrillator (ICD) is highly effective in the therapy of malign heart rhythm abnormalities. However, the ethical dilemma of harming a dying patient has received little attention. We studied the current state of knowledge and behavior of physicians and the subjective needs of ICD patients with respect to end-of-life issues.

METHODS

A literature search of articles published between 8/2010 and 3/2011 in PubMed resulted in the identification of 32 reports, of which 25 met selection criteria.

RESULTS

Practically no clinical institution (96% in Europe) offers routine counseling of ICD patients on end-of-life issues. In only about 25% of cases do doctors initiate a discussion on this issue with the ICD patient, of which the majority takes place during the final hours of the patient's life. Knowledge of legal aspects of ICD deactivation is insufficient in about 50% of physicians. Many physicians underestimate the impact of ICD shocks and often have unrealistic expectations about the patient's knowledge on technical aspects of the ICD device. The majority of patients are reluctant to address this topic and prefer to rely on the decision of their attending physician.

CONCLUSION

Despite insufficient empirical data, findings point to a low willingness of ICD patients to confront the end-of-life issue and prefer decisions to be made by their physician. Substantial knowledge gaps of physicians may cause barriers in considering the option of deactivating the ICD.

Effect of Spiritual Care on Chest Tube Removal Anxiety and Pain in Heart Surgery in Muslim Patients (Shia and Sunni)

The process of removal of a chest tube can cause pain and anxiety. Spiritual care can be considered as a component of nursing care, especially in the pain and anxiety relating to such procedures. This study was a randomized clinical trial. Eighty patients completed the study. The findings showed significant differences in anxiety and pain between groups (p = 0.001). Spiritual care reduced anxiety and pain caused by chest tube removal in patients (Shia and Sunni Islam) undergoing heart surgery.

Effect of virtual reality on pain and stress in children during Kirschner-wire removal after fracture treatment: a randomized clinical trial

BACKGROUND

Removal of Kirschner wires (K-wires) after fracture treatment in the upper limb is unpleasant for children. The aim of this study was to evaluate whether virtual reality (VR) distraction could improve pain and the overall experience for children.

METHODS

An RCT was performed in a single outpatient fracture clinic, where children (aged 6-15 years) were randomized 1 : 1, in three age strata, to additional VR or standard of care. Pain perception was assessed using the Wong-Baker Faces Pain Rating Scale by neutral observers and later by the patients and their guardians. Further measures included the Face/Legs/Activity/Cry/Consolability (FLACC) Pain Scale, the modified Yale Pain Anxiety Scale (mYPAS), and questionnaires, as well as objective data, such as heart rate variability and blood pressure.

RESULTS

A total of 146 patients were recruited into the trial. The VR group showed significantly less pain on the Wong-Baker Faces Pain Rating Scale (OR 0.23 (95% c.i. 0.12 to 0.43)) compared with the control group. Observers rated the pain >2 for 43% of patients in the VR group and 74% of patients in the control group. Observer scales (the FLACC Pain Scale and the mYPAS) during K-wire removal also indicated less pain (OR 0.36 (95% c.i. 0.19 to 0.24) and 0.29 (95% c.i. 0.16 to 0.52) respectively). The difference in pain rated >2 between the VR and control group was smaller directly after (59% versus 69% respectively) and 2 weeks after (58% versus 70% respectively) K-wire removal. Children in the VR group were less aware of the painful stimulus directly after and 2 weeks after wire extraction.

CONCLUSION

VR distraction effectively reduces pain during K-wire removal in children. VR positively impacts the procedural memory of children.

REGISTRATION NUMBER

DRKS00020229 (Deutsches Register Klinischer Studien (DRKS; that is the German Clinical Trials Register); date of registration 10 December 2019).

Foot Reflexology for Pain and Anxiety Associated with Chest Tube Removal in Patients After Coronary Artery Bypass Graft: A Randomized Controlled Trial

Background

Reflexology is a method used to control the pain and anxiety associated with chest tube removal in patients undergoing cardiovascular surgery.

Primary Study Objective

This study aimed to identify the effect of foot reflexology applied before chest tube removal on pain and anxiety levels in patients with coronary artery bypass graft surgery.

Methods/Design

This study was a randomized controlled clinical trial.

Setting

This study was conducted in the cardiovascular surgery intensive care unit of the Baskent University Ankara Hospital.

Participants

Patients, who underwent coronary artery bypass graft surgery, were randomly assigned either to the reflexology group or the control group (n = 28 individuals/group).

Intervention

The reflexology group received foot reflexology for 30 minutes in two sessions (first postoperative day and before chest tube removal).

Primary Outcome Measures

The primary outcomes of the surgery were pain, evaluated using a Numeric Pain-Rating Scale; and anxiety, evaluated using the Profile of Mood States Scale Tension-Anxiety Subscale. Pain and anxiety were determined on the first (before and after the reflexology) and second postoperative days (before and after the reflexology and immediately, 15 min, 1 hour (only pain level) after chest tube removal).

Results

The mean pain scores of the control and intervention groups were similar during chest tube removal, 15 minutes after, and 1 hour after (P > .05). Although mean anxiety scores were comparable after chest tube removal in both groups (P > .05), a significant difference was found 15 minutes later (P < .05). The increase in pain (P = .0001) and anxiety (P = .032) levels before and after the removal was significantly less in the intervention group compared to the control group, based on pain and anxiety scores.

Conclusion

Foot reflexology significantly reduced the increase in pain and anxiety during chest tube removal in patients with coronary artery bypass graft surgery.

The midterm psychological effect of cast removal procedures in children

OBJECTIVES

This study aimed to compare the course of anxiety change in children who used headphones during cast removal with controls in midterm follow-up.

PATIENTS AND METHODS

Sixty-six patients who underwent forearm fracture treatment with closed reduction and long arm casting between June 2021 and March 2023 were retrospectively reviewed. Patients were divided into two groups based on the use of headphones (n=27; 21 males, 6 females; mean age: 8.0±1.8 years; range, 6 to 12 years) or not (n=39; 27 males, 12 females; mean age: 8.9±1.8 years; range, 6 to 12 years) during cast removal with an oscillating saw. Primary outcome measures included preprocedure, postprocedure, and six-month anxiety assessments with the State-Trait Anxiety Inventory.

RESULTS

There was an acute increase in the mean state anxiety scores after the procedure, which returned to below baseline at the six-month follow-up in the headphone (31.4±8.3, 33.3±8.7, and 25.1±4.1, respectively) and control groups (34.9±11.1, 37.4±9.5, and 27.3±5.3, respectively). The mean trait anxiety scores before the procedure, after the procedure, and at six months remained similar in the headphone (33.6±3.0, 34.6±3.2, and 32.4±2.8; p>0.05) and control groups (34.1±2.7, 33.7±3.0, and 33.7±3.0, p>0.05).

CONCLUSION

This study suggests that the acute anxiety during cast removal did not create anxiety sequelae in the sixth month regardless of headphone use.

Reasons for Intrauterine Device Use, Discontinuation and Non-Use in Malawi: A Qualitative Study of Women and their Partners

The copper intrauterine device (IUD) is a safe, long-acting, and effective method of contraception that is under-utilized in many countries, including Malawi. A unique cohort of women who had enrolled in a trial of postpartum IUD use one year earlier gave insights into reasons for using, discontinuing, or not using the IUD. We conducted in-depth interviews with 18 women one year after they participated in a pilot study of a randomized controlled trial of postpartum IUD insertion, and 10 of their male partners. Women and their partners expressed a strong desire for family planning, and perceived numerous benefits of the IUD. However, fear of the IUD was common among successful users and non-users alike. This fear arose from rumours from friends and neighbors who were non-users. How women and their partners responded to this fear affected IUD adoption and continuation. Key themes included (1) Trust in information received from health care providers versus rumours from community members; (2) Partner involvement in IUD decision-making; and (3) Experience with side effects from short-term hormonal contraceptive methods. Broad community education about the IUD's benefits and safety, and proactive counseling to address couples' specific fears, may be needed to increase uptake of the method.

[Patient care and dental ethics. III. The advice of an acupuncturist for the removal of dental amalgam]

On the advice of an acupuncturist a patient requests her dentist to remove her amalgam fillings which are of a good quality. The question is discussed whether there is a moral justification to gratify the wishes of the patient.

Patients' perspectives about why they have their contraceptive Implanon NXT device removed early

BACKGROUND

Women with long-acting, reversible contraceptive devices inserted may choose to remove them prior to their planned expiry dates.

OBJECTIVE

The objective of this study was to explore Australian women's experiences with the etonogestrel subdermal contraceptive implant (Implanon NXT) and why they had it removed early.

METHODS

Semi-structured interviews were conducted with 18 women between June 2013 and January 2014. Transcriptions of the audio-taped interviews were analysed using a constant comparative analysis framework.

RESULTS

Two core themes of participants' responses that were identified in this study were influences on choice of contraception, which included convenience and information sources; and influences on removal of contraception, which included side effects and their negative impacts on relationships and financial costs.

DISCUSSION

This study highlights that women's experiences with side effects contribute to the early removal of long-acting contraceptive devices such as Implanon NXT. This study emphasises the importance of general practitioners (GPs) in providing comprehensive information about the benefits and potential side effects associated with using these implants.

Pattern of discontinuation of intrauterine copper T 380a at the University College Hospital, Ibadan: a ten-year review

AIMS AND OBJECTIVES

Intrauterine contraceptive device is a highly acceptable method of contraception, however despite it sacceptability many users still discontinue its use for various reasons, this study was embarked upon to determine the rate of its discontinuation and the factors associated with its discontinuation.

MATERIALS AND METHODS

It was a retrospective study of 10 years duration starting from January 1997 to December 2006 at the University College Hospital, Ibadan. A total of 6,515 had insertion of IUCD (Copper T380 A) over the study period and 1,295(19.9%) discontinued within the period with the highest discontinuation rate being the first year while the least discontinuation rate was the 9th year.

RESULTS

The commonest reason for discontinuation was the desire for pregnancy which accounted for 665(51.4%) of removal followed by menopause in 225(17.4%), no reason was found in 204(15.7%), side effects accounted for 101(7.8%) of removal, husbands wish 53(4.1%) and changing to another method accounted for 47(3.6%) of removal. The reasons for discontinuation were significantly associated with the clients age, side effects, number of living children and their educational status.

CONCLUSION

The rate of discontinuation is still high especially because of the desire to get pregnant while some even discontinued for no reason. It therefore becomes imperative for providers of family planning to further enlighten the populace on the benefit of limiting their family size and to also encourage the prolonged use of the device in those who discontinue for no reason by improving on our counseling methods.

The effects of virtual reality on pain, anxiety, and comfort during the chest tube removal procedure: A randomized clinical trial

PURPOSE

The purpose of the current study is to determine the effects of virtual reality on pain, anxiety, and comfort during chest tube removal.

MATERIALS AND METHODS

The research was conducted in the Cardiovascular Surgery Department of Atatürk University Health Practice and Research Hospital between January 2023 and April 2024. The study was performed as a randomized controlled experimental trial with a pretest-posttest control group. Eighty-two patients (41 in the intervention group and 41 in the control group) were included in the research. Patients in the intervention group watched a video with virtual reality glasses during chest tube removal. The "Descriptive Information Form," "Visual Analog Scale," "Verbal Pain Scale," "State Anxiety Inventory," and "Comfort Scale" were used to collect data. Number, percentage, mean, standard deviation, chi-square, paired sample t-test, independent sample t-test, Mann-Whitney U test, Wilcoxon test, and linear regression analysis were used in data evaluation. Our study was recorded in the Clinical Trials database with protocol number "NCT06550323."

RESULTS

The groups had similar descriptive characteristics (p > 0.05). The pre-procedural mean pain, anxiety, and comfort scores were similar in the two groups (p > 0.05). The post-procedural mean VAS and verbal pain scores, mean anxiety, and comfort scores of the intervention group were lower in comparison with the control group (p < 0.05).

CONCLUSION

The research findings showed that virtual reality significantly reduced pain and anxiety while increasing comfort levels during chest tube removal. Therefore, it is recommended that virtual reality be used during chest tube removal.