Introducing an ANP-led temporal artery biopsy service for patients with suspected giant cell arteritis.

Giant cell arteritis (GCA) is an uncommon autoimmune inflammatory vasculopathy that can lead to the destruction and occlusion of various arteries that consequently can cause serious complications such as stroke or sight loss. It is seen as a medical emergency. The most commonly affected vessel in GCA is the temporal artery in the side of the head, hence the condition is sometimes also referred to as 'temporal arteritis'. This article discusses the introduction of an advanced nurse practitioner-led temporal artery biopsy service.

Urology nurses lead the way in adopting an innovative prostate biopsy technique.

Jonah Rusere, Advanced Nurse Practitioner for South East London Accountable Cancer Network, outlines an opportunity for urology nurses to make a difference to prostate cancer pathways.

Pain and anxiety during bone marrow biopsy.

A bone marrow biopsy is considered to be painful, often causing anxiety. We observed large differences between patients and wondered which factors cause pain and anxiety. In a prospective study, 202 patients were analyzed. Experienced hematologists and fellows in training (17% of biopsies) performed bone marrow aspirates and biopsies from the posterior iliac crest. Demographics, disease category, performance score, source of information, number of previous biopsies, experience of the hematologist, and length and quality of the biopsy were recorded. Pain and anxiety were measured using a visual analog scale and verbal rating score. Data were subjected to univariate and multivariate regression. The median pain score was 1.9 (range 0-10); 21% did not experience any pain. Anxiety scored 1.8 (range 0-10), and correlated positively with pain (p = .000). By univariate analysis, young age, poor performance, the physician as source of information, and prolonged procedures were associated with more pain. In multivariate analysis, anxiety, information from the physician, and a prolonged procedure persisted. Length or artifacts of the core biopsy did not correlate with pain. In conclusion, bone marrow biopsies performed in an optimal setting by experienced hematologists cause only mild pain, with, however, some patients experienced serious problems. To reduce pain, not only careful local anesthesia, but also the addition of systemic analgesics and especially anxiety reduction seems to be useful.

Predictors of nonalcoholic steatohepatitis in obese children.

As the prevalence of childhood obesity increases, the incidence of nonalcoholic fatty liver disease and nonalcoholic steatohepatitis (NASH) also escalates. This study's purpose was to identify the clinical criteria to aid in determining when a liver biopsy is indicated for this growing population because currently no guidelines exist. We performed a retrospective chart review on all patients who were seen in the Nutrition Exercise and Weight Loss Kids™ Program at the Children's Hospital of Wisconsin from July 2003 through December 2004. We analyzed only individuals who underwent liver biopsy with the following criteria: (1) no evidence of other liver disease and (2) aspartate transaminase or alanine aminotransferase greater than 200 IU/L or any elevation of or for more than 6 months. Of the 284 patients reviewed, only eight patients (3%) met the criteria for analysis. Biopsy results demonstrated that 100% had histological evidence of NASH with steatosis, and seven of the eight (87.5%) had NASH with fibrosis, cirrhosis, or both. Obese children with an aspartate transaminase or alanine aminotransferase greater than 200 IU/L or any elevation of aspartate transaminase or alanine aminotransferase for more than 6 months, have a strong likelihood of having NASH with or without fibrosis, cirrhosis, or both.

Nurse practitioner-led prostate biopsy in the United Kingdom.

As prostate cancer detection rates increase, multi-professional health care teams with nurse practitioners are adopting some roles that have predominantly been in the medical domain. This article reports the development of nurse practitioners undertaking prostate biopsies in the United Kingdom and presents an audit demonstrating the safety of nurse practitioners conducting this procedure.

Empowering advanced practitioners to set up nurse led clinics for improved outpatient care.

Nurse led clinics have been shown to provide more efficient outpatient care and reduce waiting times. A hospital urology department set up two clinics to improve the patient care pathway, one of which is led by advanced nurse practitioners. This article describes the training and development audit results and plans.

Lactose intolerance: a nursing perspective.

Deficiency of intestinal lactase, the enzyme required for lactose digestion, can result in symptoms of gastrointestinal malabsorption, or lactose intolerance. The knowledge needed for accurate nursing assessment, diagnostic procedural care, teaching, and referral of affected patients is reviewed.

The Effect of Barcode Technology Use on Pathology Specimen Labeling Errors.

Pathology specimen labeling errors occur for a variety of reasons. We investigated the use of barcode technology as a method to improve the accuracy of pathology specimen labeling and patient safety. We also assessed nurses' perceptions of system quality, information quality, service quality, user satisfaction, and net benefits. Sixty-eight perioperative nurses who work in a teaching hospital in Taiwan completed the survey. Nurses scored net benefits as highly contributing to their satisfaction, whereas system quality contributed most to dissatisfaction. Further, we analyzed pathology specimen records before and after implementing the barcode system and found that specimen management errors significantly decreased. The use of a reliable barcode system could improve specimen labeling accuracy and enhance nurses' satisfaction with this technology.

Feasibility of family member presence in the OR during breast biopsy procedures.

Family-centered care is an accepted and promoted philosophy within the health care community. Perioperative nurses are empowered to support change in the health care arena and to examine and institute policies that affect patient care. This study examined the feasibility of family presence in the OR during breast biopsy procedures performed with local anesthesia, by ascertaining perioperative nurses' attitudes toward the concept. Family presence in the OR during breast biopsy procedures is considered a novel initiative. The results of this study indicate that the feasibility of instituting this intervention would be challenged by system barriers.

Getting ready: developing an educational intervention to prepare African American women for breast biopsy.

Focus groups with African American women who had experienced a breast biopsy were conducted during the process of "getting ready" for a breast biopsy educational study in which the intervention's educational materials and study instruments were developed and pre-tested. Recommendations were made for revising the breast biopsy educational booklet. As a result of the focus group discussions, changes were made in several of the graphics, the design and size of the booklet, and the tone of the piece. In addition, language describing the biopsy procedure was further simplified. The outcomes of this study were culturally tailored study materials to be used in an educational intervention to prepare African American women undergoing a breast biopsy procedure.

The development of the nurse biopsy role.

Research shows that nurse surgery posts strengthen continuity of care and allow collaboration with other health professionals to ensure patients receive appropriate and timely care. The consistent and integrated approach provided with the nurse biopsy role fills gaps in service provision and avoids duplication of services. Skin cancer is the most common cancer in the UK and at Queen's Medical Centre in Nottingham they see approximately 160 suspected cases each week. Before the introduction of the nurse biopsy role there was an 8-week wait for a biopsy by the doctor and a further 8-week wait for the removal of the tumour. Now, a patient with a suspected skin cancer can have a biopsy on the first visit to the clinic, reducing the wait from 8 weeks to 0 weeks. This reduction in waiting time facilitates improved mortality and morbidity from the skin cancer. It took 3 years to develop the nurse biopsy role in Nottingham and another 2 years to provide the service that is currently available. The nurse-led biopsy service is now being adopted nationwide, as recommended by the All Parliamentary Group on Skin (2003). The dermatology department at Queen's Medical Centre in Nottingham also runs an annual course to teach the surgery skills required to primary- and secondary-care nurses.

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.

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.

Bone marrow aspiration and biopsy: collection and interpretation.

PURPOSE/OBJECTIVES: To describe the role of the oncology nurse practitioner in the performance of bone marrow aspiration and biopsy and discuss the indications and diagnostic value of bone marrow examination. DATA SOURCES: Published articles, textbooks, personal experience. DATA SYNTHESIS: Bone marrow examination is useful in the diagnosis of many nonhematologic and hematologic conditions. Having a nurse practitioner perform bone marrow aspiration can improve patient care and comfort. CONCLUSIONS: Greater understanding of bone marrow aspiration procedure and diagnostic tests helps nurse practitioners and oncology nurses to provide better patient care. IMPLICATIONS FOR NURSING PRACTICE: Advanced practice nurses in the oncology setting must take an active role in the development and implementation of clinical practice protocols for bone marrow collection.

Right ventricular endomyocardial biopsy. Obtaining specimens via the internal jugular vein.

A right ventricular endomyocardial biopsy is a useful procedure for monitoring heart transplant patients or in diagnosing and treating patients with various cardiac and systemic diseases. When performed by an experienced cardiologist, there is little risk. The procedure, however, does require the nurse to perform the necessary patient preparation and monitoring along with standard nursing care to be successful.

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.

Women's experience with breast biopsy.

The purpose of this study was to obtain descriptions of the perioperative experiences of women who underwent breast biopsies with local anesthesia. Twenty-two participants were interviewed, and open-ended questions were used to allow the women to describe their experiences. Data analysis revealed three major themes--certitude, care, and justice. The women's most pervasive need was to have the biopsy results as soon as possible. They viewed the surgical phase of the biopsy as a stepping-stone to achieving certitude associated with having the pathology results. The surgical phase of the biopsy did not hold as much significance for the women as the researcher had anticipated.

Understanding patients' needs is the foundation of perioperative nursing.

As I reflected on Mrs L's procedure, I realized the importance of my role. I coordinated the efforts of the radiologist, radiological technologist, surgeon, pathologist, and nurses to provide Mrs L with a positive surgical experience, and I collaborated with Mrs L and her husband to make them as comfortable and relaxed as possible. I connected with Mrs L and her husband--they knew I would help them in any way to make this a positive experience. In addition, I collected data about Mrs L's perception and satisfaction with her experience to explore her response to her stereotactic surgical biopsy procedure experience. Perioperative nurses are important to patients and their family members. By listening to patients' needs, planning for their individual care, and being present, perioperative nurses help patients through difficult situations. I use my experience and knowledge to serve as a role model for breast imaging personnel, nurses, and other coworkers, and to improve each patient's perioperative experience.

Stereotactic biopsy procedures for brain tumor diagnosis.

Stereotactic biopsy procedures, in which a computer-based, three-dimensional-image-guided system accurately locates patients' brain tumors, are relatively new diagnostic methods. Complications from stereotactic biopsy procedures are minimal compared with open craniotomy procedures because they are performed with local anesthesia. Perioperative nurses should have knowledge of and be trained in stereotactic biopsy procedures to ensure optimal care for patients undergoing these procedures.