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.

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.

O itinerário terapêutico do paciente em tratamento oncológico: implicações para a prática de enfermagem / El itinerario terapéutico del paciente en tratamiento oncológico: implicaciones para la práctica de enfermería / The therapeutic itinerary of patient in oncological treatment: implications for nursing practice

RESUMO A trajetória do cliente oncológico ainda é permeada por percalços que interferem em seu prognóstico e qualidade de vida. Assim, este estudo visa a mapear o itinerário do paciente oncológico desde o diagnóstico até o tratamento e analisar suas implicações nas ações de enfermagem para o controle do câncer. Estudo qualitativo, realizado através da técnica de história oral de dez clientes oncológicos atendidos em um hospital federal no município do Rio de Janeiro, Brasil. Os dados foram tratados de acordo com a técnica de análise temática, além da confecção de representações do itinerário terapêutico de cada entrevistado. Foram identificados três eixos temáticos: trajetória antes do diagnóstico, trajetória do diagnóstico ao início do tratamento, e trajetória no tratamento. Percebe-se que o acesso aos serviços apresenta-se como um problema que culmina no agravamento da doença, no aparecimento de metástases e a morte do paciente, além de criar condições para a falta de adesão ao tratamento.

RESUMEN La trayectoria del cliente oncológico todavía es permeada por inconvenientes que interfieren en su pronóstico y calidad de vida. Así, este estudio pretende identificar el itinerario del paciente oncológico desde el diagnóstico hasta el tratamiento y analizar sus implicaciones en las acciones de enfermería para el control del cáncer. Estudio cualitativo, realizado a través de la técnica de historia oral de diez clientes oncológicos atendidos en un hospital federal en el municipio de Rio de Janeiro, Brasil. Los datos fueron tratados de acuerdo con la técnica de análisis temático, además de la confección de representaciones del itinerario terapéutico de cada entrevistado. Fueron identificados tres ejes temáticos: trayectoria antes del diagnóstico; trayectoria del diagnóstico al inicio del tratamiento; y trayectoria en el tratamiento. Se nota que el acceso a los servicios se presenta como un problema que culmina en el agravamiento de la enfermedad, el en surgimiento de metástasis y la muerte del paciente, además de crear condiciones para la falta de adhesión al tratamiento.

ABSTRACT The course of oncology patients is still crossed by setbacks that interfere with their prognosis and quality of life. This study aims to map the itinerary of cancer patients from diagnosis to treatment and to analyze its implications in nursing healthcare practices for the control of cancer. This is a qualitative study, conducted using oral history technique with ten cancer patients treated in a federal hospital in the city of Rio de Janeiro, Brazil. The data were analyzed according to thematic analysis technique and with the making of representations of the therapeutic itinerary of each interviewee. Three main themes were identified: course before diagnosis, course from diagnosis to the beginning of treatment, and course during treatment. We observed that the access to medical services is presented as a problem that culminates in the worsening of the disease, appearing of metastases and death of the patient, in addition to creating conditions that hinder the adherence to treatment.

Awaiting diagnosis of breast cancer: strategies of enduring for preserving self.

PURPOSE/OBJECTIVES: To explicate the emotional experiences of women undergoing breast cancer diagnosis who are waiting for the results of breast biopsy. RESEARCH APPROACH: Glaserian Grounded Theory. SETTING: Urban area in western Canada. PARTICIPANTS: 37 women aged 32-76 years. The breast cancer diagnosis was positive for 11 women, negative for 24 women, and two results were unclear. METHODOLOGIC APPROACH: Unstructured, recorded telephone interviews. FINDINGS: Undergoing breast cancer diagnosis is a profoundly distressing experience dictated by diagnostic processes and procedures. Women rapidly transitioned from wellness to frightening phases of facing cancer to continuing terror during the testing phase. While waiting to hear results, women controlled their emotions, which enabled them to get through the experience and highlighted the protective function of enduring and its necessity for survival. The basic social psychological process, preserving self, is the outcome of enduring. CONCLUSIONS: A mid-range theory, Awaiting Diagnosis: Enduring for Preserving Self, was developed. This theory explicates the emotional responses of women who were undergoing diagnosis for breast cancer and provides a theoretical behavioral basis for responding to cues and signals of suffering. INTERPRETATION: The Praxis Theory of Suffering enables nurses to recognize and respond according to the behaviors of suffering, and to endure with healthy, adaptive, and normalizing behaviors that enable preserving self.

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.

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.

Patients' lived experiences of excisional breast biopsy: a phenomenological study.

AIMS: The purpose of this study was to explore the lived experience of patients undergoing an excisional breast biopsy. BACKGROUND: It has been determined that women who feel a lump or a lesion in their breast delay seeking medical treatment because it could be cancer and they might need a mastectomy and/or the cancer may not be treatable. After women go to a health-care facility and are told that they need to have a biopsy to make a clear diagnosis they want to have the biopsy performed as soon as possible. METHOD: A phenomenological approach from a Heideggerian hermeneutical perspective was used. Participants were 20 patients who had an excisional breast biopsy in the day surgery of a university research and training hospital general surgery division under general anaesthesia between the dates of 1 December 2004-30 June 2005 and who returned one week later for monitoring, who were over 18 years old and who volunteered to participate in the research. Data were collected using in-depth interviewing and analysed using the principles of Heideggerian hermeneutics. RESULTS: Three themes were identified: need for information, fear, spiritual needs. CONCLUSION: It was determined that patients undergoing excisional breast biopsy had significant information and spiritual needs and experienced a fear of having cancer, losing their breasts and dying in surgery. Relevance to clinical practice. Although there are many studies about breast cancer and day surgery patients' experiences in the literature, no studies were found about patients' experiences with day surgery excisional breast biopsy procedures. The results provide a possible framework for patient care.

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.

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.