Beyond intuition: patient fever symptom experience.

CONTEXT: Fever is an important sign of inflammation recognized by health care practitioners and family caregivers. However, few empirical data obtained directly from patients exist to support many of the long-standing assumptions about the symptoms of fever. Many of the literature-cited symptoms, including chills, diaphoresis, and malaise, have limited scientific bases, yet they often represent a major justification for antipyretic administration. OBJECTIVES: To describe the patient experience of fever symptoms for the preliminary development of a fever assessment questionnaire. METHODS: Qualitative interviews were conducted with 28 inpatients, the majority (86%) with cancer diagnoses, who had a recorded temperature of ≥38°C within approximately 12 hours before the interview. A semi-structured interview guide was used to elicit patient fever experiences. Thematic analyses were conducted by three independent research team members, and the data were verified through two rounds of consensus building. RESULTS: Eleven themes emerged. The participants reported experiences of feeling cold, weakness, warmth, sweating, nonspecific bodily sensations, gastrointestinal symptoms, headaches, emotional changes, achiness, respiratory symptoms, and vivid dreams/hallucinations. CONCLUSION: Our data not only confirm long-standing symptoms of fever but also suggest new symptoms and a level of variability and complexity not captured by the existing fever literature. Greater knowledge of patients' fever experiences will guide more accurate assessment of symptoms associated with fever and the impact of antipyretic treatments on patient symptoms in this common condition. Results from this study are contributing to the content validity of a future instrument that will evaluate patient outcomes related to fever interventions.

Cryotherapy for treatment of anogenital warts.

Human papillomavirus is a group of viruses that produce anogenital warts for which there is no cure. Untreated anogenital warts can spread and form large clusters that are bothersome, painful, and embarrassing to the patient as well as being a significant health risk. One of the infectious disease clinics of the authors' hospital sees an average of 200 HIV-positive individuals per month. Approximately 10% of these patients have anogenital warts. The attending physicians asked the clinical nursing staff if they would be willing to be trained to remove these warts using cryotherapy techniques, if patient efforts at other remedies failed. This request provoked a decision-making challenge for the staff. This article will describe the decision-making process and conclude with the procedure that was created as a result of the decision making.