The impact of music therapy on pain and stress reduction during oocyte retrieval - a randomized controlled trial.

RESEARCH QUESTION: Does music therapy help in reducing pain and anxiety in women undergoing transvaginal ultrasound-guided oocyte retrieval (TUGOR)? DESIGN: In this randomized controlled open label study, 209 participants were recruited and randomized into three groups (music group, n = 70; headphone group, n = 70; control group, n = 69). Patients' psychological status was assessed using the visual analogue scale of pain (VAS-P), satisfaction of pain control, state-trait anxiety inventory (STAI), Beck depression inventory (BDI), and general health questionnaire (GHQ). Stress biomarkers, including salivary alpha amylase (sAA) and salivary cortisol (sCort), were measured before and after TUGOR. RESULTS: No significant differences were found in psychological scoring of STAI, BDI, GHQ and the stress biomarkers. Although neither the anxiety scores nor the analgesic requirements differed among the three groups, the visual measure of vaginal pain (median, range) showed music group (20,0-70) was significantly (P = 0.005) lower than headphone group (30,0-90) and control group (30,0-100). The degree of satisfaction with pain control (median, range) in the music group (80,30-100), was significantly (P = 0.001) higher than the headphone group (80,10-100) and control group (70,0-100). CONCLUSION: Music is a simple, inexpensive and effective way to reduce pain score and increase satisfaction with pain control during TUGOR procedure, which may justify its routine use.

Autonomic responses to ultrasound-guided percutaneous needle electrolysis of the patellar tendon in healthy male footballers.

BACKGROUND: Ultrasound (US)-guided percutaneous needle electrolysis (PNE) is a novel minimally invasive approach, which involves the application of a galvanic current via an acupuncture needle. As in any procedure involving needling, vagal reactions have been reported during PNE. OBJECTIVE: To examine for changes in autonomic activity during the US-guided PNE technique on healthy patellar tendons by measurement and analysis of heart rate variability (HRV). METHODS: Twenty-two male footballers were randomly allocated to: a control group (11 players), for whom HRV was recorded for 10 min, both at rest and during an exhaustive US examination of the patellar tendon and adjacent structures; and an experimental group (11 players), for whom HRV was recorded for 10 min, both at rest and during application of US-guided PNE on the patellar tendon. The following HRV parameters were assessed: mean NN interval, mean heart rate, time domain parameters (SDNN, rMSSD, pNN50), diameters of the Poincaré plot (SD1, SD2), stress score, and sympathetic/parasympathetic ratio. RESULTS: There were no differences between groups in any baseline measurements, nor were there any significant differences between control group measurements (baseline vs intervention). The experimental group exhibited statistically significant increases in SDNN/SD1 (p=0.02/p=0.03) and SD2 (p=0.03), indicating increased parasympathetic and decreased sympathetic activity, respectively. CONCLUSIONS: US-guided PNE was associated with an autonomic imbalance characterised by greater parasympathetic activity, which could potentially result in a vasovagal reaction. Care should be taken to monitor for adverse reactions during US-guided PNE and simple HRV indicators may have a role in early detection.

Quality of Life, Pain Perception, and Distress Correlated to Ultrasound-Guided Peripherally Inserted Central Venous Catheters in Palliative Care Patients in a Home or Hospice Setting.

CONTEXT: Intravenous fluid administration with peripherally inserted central venous catheters (PICCs) and midline catheters in palliative care. OBJECTIVES: To evaluate distress and pain perceived by patients during the positioning of a PICC or midline catheter, both in the home and hospice settings. METHODS: This was a prospective observational study performed by the Palliative Care Network of Pordenone. In addition to evaluating distress and pain, we monitored patient quality of life and the devices used. Quality of life was measured with the European Organization for Research and Treatment of Cancer-Core 15-Palliative scale. RESULTS: From May 2012 to July 2013, 48 patients were enrolled in the study. The level of distress during the procedure was null or very low in 95.8% of the patients and completely absent after one week. Pain during insertion was null or very little in 93.8% of the patients and zero after one week in 98% of the patients. Quality of life was significantly improved after one week for certain specific parameters and also globally. The number of catheter days monitored was 3097. The weekly monitoring of the devices revealed a series of minor complications. Only two catheters were removed for serious complications. CONCLUSION: Our results showed a low impact on pain and distress, a low level of local and systemic complications and a favorable impact on patients' quality of life. However, other studies are necessary to evaluate the cost-effectiveness of the use of these devices and their role in palliative care.

Transrectal ultrasound prostate biopsy (TRUS-Bx): patient perspectives.

Prostate cancer continues to be a complex disease for which a cause or cure has not yet been identified. Many men are diagnosed each year and the incidence is likely to increase as greater numbers of men reach "old" age. The transrectal ultrasound prostate biopsy (TRUS-Bx) is the predominant method to diagnose prostate cancer, and varying levels of patient pain have been associated with the procedure. The purpose of this ethnographic research study was to describe TRUS-Bx from the patients' perspective. Results from this study indicated that TRUS-Bx pain was strongly influenced by psychosocial factors, as well as physical aspects of the procedure.

[Complications of prostatic echo-guided transrectal biopsy and tolerance depending on the patient and the operator. Study of 205 patients]. / Complicaciones de la biopsia transrectal ecodirigida prostática y tolerancia según el paciente y el realizador. Estudio de 305 pacientes.

OBJECTIVE: Ultrasound-guided transrectal biopsy of the prostate is generally considered to be well-tolerated and with few complications. The results of a prospective study that evaluated patient and biopsy performer's perception of the foregoing aspects are presented. METHODS: The records of 305 consecutive patients submitted to ultrasound-guided transrectal biopsy were analyzed. Aspects of the physical examination and biopsy performer's assessment of patient tolerance were recorded in 290 cases. 264 patients filled out a questionnaire on different aspects of the test. A telephone interview was carried out to obtain data on side-effects and complications of the biopsy procedure. Patient and biopsy performer's perception of tolerance and complications of ultrasound-guided transrectal biopsy were analyzed. RESULTS: Biopsy could not be performed in 1% of the cases due to pain. Before biopsy 34.5% of the patients thought the procedure would be painful, while only 6.8% sustained this view after biopsy. Insertion of the transducer and punction were considered to be painful by 8% and 12.9% of the patients, respectively, and 2.9% considered anesthesia should be used for the procedure. Tolerance of biopsy punction remained unchanged throughout the procedure in 53.2% and became worse as the test proceeded in the remaining patients. Anxiety and increased anal tone were found to be the only factors that had an impact on tolerance. The complications were: fever > 38 degrees C (0.7%), rectal bleeding that required admission to the observation ward (1%), hematuria (51.1%), hemospermia (21.3%), difficulty in voiding (2.5%) and urinary retention (0.3%). Moderate vagal reactions were the most common immediate complications (2.4%). CONCLUSIONS: Ultrasound-guided transrectal biopsy is generally well-tolerated and with few complications. Rectal bleeding is the complication that most frequently requires management and causes more anxiety to patients, but infection is the most severe.

Prostate cancer treatment with ultrasound-guided transperineal brachytherapy: analysis of the treatment results of our first 150 patients.

This paper presents outcome data from our initial 150 patients who had received all or part of their radiation dose for the treatment of adenocarcinoma of the prostate using permanent radioactive seed implantation. Median follow-up for this group is now three years. Fifty-six patients had tumors with gleason scores of 7 or greater, and 94 had gleason scores of 6 or less. The average age was 67 (range 42 to 79). Ninety-five percent have maintained biochemical control of their disease (PSA level of 1.0 or less) since the time of implant. Questionnaires were sent to all patients to assess quality of life issues. Fifty-eight percent have maintained potency. Ninety-eight percent of those surveyed said they would recommend this treatment to other men with prostate cancer. Our results support the findings of other published series. Ultrasound-guided transperineal brachytherapy is a well-tolerated procedure with excellent cancer control rates and should be considered as a treatment option in men with localized prostate cancer.