Needle phobia

2010 ◽  
Author(s):  
Allan M Cyna ◽  
Marion I Andrew
Keyword(s):  
Communication Skills ◽  
Medical Devices ◽  
Needle Insertion ◽  
Awake Patient ◽  
Blood Tests ◽  
Perception Of Control ◽  
Increased Risk ◽  
Reduction Strategies ◽  
Key Issues ◽  
Mind Set

Needle phobia describes an anticipatory fear of needle insertion, and is a well-recognized clinical entity of particular relevance to the anaesthetist. It may affect up to 10 % of the general population, is more common in the young, and can prevent patients from seeking medical care by avoiding immunizations, necessary blood tests or hospital procedures. The development of trust, a perception of control and an understanding of the conscious–subconscious aspects of the problem can help patients. In addition, patience, time and recognized communication skills are frequently needed if this distressing problem is to be managed effectively . Needle phobia is usually a learned response. Trust, control and perceptions rather than the pain itself are the key issues in needle phobia. Nevertheless pain reduction strategies such as EMLA, ice , premedication such as dexometomidine, stress-reducing medical devices and hypnosis, may have a role in management. Anaesthetists have traditionally used reassurance, EMLA and avoidance of needle insertion in the awake patient by giving inhalational inductions. However, this approach tends to reinforce the avoidance behaviour of both anaesthetist and patient! In addition, it wastes a valuable opportunity to educate patients in ways that can provide them with the necessary skills to manage future blood tests, drips and the like more easily. In some cases avoiding IV access prior to inducing anaesthesia—for example, at a Caesarean section — can put patients at increased risk of complications. Patients with needle phobia are like all patients only more so! At one level they function consciously and logically and are amenable to reason. However, in the context of hospital procedures such as blood tests and IV cannulation, subconscious responses take over. These patients often recognize that their behaviour is silly or even stupid, but find that they just can’t help themselves. They may describe their predicament as being in ‘two minds about it’ or ‘beside themselves’. This mind set illustrates, probably more clearly than any other, the conscious–subconscious basis of the problem.

The Role of Revascularisation in Patients Undergoing Non-cardiac Surgery

2010 ◽  
Vol 5 (1) ◽  
pp. 104
Author(s):  
Daniel S Menees ◽  
Eric R Bates ◽  
◽  
Keyword(s):  
Cardiac Surgery ◽  
Prediction Models ◽  
Cardiovascular Complications ◽  
Weight Of Evidence ◽  
Beta Blockade ◽  
Cardiac Morbidity ◽  
Increased Risk ◽  
Reduction Strategies ◽  
Artery Disease ◽  
Risk Reduction Strategies

Coronary artery disease (CAD) affects millions of US citizens. As the population ages, an increasing number of people with CAD are undergoing non-cardiac surgery and face significant peri-operative cardiac morbidity and mortality. Risk-prediction models can be used to help identify those patients at increased risk of peri-operative cardiovascular complications. Risk-reduction strategies utilising pharmacotherapy with beta blockade and statins have shown the most promise. Importantly, the benefit of prophylactic coronary revascularisation has not been demonstrated. The weight of evidence suggests reserving either percutaneous or surgical revascularisation in the pre-operative setting for those patients who would otherwise meet independent revascularisation criteria.

scholarly journals Promoting Team-Based Exercise Among African American Breast Cancer Survivors

2018 ◽  
Vol 40 (12) ◽  
pp. 1885-1902 ◽  
Author(s):  
Linda B. Piacentine ◽  
Karen M. Robinson ◽  
Leslie J. Waltke ◽  
Judy A. Tjoe ◽  
Alexander V. Ng
Keyword(s):  
Breast Cancer ◽  
African American ◽  
Cancer Survivors ◽  
Breast Cancer Survivors ◽  
Well Being ◽  
Walking Program ◽  
Increased Risk ◽  
Before And After ◽  
Mind Set ◽  
Poor Outcomes

Physical activity benefits the health and well-being of breast cancer survivors (BCS). Yet, many African American survivors do not routinely exercise and have increased risk of poor outcomes. The purpose of this mixed-method study was to identify motivational factors compelling African American BCS to participate in a 14-week team walking program and to intend to continue exercise after the intervention concluded. Focus groups were held with participants ( n = 12) before and after training. Content analysis discovered themes before the intervention: Not wanting to go at it alone, exercise not a life or treatment priority, cancer treatment affected activity, advocates to exercise, and can exercise really help? Four themes postintervention themes included: In the same boat, changed mind-set, improved weight and activity, and overcoming barriers. Physical data verified improvements. Results suggest that a team-based exercise training program may assist in overcoming a sedentary behavior tendency and subsequently improve health among survivors.

scholarly journals Anatomy Teaching – The Cruellest Cut of All

2007 ◽  
Vol 89 (6) ◽  
pp. 196-197 ◽  
Author(s):  
Dick Rainsbury ◽  
Alex Barbour ◽  
Vishy Mahadevan
Keyword(s):  
Communication Skills ◽  
Human Body ◽  
Pathological Conditions ◽  
Steering Group ◽  
Basic Language ◽  
Wide Range ◽  
The Future ◽  
Key Issues ◽  
Fit For Purpose ◽  
Anatomy Teaching

The conference, Anatomy Teaching – the Cruellest Cut of All, was attended by 160 delegates representing a wide range of professions. The aim was to highlight the key issues surrounding the teaching of anatomy today and to reach a consensus on how to make teaching fit for purpose in the future. Andrew Raftery, chair of the College's anatomy steering group and the vocal champion for anatomy on the College Council, eloquently set the scene for the day. He reminded the audience that anatomy remained the basic language of medicine, which through dissection as well as illustrating biological variations and common pathological conditions also promoted teamwork, communication skills, the reality of death and a respect for the human body.

Silicone-Based Tissue-Mimicking Phantom for Needle Insertion Simulation

2014 ◽  
Vol 8 (2) ◽  
Author(s):  
Yancheng Wang ◽  
Bruce L. Tai ◽  
Hongwei Yu ◽  
Albert J. Shih
Keyword(s):  
Mechanical Properties ◽  
Elastic Modulus ◽  
Medical Devices ◽  
Room Temperature ◽  
Needle Insertion ◽  
Mineral Oil ◽  
Medical Procedures ◽  
Insertion Force ◽  
Needle Insertion Force ◽  
Porcine Tissues

Silicone-based tissue-mimicking phantom is widely used as a surrogate of tissue for clinical simulators, allowing clinicians to practice medical procedures and researchers to study the performance of medical devices. This study investigates using the mineral oil in room-temperature vulcanizing silicone to create the desired mechanical properties and needle insertion characteristics of a tissue-mimicking phantom. Silicone samples mixed with 0, 20, 30, and 40 wt. % mineral oil were fabricated for indentation and needle insertion tests and compared to four types of porcine tissues (liver, muscle with the fiber perpendicular or parallel to the needle, and fat). The results demonstrated that the elastic modulus and needle insertion force of the phantom both decrease with an increasing concentration of mineral oil. Use of the mineral oil in silicone could effectively tailor the elastic modulus and needle insertion force to mimic the soft tissue. The silicone mixed with 40 wt. % mineral oil was found to be the best tissue-mimicking phantom and can be utilized for needle-based medical procedures.

scholarly journals The Influence of In-Season Training Loads on Injury Risk in Professional Rugby Union

2016 ◽  
Vol 11 (3) ◽  
pp. 350-355 ◽  
Author(s):  
Matthew J. Cross ◽  
Sean Williams ◽  
Grant Trewartha ◽  
Simon P.T. Kemp ◽  
Keith A. Stokes
Keyword(s):  
Generalized Estimating Equations ◽  
Injury Risk ◽  
Reference Group ◽  
Harmful Effect ◽  
Rugby Union ◽  
Time Loss ◽  
Risk Of Injury ◽  
Increased Risk ◽  
Reduction Strategies ◽  
Risk Reduction Strategies

Purpose:To explore the association between in-season training-load (TL) measures and injury risk in professional rugby union players.Methods:This was a 1-season prospective cohort study of 173 professional rugby union players from 4 English Premiership teams. TL (duration × session-RPE) and time-loss injuries were recorded for all players for all pitch- and gym-based sessions. Generalized estimating equations were used to model the association between in-season TL measures and injury in the subsequent week.Results:Injury risk increased linearly with 1-wk loads and week-to-week changes in loads, with a 2-SD increase in these variables (1245 AU and 1069 AU, respectively) associated with odds ratios of 1.68 (95% CI 1.05–2.68) and 1.58 (95% CI 0.98–2.54). When compared with the reference group (<3684 AU), a significant nonlinear effect was evident for 4-wk cumulative loads, with a likely beneficial reduction in injury risk associated with intermediate loads of 5932–8651 AU (OR 0.55, 95% CI 0.22–1.38) (this range equates to around 4 wk of average in-season TL) and a likely harmful effect evident for higher loads of >8651 AU (OR 1.39, 95% CI 0.98–1.98).Conclusions:Players had an increased risk of injury if they had high 1-wk cumulative loads (1245 AU) or large week-to-week changes in TL (1069 AU). In addition, a U-shaped relationship was observed for 4-wk cumulative loads, with an apparent increase in risk associated with higher loads (>8651 AU). These measures should therefore be monitored to inform injury-risk-reduction strategies.

scholarly journals 375. High Laboratory-confirmed SARS-CoV-2 Attack Rate in Lima Health Care Personnel During August 2020-March 2021 Suggests Role for Improved Infection Control

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S289-S290
Author(s):  
Matthew Westercamp ◽  
Giselle Soto ◽  
Rachel Smith ◽  
Eduardo Azziz-Baumgartner ◽  
Susan Bollinger ◽  
...  
Keyword(s):  
Attack Rate ◽  
Healthcare Workers ◽  
P Value ◽  
Risk Of Infection ◽  
Vaccine Introduction ◽  
Specimen Collection ◽  
Increased Risk ◽  
Reduction Strategies ◽  
Risk Reduction Strategies

Abstract Background Peru has one of the highest per capita SARS-CoV-2 death rates in Latin America. Healthcare workers (HCW) are a critical workforce during the COVID-19 pandemic but are themselves often at increased risk of infection. We evaluated SARS-CoV-2 attack rate and risk factors among frontline HCWs. Methods We performed a prospective cohort study of HCW serving two acute care hospitals in Lima, Peru from Aug 2020 to Mar 2021. Participants had baseline SARS-CoV-2 serology using the CDC ELISA, active symptom monitoring, and weekly respiratory specimen collection with COVID-19 exposure/risk assessment for 16-weeks regardless of symptoms. Respiratory specimens were tested by real-time reverse transcriptase PCR (rRT-PCR). Results Of 783 eligible, 667 (85%) HCW were enrolled (33% nurse assistants, 29% non-clinical staff, 26% nurses, 7% physicians, and 6% other). At baseline and prior to COVID-19 vaccine introduction, 214 (32.1%; 214/667) were reactive for SARS-CoV-2 antibodies. In total, 72 (10.8%; 72/667) HCWs were found to be rRT-PCR positive during weekly follow-up. Of the rRT-PCR positive HCWs, 37.5% (27/72) did not report symptoms within 1-week of specimen collection. During follow up, HCW without detectable SARS-CoV-2 antibodies at baseline were significantly more likely to be rRT-PCR positive (65/453, 14.3%) compared to those with SARS-CoV-2 antibodies at baseline (4/214, 1.9%) (p-value: &lt; 0.001). Three HCW were both serologically reactive and rRT-PCR positive at baseline. Looking only at HCW without SARS-CoV-2 antibodies, nurse assistants (rRT-PCR positive: 18.6%; 27/141) and non-clinical healthcare workers (16.5%; 21/127) were at greater risk of infection compared to nurses (8.5%; 10/118), physicians (7.9%; 3/38), and other staff (10.3%; 4/29) (RR 1.95;95%CI 1.2,3.3; p-value: 0.01). Conclusion Baseline SARS-CoV-2 prevalence and 16-week cumulative incidence were substantial in this pre-vaccination Peruvian HCW cohort. Almost 40% of new infections occurred in HCW without complaint of symptoms illustrating a limitation of symptom-based HCW screening for COVID-19 prevention. Nurse assistants and non-clinical healthcare workers were at greater risk of infection indicating a role for focused infection prevention and risk reduction strategies for some groups of HCW. Disclosures Fernanda C. Lessa, MD, MPH, Nothing to disclose

scholarly journals Developmental psychiatry – insights from learning disability∗

2000 ◽  
Vol 177 (3) ◽  
pp. 201-206 ◽  
Author(s):  
Sheila Hollins
Keyword(s):  
Learning Disability ◽  
Communication Skills ◽  
Professional Education ◽  
Clinical Service ◽  
Service Research ◽  
Annual Lecture ◽  
Medical Superintendent ◽  
Key Issues ◽  
The Uk ◽  
Developmental Psychiatry

BackgroundThe Blake Marsh lecture, an annual lecture on learning disability, was endowed in 1963 in memory of Dr Blake Marsh, the former medical superintendent of Bromham House Colony in Bedford. The first lecture was given in 1967.AimsTo review the speciality of the psychiatry of learning disability and how it is currently practised in the UK.MethodClinical, service, research and educational issues in learning disability psychiatry are reviewed and illustrated.ResultsKey issues which emerge in all four areas include the importance of communication skills, consultation with users and carers, professional education and partnership.ConclusionsThe psychiatry of learning disability is a complex, varied and stimulating branch of psychiatry with a strong developmental focus.

Focused history taking

2011 ◽  
Author(s):  
Stanley Tamuka Zengeya ◽  
Tiroumourougane V Serane
Keyword(s):  
Communication Skills ◽  
Correct Diagnosis ◽  
Management Plan ◽  
Age Group ◽  
History Taking ◽  
Health Issues ◽  
Clinical Exam ◽  
Current Health ◽  
Paediatric Case ◽  
Key Issues

Focused history taking is a vital part of the MRCPCH clinical exam; candidates are expected to grasp the key issues and formulate an effective management plan. This station requires candidates to be efficient, purposeful, and well-directed in their approach. The candidate is expected to obtain and present the key facts in the history and suggest an appropriate management plan. The examiner sits in the room as an observer while the candidate takes the history. This gives the examiner ample opportunity to assess the candidate’s communication skills, general approach, and knowledge of the condition. Only 13 minutes are allowed with the patient in the presence of the examiner. In the subsequent 9 minutes, the candidate will present and discuss the history. Problem-oriented history and management is the most effective way of approaching this station. The objectives of obtaining a focused paediatric history are: • to establish and maintain rapport with the child and parents • to obtain an overview of the child’s previous and current health issues • to establish the psychological, family, and social context of a child’s illness • to reach a correct diagnosis (or form a differential diagnosis) • to plan an appropriate management strategy. Although the principles of history taking in children are similar to those used for adults, there are important differences in the scheme and the details. The paediatric case history is potentially more difficult to elicit and is influenced by the age of the child. For each age group, you will have to adapt your style. The primary historian may be the child or another person, usually the parent. The consultation itself is triadic, involving the child, their family (or caregiver), and the doctor. Always keep in mind the principles of communication (discussed in chapter 2) and use an empathic approach while taking the history. Although in most cases the parents give the history, the child must also be encouraged to speak. In young children who have limited speech, you must take the history through the parents or the carers. In teenagers, there is a difficult line to tread between giving the child complete autonomy and allowing the parent to be the main historian.

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