A nonpharmacological method can be an alternative or complement to analgesics.The aim of this study was to evaluate if music medicine influences pain and anxiety in children undergoing lumbar punctures. A randomized clinical trial was used in 40 children (aged 7-12 years) with leukemia, followed by interviews in 20 of these participants. The participants were randomly assigned to a music group (n = 20) or control group (n = 20). The primary outcome was pain scores and the secondary was heart rate, blood pressure, respiratory rate, and oxygen saturation measured before, during, and after the procedure. Anxiety scores were measured before and after the procedure. Interviews with open-ended questions were conducted in conjunction with the completed procedures. The results showed lower pain scores and heart and respiratory rates in the music group during and after the lumbar puncture. The anxiety scores were lower in the music group both before and after the procedure. The findings from the interviews confirmed the quantity results through descriptions of a positive experience by the children, including less pain and fear.

The frequency of subjective cardiac and psychological complaints among men and women a year after a confirmed diagnosis of myocardial infarction (MI) were compared. Among 660 survivors, 595 patients completed mailed questionnaires at home one year after the MI. There were 421 men, mean age 67.1 +/- 10.7 years, and 174 women, mean age 72.1 +/- 10.6 years. Controlling for the significantly higher mean age among the women, the latter more often had a previous history of angina pectoris, 54.6% (P < or = 0.05) versus 42.9%, and heart failure, 24.7% versus 13.5% (P < or = 0.01). Despite these facts, the women were significantly less often referred to CCU, 82.2% versus 91.7% (P < or = 0.05). One year after the MI, controlling for differences in age and co-morbidity, women reported significantly higher frequencies of psychological and psychosomatic complaints, including sleep disturbances. These differences may have clinical implications for diagnosis and treatment of women with coronary heart disease.

The purpose of this study was to describe patients' experience during and after coronary angiography and percutaneous coronary intervention. Data were collected by interviews with 14 patients. A qualitative content analysis approach was used. Four main categories were identified that describe patients' experience of the hours during and following intervention: emotional thoughts, bodily sensations, nursing intervention of importance, and personal strategies. All patients made a comment on staff conduct and pointed out that even minor nursing actions may be of great importance. Patients were most positive toward the transradial approach. Even though the approach via arteria radialis will increase, many patients will still have their procedure done via arteria femoralis. In spite of all research and technical developments, the patients' experience from intervention via arteria femoralis is pretty much the same as it was 1997.

Aim-To describe various symptoms other than pain among consecutive patients on the waiting list for possible coronary revascularisation in relation to estimated severity of chest pain. Design-All patients were sent a postal questionnaire for symptom evaluation.Subjects-All patients in western Sweden on the waiting list in September 1990 who had been referred for coronary angiography or coronary revascularisation (n = 904). Results-88% of the patients reported chest pain symptoms that limited their daily activities to a greater or lesser degree. Various psychological symptoms including anxiety and depression were strongly associated with the severity of pain (P < 0-001), as were sleep disturbances (P < 0*001), and dyspnoea and various psychosomatic symptoms (P < 0.001). Nevertheless only 44% of the patients reported chest pain as the major disruptive symptom, whereas the remaining 56% reported uncertainty about the future, fear, or unspecified symptoms as being the most disturbing. Conclusions-In a consecutive series of patients on the waiting list for possible coronary revascularisation, half the participants reported that uncertainty and fear were more disturbing than chest pain. (Heart 1996;75:257-260) Keywords: coronary revascularisation; ischaemic heart disease; chest pain; quality of life The number of patients with symptomatic ischaemic heart diseases requiring evaluation for revascularisation has increased during the past two decades. Some of these patients can be maintained on anti-ischaemic treatment with nitrates, ,B blockers, and calcium blockers with good pain control or relief. The major indication for coronary angiography and revascularisation is chest pain affecting the quality of life despite optimum medical treatment.l4In a subset of patients, especially those with more advanced coronary artery disease and depressed cardiac function, bypass surgery may improve survival.5-'0 The effects on other aspects of the quality of life are less well documented." 12 This study was undertaken to describe symptoms and complaints among patients referred for either coronary angiography or revascularisation, with the emphasis on the severity of pain and reduction of wellbeing; an additional aim was to evaluate the relation between pain and the other factors affecting wellbeing. We already knew that the patients had to wait a long time for revascularisation and that their relations with doctors and hospitals were often poor.

The aim of this study was to increase patients' adherence to the treatment of hypertension through the consultation training of nurses. Thirty-three nurses were included in the study. In the intervention group (IG), 19 nurses took part in a three-day residential training course on the Stages of Change model, Motivational Interviewing and guidelines for cardiovascular prevention, and recruited 153 patients. Sixteen nurses in the control group (CG) recruited 59 patients. A decrease in systolic and diastolic blood pressure and total cholesterol was noticed in both groups over the two years.Heart rate (p=0.027), body mass index (p=0.019), weight (p=0.0001), waist (p=0.041), LDL-cholesterol (p=0.0001), the waist hip ratio (p=0.024), and perceived stress (p=0.001) decreased to any great extent only in the IG. After two years, 52.6% of the patients in the IG (p=0.13) reached the target of ≤ 140/90 mmHg in blood pressure compared with 39.2% in the CG. For self-reported physical activity there was a significant (p=0.021) difference between the groups. The beneficial effects of the consultation training on patients' weight-parameters, physical activity, perceived stress and the proportion of patients who achieved blood pressure control emphasise consultation training and the use of behavioural models in motivating patients to adhere to treatment.

No abstract

We have studied, in 10 patients undergoing hip replacement surgery, the release of cytokines (tumour necrosis factor-alpha (TNF-alpha), interleukin-1 alpha (IL-alpha), interleukin-1 beta (IL-1 beta), interleukin-4 (IL-4), interleukin-6 (IL-6) and interleukin-8 (IL-8)) in association with retransfusion of autologous shed blood. The patients were reinfused with whole blood collected after operation. The median volume returned to the patients was 300 ml whole blood (25-75% range = 300-425 ml). Before reinfusion, blood was filtered. Plasma concentrations of IL-6 increased 1 and 60 min after retransfusion (P < 0.05). The plasma concentrations of TNF-alpha, IL-1 alpha, IL-1 beta, IL-4 and IL-8 did not change significantly after retransfusion of shed wound blood. However, there were increased concentrations of IL-1 alpha, IL-1 beta, IL-6 and IL-8 in the collected blood (P < 0.001). The filtration procedure did not reduce significantly the concentrations of these factors. This study shows that whole blood collected from a surgical wound contains large concentrations of cytokines. Filtration of the shed wound blood did not reduce significantly these levels and retransfusion caused increased plasma concentrations of IL-6.

Counselling following a hypertension programme gives hypertensive patients a chance to execute lifestyle changes and have their medication adjusted to achieve goals for blood pressure control. Further prospective studies in this area, with well-defined intervention approaches and several years of follow up, are necessary.