Strategies for implementing a guided imagery program to enhance patient experience.

The patient in acute care settings can have severe emotional and physical stresses that are also experienced by family and significant others. The experience in a hospital has often been described as overwhelming; it can evoke feelings of fear, anger, helplessness, and isolation. Guided imagery, one of the most well-studied complementary therapies, is used increasingly to improve patients' experiences and healthcare outcomes. More and more, patients are relying on the use of guided imagery to provide a significant source of strength, support, and courage as they prepare for a procedure or manage the stresses of a hospital stay. This article provides a brief review of the research base for guided imagery and broad indications for its use. It describes key elements of the therapy and outlines steps to implement a program of guided imagery that can be used in variety of settings.

[Intraoperative ERCP for therapy of common bile duct stones during laparoscopic cholecystectomy]. / Die intraoperative ERCP zur Behandlung der Choledocholithiasis während der laparoskopischen Cholezystektomie.

The data of 166 patients that underwent laparoscopic cholecystectomy between November 1989 and December 1997 are given. In all cases intraoperative ERC and extraction of bile duct stones within the laparoscopic surgery were performed. The results show that by intraoperative simultaneous ERC bile duct stones can be removed with a success rate of 98.8% and a mortality rate of 0%. Intraoperative ERC is a secure and economic kind of treatment, especially the patient profits from this minimal invasive procedure.

Effect of guided imagery on quality of life for patients with chronic tension-type headache.

OBJECTIVE: To determine the effect of adjuvant guided imagery on patients with chronic tension-type headache. BACKGROUND: Management of chronic tension-type headache often requires a combination of pharmacological and nonpharmacological therapies. Guided imagery is a relaxation technique based on visualizing pleasant images and body awareness. METHODS: One hundred twenty-nine patients with chronic tension-type headache completed the Headache Disability Inventory and the Medical Outcomes Study Short Form (SF-36) at their initial visit to a specialty headache center and again 1 month after the visit. In addition to individualized headache therapy, patients listened to a guided imagery audiocassette tape daily for the month. One hundred thirty-one control subjects received individualized therapy without guided imagery. RESULTS: Controls and the patients who listened to the guided imagery tape improved in headache frequency, headache severity, patient global assessment, quality of life, and disability caused by headache. More guided imagery patients (21.7%) than controls (7.6%) reported that their headaches were much better (P = .004). The guided imagery patients had significantly more improvement than the controls in three of the SF-36 domains: bodily pain (95% CI; guided imagery patients 11.0, controls 0.2), vitality (95% CI; guided imagery patients 10.9, controls 1.7), and mental health (95% CI; guided imagery patients 7.8, controls 0.4). CONCLUSIONS: Guided imagery is an effective adjunct therapy for the management of chronic tension-type headache.

Guided imagery as a coping strategy for perioperative patients.

Patients who undergo surgery usually experience fear and apprehension about their surgical procedures. Guided imagery is a simple, low-cost therapeutic tool that can help counteract surgical patients' fear and anxiety. The authors randomly assigned 130 patients undergoing elective colorectal surgical procedures into two groups. Members of one group received routine perioperative care. Members of the other group listened to guided imagery tapes for three days before their surgical procedures, during anesthesia induction, intraoperatively, in the postanesthesia care unit, and for six days after surgery. The authors measured patients' anxiety levels, pain perceptions, and narcotic medication requirements. The patients in the guided imagery group experienced considerably less preoperative and postoperative anxiety and pain, and they required almost 50% less narcotic medications after their surgical procedures than patients in the control group.

Guided imagery: a significant advance in the care of patients undergoing elective colorectal surgery.

PURPOSE: Guided imagery uses the power of thought to influence psychologic and physiologic states. Some studies have shown that guided imagery can decrease anxiety, analgesic requirements, and length of stay for surgical patients. This study was designed to determine whether guided imagery in the perioperative period could improve the outcome of colorectal surgery patients. METHODS: We conducted a prospective, randomized trial of patients undergoing their first elective colorectal surgery at a tertiary care center. Patients were randomly assigned into one of two groups. Group 1 received standard perioperative care, and Group 2 listened to a guided imagery tape three days preoperatively; a music-only tape during induction, during surgery, and postoperatively in the recovery room; a guided imagery tape during each of the first six postoperative days. Both groups had postoperative patient-controlled analgesia. All patients rated their levels of pain and anxiety daily, on a linear analog scale of 0 to 100. Total narcotic consumption, time to first bowel movement, length of stay, and number of patients with complications were also recorded. RESULTS: Groups were similar in age and gender distribution, diagnoses, and surgery performed. Median baseline anxiety score was 75 in both groups. Before surgery, anxiety increased in the control group but decreased in the guided imagery group (median change, 30; P < 0.001). Postoperatively, median increase in the worst pain score was 72.5 for the control group and 42.5 for the imagery group (P < 0.001). Least pain was also significantly different (P < 0.001), with a median increase of 30 for controls and 12.5 for the imagery group. Total opioid requirements were significantly lower in the imagery group, with a median of 185 mg vs. 326 mg in the control group (P < 0.001). Time to first bowel movement was significantly less in the imagery group (median, 58 hours) than in the control group (median, 92 hours; P < 0.001). The number of patients experiencing postoperative complications (nausea, vomiting, pruritus, or ileus) did not differ in the two groups. CONCLUSION: Guided imagery significantly reduces postoperative anxiety, pain, and narcotic requirements of colorectal surgery and increases patient satisfaction. Guided imagery is a simple and low-cost adjunct in the care of patients undergoing elective colorectal surgery.

[Value of intraoperative laparoscopic cholangiography]. / Zur Wertigkeit der intraoperativen laparoskopischen Cholangiographie.

Discussion about the necessity of intraoperative cholangiography restarted when laparoscopic cholecystectomy was established. The value of cholangiography was examined in a prospectively randomized study of one hundred patients. We could show that the routinely performed intraoperative cholangiography represents a careful, secure and sensitive method for the detection of common bile duct stones. As it is not very time consuming nor linked to high costs we believe it to be unrenouncible. It allows a detailed anatomic presentation and may be combined with ERCP for definitive treatment of bile duct stones.

[Bouveret syndrome--a rare form of pyloric obstruction]. / Das Bouveret-Syndrom--eine seltene Form der Magenausgangsstenose.

Gallstone ileus represents a severe complication of cholelithiasis. The incidence of serious disease concomitant with gallstone ileus is high; it is most often seen in elderly patients and contributes to its high morbidity and mortality rates. Bouveret's syndrome is a rare form of gallstone ileus, characterized by its duodenal site after migration through a cholecysto-duodenal fistula in almost all cases. We report on a patient with Bouveret's syndrome. The etiology, pathogenesis, diagnosis and therapeutic approach with literature review are presented and discussed.

Occult fracture patterns of the knee associated with anterior cruciate ligament tears: assessment with MR imaging.

One hundred consecutive magnetic resonance (MR) images of the knee in patients with acute complete anterior cruciate ligament (ACL) tears were reviewed to evaluate the prevalence and patterns of associated occult fractures. Eighty-nine occult fractures were identified in 56 knees. All occult fractures were in the posterior aspect of the lateral tibial plateau. Of these, occult fractures were isolated in 24 cases (43%) and were in combination with fractures in the middle aspect of the lateral femoral condyle in 26 (46%), with fractures in the posterior aspect of the medial tibial plateau in four (7%), and with fractures involving all three areas in one (2%). Disruption of the ACL under valgus stress leads to anterior translation of the tibia and relative external rotation of the femur. This allows impaction of the posterior portion of the lateral tibial plateau against the middle of the lateral femoral condyle and accounts for the unique pattern of occult fractures associated with ACL tears. An occult fracture of the posterior lateral tibial plateau with or without an associated fracture in the lateral femoral condyle ("kissing contusion") is a relatively frequent finding in acute ACL tears and, when present, is highly suggestive of such an associated tear.

[Appearance of the femur head epiphysis in healthy children and in children with hip dysplasia]. / Uber das Auftreten der Hüftkopfkernepiphyse bei gesunden Kindern und Kindern mit Hüftdysplasie.

In a retrospective study we evaluated 4341 sonographic examinations of 1160 healthy children and 209 children with congenital hip dysplasia with special reference to the appearance of the femoral head epiphysis. In healthy children the epiphysis appeared between the first and seventh month. In more than 95% of the children, the epiphysis was sonographically present after the seventh month. In children with congenital hip dysplasia the first appearance of the femoral hip epiphysis had a retardation of one to two months. In most of the healthy children the epiphysis appeared in the fourth month, and after the ninth month in almost all of the normal hip joints the epiphysis is present. In children with normal hip joint configuration and missing femoral head epiphysis at three months, the final ultrasound examination should not be done before the seventh month. Thus, clinically unnecessary ultrasound examination in 6-week intervals can be reduced.

Single-dose piperacillin versus cefoxitin combined with 10 percent mannitol bowel preparation as prophylaxis in elective colorectal operations.

A prospective, randomized study was utilized to compare the effectiveness of a single dose of preoperative piperacillin versus triple-dose cefoxitin in prophylaxis for elective colorectal operations. All patients received a simple 1 day mechanical bowel preparation using 10 percent mannitol preparation administered orally. Ninety-four patients were entered into the study. Septic complications occurred in 9 percent of the piperacillin patients and in 12 percent of the cefoxitin patients.