THE PSYCHOLOGICAL EFFECTS OF BREAST SCREENING IN TERMS OF PATIENTS' PERCEIVED HEALTH ANXIETIES

SUMMARY This study aimed to assess and compare the impact of letter of invitation, initial breast screening mammography, and subsequent recall procedures on the level of anxiety over breast problems. The survey of females undergoing routine breast screening procedures in a primary care setting is part of the first wave of a national breast screening programme in the UK. Women aged 50-64 registered with six general practices (n=2618) were invited by letter to attend for screening. Their self-perceived impact of receipt of invitation letter, attendance at initial screening, and recall, in terms of anxiety and concern about breast problems, was measured by a self-report questionnaire and the physical, emotional and social dysfunction subscales of the Psychological Consequences of Screening Mammography Questionnaire (PCQ). Overall, subjects' anxiety levels diminished between the receipt of their invitation letter and the completion of their screening examination. Subjects did not, however, respond to the letter of invitation and screening procedure in a homogeneous manner. In a sample of 1253, the letter of invitation reduced anxiety about breast problems in 39.7%, increased anxiety in 24.6%, and had no appreciable effect in 35.7%. In the 1280 who attended for breast screening, the examination procedure reduced anxiety about breast problems in 55.9%, increased anxiety in 12.8%, and had no appreciable effect in 31.3%. In a smaller sample (n=33) who completed questionnaires at recall, there were significant increases in PCQ-measured anxiety. Throughout the study, the PCQ was sensitive to change in anxiety over breast problems. We conclude that screening procedures can either increase or reduce anxiety about breast problems, or have no appreciable effect. Subjects' perception of the impact of receiving the letter of invitation and undergoing the screening examination procedure is related to previous levels of concern over breast problems. Conclusions about the psychological effect of breast screening cannot be drawn without consideration of the time and place of the baseline assessment. Participants in breast screening programmes therefore cannot be considered a homogeneous entity. Caution should be exercised when assessing the impact of screening procedures on entire populations as this approach might mask an important diversity of response.     

Micturition problems in relation to quality of life in men with prostate cancer or benign prostatic hyperplasia: comparison with men from the general population

The aim of the study was to investigate men with prostate cancer and benign prostatic hyperplasia (BPH) in comparison with men from the general population in aspects of presence and frequency of micturition problems in remembrance of prior to treatment and currently. Further, the aim was to investigate the impact of micturition problems on quality of life and the association with micturition problems, and quality of life and sense of coherence (SOC). The samples consisted of 155 men with prostate cancer, 131 with BPH, and 129 from the general population. Micturition problems were assessed with study-specific questions, modified International Prostate Symptom Score (IPSS), quality of life questionnare (QLQ C-30), and SOC questionnaires. Parametric and nonparametric statistics were applied. Most troublesome urinary problems were leakage, feelings of discomfort, and disrupted urinary function and frequency. Men with urological diagnosis had more micturition problems, fatigue, and sleeping difficulties than men from the general population, but the cancer diagnosis did not add to the problems. Role and social functioning (prostate cancer), emotional functioning (BPH), and grade of fatigue (general population) showed itself vital for overall quality of life. Thus, help in solving issues of micturition problems, fatigue, and sleeping disturbances may contribute to maintenance of role, social, and emotional aspects of life.     

Improving lower urinary tract symptoms in BPH

Benign prostatic hyperplasia (BPH) is one of the most common diseases to affect older men. Histological disease is present in more than 60% of men beyond their sixties, and more than 40% of men in this age group have lower urinary tract symptoms (LUTS). The prevalence increases with age. About one-fifth of patients with symptomatic disease who present to a doctor will eventually be treated surgically. The remainder will often be managed initially by active surveillance. The majority of these men suffer gradual progression of symptoms and increasingly require treatment. BPH is characterised by a spectrum of obstructive and irritative symptoms, known collectively as LUTS. Poor urinary flow and the sensation of incomplete bladder emptying are the two symptoms that correlate most closely with the eventual need for prostate surgery. Untreated, a significant number of men with BPH will eventually develop acute urinary retention. In addition tosymptom assessment, digital rectal examination can provide an estimate of prostate volume and exclude a palpable nodule suggestive of prostate cancer. PSA testing provides additional information about the risk of prostate cancer being present. Medical management of BPH is suitable for most patients with moderate symptoms. The two main evidence-based approaches are treatment with alpha1-blockers and 5alpha-reductase inhibitors (5-ARLs). Severely symptomatic patients may also respond to these drugs. Mild symptoms should usually be managed by active surveillance. Combination therapy with an alpha1-blocker and a 5-ARI is more effective than monotherapy in terms of symptom relief and prevention of progression.     

Symptoms and symptom distress in localized prostate cancer

For over a decade, symptom distress has been a key concept in several studies of cancer. However, the definition of symptom distress is still unclear, and there are few measures targeting symptom distress, in general, and specific cancers, in particular. Prostate cancer is the sixth most common cancer worldwide and the second leading cause of death in American men. Many men with clinically localized prostate cancer may experience unique and multidimensional symptoms that occur from diagnosis through treatment, and thereafter. These symptoms associated with the disease and its treatments are in the form of physical and psychological sequelae such as urinary and bowel problems and sexual dysfunction. The purposes of this article are to (1) systematically review literature on symptoms and symptom distress in localized prostate cancer and (2) synthesize evidence of symptom distress applications and measurement in this group. A comprehensive, systematic review was conducted to identify original, data-based studies of symptoms and symptom distress in localized prostate cancer. Clarification of symptom distress and more comprehensive information about symptoms and symptom distress will provide nurses with a better foundation for developing self-management interventions aimed at ameliorating symptom distress and, ultimately, enhancing the quality of life of patients with localized prostate cancer.     

Prostate Cancer in Primary Care

Prostate cancer is a common malignancy seen worldwide. The incidence has risen in recent decades, mainly fuelled by more widespread use of prostate-specific antigen (PSA) testing, although prostate cancer mortality rates have remained relatively static over that time period. A man’s risk of prostate cancer is affected by his age and family history of the disease. Men with prostate cancer generally present symptomatically in primary care settings, although some diagnoses are made in asymptomatic men undergoing opportunistic PSA screening. Symptoms traditionally thought to correlate with prostate cancer include lower urinary tract symptoms (LUTS), such as nocturia and poor urinary stream, erectile dysfunction and visible haematuria. However, there is significant crossover in symptoms between prostate cancer and benign conditions affecting the prostate such as benign prostatic hypertrophy (BPH) and prostatitis, making it very challenging to distinguish between them on the basis of symptoms. The evidence for the performance of PSA in asymptomatic and symptomatic men for the diagnosis of prostate cancer is equivocal. PSA is subject to false positive and false negative results, affecting its clinical utility as a standalone test. Clinicians need to counsel men about the risks and benefits of PSA testing to inform their decision-making. Digital rectal examination (DRE) by primary care clinicians has some evidence to show discrimination between benign and malignant conditions affecting the prostate. Patients referred to secondary care for diagnostic testing for prostate cancer will typically undergo a transrectal or transperineal biopsy, where a number of samples are taken and sent for histological examination. These biopsies are invasive procedures with side effects and a risk of infection and sepsis, and alternative tests such as multiparametric magnetic resonance imaging (mpMRI) are currently being trialled for their accuracy and safety in diagnosing clinically significant prostate cancer.     

中专在校护生心理健康现状的调查分析

目的 了解中专护生心理健康的现状.为心理健康教育提供有针对性的指导.方法 应用心理健康诊断测验量表(MHT量表)对642名在校护生以问卷方式进行心理健康状况调查,并进行相关性分析.结果 有严重心理问题(≥65分)的学生占0.78%,有较严重心理问题(<65分且≥56分)的学生占4.52%.各年级学生在学习焦虑、过敏倾向、身体症状焦虑3方面有明显的差异,P<0.05.结论 中专护生心理健康总体状况良好,但还是有较多的人存在学习焦虑、过敏倾向和身体症状焦虑,且各年级存在差异.中专护校应进一步加强对学生的心理健康教育,并争取家长的密切配合,对有心理障碍的护生给予相应的干预措施,以提高中专护生的整体心理健康水平.     

TVP: A cheaper and effective alternative to TURP

Summary

Transurethral electrovaporization of the prostate (TVP) is a new minimally invasive procedure to treat enlargement of the prostate. It was the aim of this study to compare the efficacy, post-operative morbidity and costs of transurethral resection (TURP) with TVP of the prostate. Forty men requiring a transurethral resection of the prostate over a period of 12 months were randomly selected to undergo either TURP (20 men) or TVP (20 men). The improvement in the urinary symptoms and peak urinary flow of the two groups were measured before and after surgery. The post-operative morbidity, hospital stay, operating time and the costs of the two procedures were analysed in detail. Both TURP and TVP were found to have the same efficacy in relieving prostatic symptoms and obstruction with a successful surgical outcome in 85% of the men. The mean hospital stay for the TVP group (1.85 days) was significantly lower than the TURP group (3.5 days) as were the postoperative bladder irrigation and catheterization time (P < 0.0001). TVP was significantly cheaper than TURP due mainly to the reduced hospital stay, blood transfusions and cost of bladder irrigants. The overall morbidity was less for the TVP group (10%) in comparison to TURP (15%). TVP is as effective as TURP in relieving prostatic symptoms while being less morbid and cheaper with a shorter hospital stay: probably a better alternative to TURP.     

Self-esteem and self-acceptance: an examination into their relationship and their effect on psychological health

Nurses are increasingly using cognitive behaviour therapy as an intervention for psychological problems attached to a variety of clinical conditions. Developing both self-acceptance and self-esteem have been identified as ways to enhance cognitive interventions. However, there are disagreements about the relationship between self-esteem and self-acceptance and their influence on psychological health. The study examined the relationship between these concepts and also the association between the concepts and psychological health. Fifty-eight participants with a diagnosis of severe and enduring mental health problems were assessed recording levels of self-esteem, self-acceptance, depression, anxiety and psychological well-being. The results revealed that, in comparison with the general population, the sample were more likely to have lower self-acceptance and self-esteem, and higher levels of anxiety, depression and psychological ill health. The concepts of self-esteem and self-acceptance were found to be similar but not synonymous. Self-esteem was more closely associated with affect, with higher levels of self-esteem being indicative of lower levels of depression. Self-acceptance appeared to be more closely associated with general psychological well-being and to be more helpful when undertaking clinical work for general psychological problems.     

Prevalence of lower urinary tract symptoms and prostate enlargement in the primary care setting

PURPOSE: Men with lower urinary tract symptoms (LUTS) from benign prostatic hyperplasia often do not discuss their symptoms with their primary care physicians (PCPs). The primary objectives of this study were to estimate the prevalence of LUTS, prostate enlargement, and prostate-specific antigen (PSA) > or = 1.5 ng/ml in men visiting their PCP and to assess patients' intent to discuss LUTS with their PCP. METHODS: Men over age 50 presenting for a routine office visit at one of six PCP offices during the 8-week data collection period were invited to participate in this cross-sectional study. Men with prostate cancer, bladder cancer, indwelling urethral catheter or previous pelvic irradiation were excluded. Four hundred and forty-four men were enrolled and completed a self-administered questionnaire [including the International Prostate Symptom Score (IPSS)], provided a blood sample for PSA, and underwent a digital rectal examination (DRE), with the prostate classified as enlarged or non-enlarged by their PCP. RESULTS: Forty-two per cent of men had IPSS > 7; 48% had an enlarged prostate based on DRE and 43% had PSA > or = 1.5 ng/ml. Twenty-nine per cent (n = 129) of men had IPSS > 7 and enlarged prostate or PSA > or = 1.5 ng/ml. Of these men, 33% (n = 42) intended to discuss their symptoms with their PCP. CONCLUSIONS: Although a significant percentage of men in this older population had enlarged prostate and LUTS, only one-third of them intended to discuss their symptoms with their physician. PCPs may need to increase efforts to detect LUTS and enlarged prostate in older men.     

alpha1-Adrenoceptor subtype selectivity and lower urinary tract symptoms

Benign prostatic hyperplasia is a common cause of urinary flow obstruction in aging men and may lead to lower urinary tract symptoms (LUTS). Benign prostatic hyperplasia has 2 physiological components: a static component related to increased prostate size and a dynamic component related to increased prostate smooth muscle tone. alpha1-Adrenoceptors (alpha1ARs) maintain prostate smooth muscle tone; hence, alpha1-antagonists (blockers) relax prostate smooth muscle and decrease urethral resistance, ultimately leading to relief of LUTS. This review focuses on alpha1AR subtypes and their location in lower urinary tract tissues involved in LUTS (prostate, bladder, spinal cord); it also summarizes major clinical trials published to date on the efficacy of alpha1AR blockers for LUTS. Benefits and adverse effects of clinically available alpha1AR antagonists are reviewed, followed by recent information on interactions between alpha1AR subtype antagonists and type 5 phosphodiesterase inhibitors used for impotence. alpha1-Adrenoceptor antagonists have become the mainstay of therapy for LUTS; knowledge about specific alpha1AR subtypes should facilitate rational choice of alpha1AR blocker therapy by clinicians.     

Couple distress after localised prostate cancer

Background

The experience of the diagnosis of prostate cancer is distressing for both men and their partners. The present study describes the prevalence of psychological distress in men with prostate cancer and their partners, and the predictors of adjustment outcomes.

Methods/design

A cross-sectional survey of 189 prostate cancer patients who were scheduled for or had undergone surgery for localised prostate cancer and their partners assessed socio-demographic variables, masculine self-esteem and social intimacy, psychological adjustment and quality of life.

Results

Overall, patients and partners reported low distress; however, female partners were more anxious with 36 % reporting mild to severe anxiety. For men, masculine self-esteem and time since diagnosis were most strongly related to mental health status; urinary bother most influenced physical quality of life. For female partners, the man’s psychological distress and his sexual bother were most strongly related to her mental health status; higher social intimacy was most strongly associated with physical quality of life.

Conclusion

The correlates of distress after the diagnosis of prostate cancer differ between patients and female partners. For men, masculine self-esteem may be most crucial, whereas for women, her partner’s level of distress may matter most. Research to better understand these interactions is needed.     

高功率绿激光治疗高龄高危前列腺疾病的围术期护理

目的探讨120 W高功率绿激光选择性前列腺汽化术治疗高危前列腺疾病的围术期护理方法。方法通过口头、书面、演示、录像等多种方式对患者进行术前宣教,术前控制并发症及心理护理,提高术中配合的默契及预见性,术后密切观察生命体征和排尿症状,给予正确的饮食和出院指导。结果 29例患者顺利完成手术,手术时间30～85 min,平均(43.0±18.4)min;术后留置导尿管时间24～96 h,平均(38.8±15.1)h;无尿失禁、继发性出血、急性尿潴留再次手术病例。结论重视围术期护理,采取针对性的心理护理、完善的术前准备以及术后严密的病情观察、合理的健康指导是确保120 W高功率PVP治疗高龄高危前列腺疾病疗效的关键。     

Benign prostatic hyperplasia and urinary symptoms: Evaluation and treatment

Benign prostatic hyperplasia (BPH) is one of the most common conditions affecting middle-aged men. This condition can be microscopic, macroscopic, symptomatic, or asymptomatic. Up to 15% to 25% of men aged 50–65 years have lower urinary tract symptoms (LUTS) consisting of nocturia, urgency, frequency, a sensation of not completely emptying the bladder, stop-start urination, straining to urinate, a need to urinate soon after voiding, and weak urinary stream. These symptoms usually are associated with benign enlargement of the prostate gland that is of sufficient severity to interfere with a man’s quality of life. Although LUTS is often associated with BPH, LUTS can also be due to various unrelated syndromes such as heart failure, urinary tract infections, and diabetes. Most men will have benign hyperplasia of the prostate gland and this benign growth compresses the urethra resulting in LUTS. This article will discuss the evaluation, pharmacological management, minimally invasive treatment, and surgical therapy of this common condition affecting millions of American men.     

Utilities for prostate cancer health states in men aged 60 and older

PURPOSE: We sought to measure utilities for prostate cancer health states in older men. METHODS: A total of 162 men aged 60 years or older (52% of whom had been diagnosed with prostate cancer) provided standard gamble utilities for 19 health states associated with prostate cancer or its treatment using an interactive, computer-based utility assessment program. Demographics and experience with specific health states were examined as predictors of ratings using ordinary least squares regression analysis. RESULTS: Mean utilities ranged from 0.67 to 0.84 for living with symptom-free cancer under conservative management ("watchful waiting") and from 0.71 to 0.89 for symptoms occurring with treatment (prostatectomy, radiation, and hormone ablation). For long-term treatment complications, bowel problems (0.71) were rated as significantly worse than impotence (0.89), urinary difficulty (0.88), or urinary incontinence (0.83). Combinations of these conditions were rated as significantly worse than individual component states. Men who had experienced impotence or urinary incontinence rated these states as slightly better than men who had not experienced the specific problems. CONCLUSIONS: Both "watchful waiting" and treatment complications from prostate cancer treatments can have large impacts on quality of life. Mean ratings are important for use in policy-making and cost-effectiveness analyses. Variation in ratings across patients suggests that mean scores do not reflect individual preferences and that shared decision-making may be best for clinical decisions.     

Diagnosis and management of benign prostatic hyperplasia

Benign prostatic hyperplasia is a common condition affecting older men. Typical presenting symptoms include urinary hesitancy, weak stream, nocturia, incontinence, and recurrent urinary tract infections. Acute urinary retention, which requires urgent bladder catheterization, is relatively uncommon. Irreversible renal damage is rare. The initial evaluation should assess the frequency and severity of symptoms and the impact of symptoms on the patient's quality of life. The American Urological Association Symptom Index is a validated instrument for the objective assessment of symptom severity. The initial evaluation should also include a digital rectal examination and urinalysis. Men with hematuria should be evaluated for bladder cancer. A palpable nodule or induration of the prostate requires referral for assessment to rule out prostate cancer. For men with mild symptoms, watchful waiting with annual reassessment is appropriate. Over the past decade, numerous medical and surgical interventions have been shown to be effective in relieving symptoms of benign prostatic hyperplasia. Alpha blockers improve symptoms relatively quickly. Although 5-alpha reductase inhibitors have a slower onset of action, they may decrease prostate size and alter the disease course. Limited evidence shows that the herbal agents saw palmetto extract, rye grass pollen extract, and pygeum relieve symptoms. Transurethral resection of the prostate often provides permanent relief. Newer laser-based surgical techniques have comparable effectiveness to transurethral resection up to two years after surgery with lower perioperative morbidity. Various outpatient surgical techniques are associated with reduced morbidity, but symptom relief may be less durable.     

Health‐related quality of life in patients undergoing TURP: Translating evidence into urological nursing practice

How can the deterioration of the health‐related quality of life (HRQoL) in patients undergoing transurethral resection of the prostate (TURP) be prevented by urological nurses? The intention of this study is to examine the relevant literature regarding HRQoL among those undergoing TURP. Transurethral resection of the prostate is fully considered as a historical reference‐standard procedure for treating benign prostatic hyperplasia. Even though this method is highly effective and offers significant progress in urinary functioning, it is related to a risk of complications recognized as TURP syndrome which may impact patients' HRQoL. Several studies have discussed the management of TURP syndrome; however, they did not clearly elucidate the comprehensive aspect of HRQoL pertaining to physiological and psychological elements. As a consequence, this clinical condition may cause unpromising outcomes in regard to residual physical and psychological symptoms after TURP. Wilson and Cleary's model of HRQOL was thoughtfully chosen to guide this study. Several themes of the model were discussed as follows: biological and physiological factors, symptoms and general health perceptions, functional status, patient preferences, emotional and psychological factors, and overall quality of life. We generated a model of HRQoL along with nursing care with respect to the patients undergoing TURP. The findings of this study will render a positive contribution to improving TURP outcomes as well as preventing deterioration of patients' HRQoL.     

Premorbid mental health status of adult burn patients: comparison with a normative sample

The presence of psychiatric problems in burn patients has been found to have an impact on their burn care and long-term adjustment. This study investigated rates of previous mental health symptoms in a sample of 199 hospitalized burn patients screened for previous psychiatric diagnoses. Patients were instructed to fill out a questionnaire about their mental health functioning on the Rand Inventory for the month preceding their burn injury. Scores compared with a national normative sample on the Rand Mental Health Inventory revealed that burn patients scored higher on psychological distress, anxiety, depression, and loss of behavioral and emotional control. These results reflect other studies in the literature, indicating that burn patients are premorbidly more psychologically vulnerable than the general population, a factor that likely contributes to many of them sustaining their injuries.