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Elvira V Lang

Publications and source records attributed to Elvira V Lang.

16 recordsLinked to original sources
PubMed2006

Adjunctive self-hypnotic relaxation for outpatient medical procedures: a prospective randomized trial with women undergoing large core breast biopsy.

Medical procedures in outpatient settings have limited options of managing pain and anxiety pharmacologically. We therefore assessed whether this can be achieved by adjunct self-hypnotic relaxation in a common and particularly anxiety provoking procedure. Two hundred and thirty-six women referred for large core needle breast biopsy to an urban tertiary university-affiliated medical center were prospectively randomized to receive standard care (n=76), structured empathic attention (n=82), or self-hypnotic relaxation (n=78) during their procedures. Patients' self-ratings at 1 min-intervals of pain and anxiety on 0-10 verbal analog scales with 0=no pain/anxiety at all, 10=worst pain/anxiety possible, were compared in an ordinal logistic regression model. Women's anxiety increased significantly in the standard group (logit slope=0.18, p<0.001), did not change in the empathy group (slope=-0.04, p=0.45), and decreased significantly in the hypnosis group (slope=-0.27, p<0.001). Pain increased significantly in all three groups (logit slopes: standard care=0.53, empathy=0.37, hypnosis=0.34; all p<0.001) though less steeply with hypnosis and empathy than standard care (p=0.024 and p=0.018, respectively). Room time and cost were not significantly different in an univariate ANOVA despite hypnosis and empathy requiring an additional professional: 46 min/161 dollars for standard care, 43 min/163 dollars for empathy, and 39 min/152 dollars for hypnosis. We conclude that, while both structured empathy and hypnosis decrease procedural pain and anxiety, hypnosis provides more powerful anxiety relief without undue cost and thus appears attractive for outpatient pain management.

Adult↗
PubMed2005

Can words hurt? Patient-provider interactions during invasive procedures.

Patients are often prepared for procedural discomforts with descriptions of pain or undesirable experiences. This practice is thought to be compassionate and helpful, but there is little data on the effect of such communicative behavior. This study assesses how such descriptions affect patients' pain and anxiety during medical procedures. The interactions of patients with their healthcare providers during interventional radiological procedures were videotaped during a previously reported 3-arm prospective randomized trial assessing the efficacy of self-hypnotic relaxation. One hundred and fifty-nine videos of the standard care and attention control arms were reviewed. All statements that described painful or undesirable experiences as warning before potentially noxious stimuli or as expression of sympathy afterwards were recorded. Patients' ratings of pain and anxiety on 0-10 numerical scales (0=No Pain, No Anxiety at All and 10=Worst Pain Possible, Terrified) after the painful event and/or sympathizing statement were the basis for this study. Warning the patient in terms of pain or undesirable experiences resulted in greater pain (P<0.05) and greater anxiety (P<0.001) than not doing so. Sympathizing with the patient in such terms after a painful event did not increase reported pain, but resulted in greater anxiety (P<0.05). Contrary to common belief, warning or sympathizing using language that refers to negative experiences may not make patients feel better. This conclusion has implications for the training in medical communication skills and suggests the need for randomized trials testing different patient-practioner interactions.

Adolescent↗
PubMed2005

Adverse cerebrovascular effects of intraarterial CO2 injections: development of an in vitro/in vivo model for assessment of gas-based toxicity.

PURPOSE: To assess whether and how CO(2) can cause ischemic injury in the central nervous system after internal carotid artery injection. MATERIALS AND METHODS: In 14 adult pigs, both internal carotid arteries were catheterized via a transfemoral approach. One carotid artery served as control and the other was injected via a prototype gas injector with defined volumes and pressures of gas. Effects were assessed by clinical observation, repeated magnetic resonance (MR) imaging, histopathology, and vital staining. An in vitro flow circuit was used to model injection parameters. RESULTS: Single injections of CO(2) did not produce persistent clinical symptomatology. In vitro conditions were created in which bubbles adhered to the tubing of the circuit, creating functional stenoses, or coalesced into larger bubbles that became trapped, thereby reducing flow and augmenting potential embologenic effects of subsequent injections. With in vitro-derived dual injection parameters, seven pigs underwent two sequential injections of CO(2). All did well after the first injections, but all had adverse effects after the second injections, including involuntary tonic-clonic muscular movements, cardiopulmonary arrest, recurrent intractable seizure activity during recovery, hemorrhagic venous infarcts on gross and histopathologic examination, and blood-brain barrier breakdown on vital staining. MR imaging was not sensitive even after symptomatic intraarterial air injection. CONCLUSIONS: Absence of adverse effects after single bolus injections in pigs does not prove the safety of intracranial CO(2) injections in human patients. Considering the possible deleterious effects of repeat intravascular injections in the highly sensitive system of the brain, it may be prudent for clinical application at other approved sites to let time pass between boluses sufficient to permit absorption of wall-adherent and coalescent bubbles that could cause gas embolic events.

Animals↗
PubMed2005

Central venous recanalization in patients with short gut syndrome: restoration of candidacy for intestinal and multivisceral transplantation.

PURPOSE: To assess feasibility and success of venous recanalization in patients with short gut syndrome who have lost their traditional central venous access and required intestinal or multivisceral transplantation. MATERIALS AND METHODS: Twelve patients between the ages of 7 and 55 years with short gut syndrome and long-standing total parenteral nutrition (TPN) dependency and/or hypercoagulability were treated. All had extensive chronic central venous occlusions and survival was dependent on restoration of access and planned transplantation. Central venous recanalizations were obtained via sharp needle recanalization techniques, venous reconstructions with stents, and/or extraanatomic access to the central venous system for placement of central venous tunneled catheters. RESULTS: Central venous access was restored in all patients without operative-related mortality. Three major hemodynamic perioperative technical complications were recorded and successfully treated. There were three self-limited early infectious complications. With a mean follow-up of 22 months, eight of the 12 patients were alive with successful small bowel or multivisceral transplantation; six of those became independent of TPN. The remaining four patients died of complications related to TPN (n = 3) or transplantation (n = 1). With a mean follow-up of 20 months, all but two of the recanalized venous accesses were maintained, for a success rate of 83%. CONCLUSIONS: Recanalizations of extensive chronic vein occlusions are feasible but associated with high risk. The technique is life-saving for TPN-dependent patients and can restore candidacy for intestinal and multivisceral transplantation. This approach is likely to be increasingly requested because of the current clinical availability of the transplant procedure.

Adolescent↗
PubMed2005

Pain and anxiety during interventional radiologic procedures: effect of patients' state anxiety at baseline and modulation by nonpharmacologic analgesia adjuncts.

PURPOSE: To assess how patients' underlying anxiety affects their experience of distress, use of resources, and responsiveness toward nonpharmacologic analgesia adjunct therapies during invasive procedures. MATERIALS AND METHODS: Two hundred thirty-six patients undergoing vascular and renal interventions, who had been randomized to receive during standard care treatment, structured empathic attention, or self-hypnotic relaxation, were divided into two groups: those with low state anxiety scores on the State-Trait Anxiety Inventory (STAI, scores < 43; n = 116) and those with high state anxiety scores (> or = 43; n = 120). All had access to patient-controlled analgesia with fentanyl and midazolam. Every 15 minutes during the procedure, patients rated their anxiety and pain on a scale of 0-10 (0, no pain/anxiety at all; 10, worst possible pain/anxiety). Effects were assessed by analysis of variance and repeated-measures analysis. RESULTS: Patients with high state anxiety levels required significantly greater procedure time and medication. Empathic attention as well as hypnosis treatment reduced procedure time and medication use for all patients. These nonpharmacologic analgesia adjunct treatments also provided significantly better pain control than standard care for patients with low anxiety levels. Anxiety decreased over the time of the procedure; patients with high state anxiety levels experienced the most significant decreases in anxiety with nonpharmacologic adjuncts whereas patients with low state anxiety levels coped relatively well under all conditions. CONCLUSION: Patients' state anxiety level is a predictor of trends in procedural pain and anxiety, need for medication, and procedure duration. Low and high state anxiety groups profit from the use of nonpharmacologic analgesia adjuncts but those with high state anxiety levels have the most to gain.

Adaptation, Psychological↗
PubMed2004

Effect of sex and gender on drug-seeking behavior during invasive medical procedures.

RATIONALE AND OBJECTIVES: To assess how sex affects patients' drug-seeking, pain, and anxiety during interventional procedures. MATERIALS AND METHODS: Data from 159 patients were derived from two control groups of a prospective randomized trial. Seventy-six patients were male, 83 female. Patients in the standard group (n = 79) received the standard care typical for the institution; patients in the attention group (n = 80) had an additional empathic provider who stayed with them throughout the procedure. All patients were asked every 15 minutes to rate their pain and anxiety on 0-10 self-rating scales. All had access to intravenous sedatives and narcotics through a patient-controlled analgesia model. Univariate analysis of variance with a between-patient factor for group and another between-patient factor for sex was used. RESULTS: There was a significant interaction between group attribution and sex with regard to drug request and pain and anxiety ratings. Patients in the attention group requested significantly fewer drugs than patients in the standard group. Men asked for more drugs than women under standard care, but for less in the attention group. Pain and anxiety ratings for women were significantly lower in the attention group compared with standard treatment, but for men, there was no significant difference. CONCLUSION: Although both men and women benefit from the presence of an empathic provider during invasive medical procedures, men benefit more in terms of medication reduction, whereas women benefit more in terms of pain and anxiety reduction. Awareness of these gender-specific differences can aid in formulation of patient-specific treatment plans.

Adolescent↗
PubMed2004

Tumor thromboembolism masquerading as bland pulmonary embolism.

Catheter-based interventions provide an important alternative to medical surgical management of massive central pulmonary thromboembolism. Because this option is increasingly being used, it is important to recognize that not all pulmonary thromboemboli are bland. The authors describe two cases in which tumor masqueraded as bland thromboembolism. Identification of tumor thromboembolism may help to alter future work-ups, provide useful prognostic information for a patient, and affect future treatment options.

Carcinoma, Bronchogenic↗
PubMed2004

Inhaled nitric oxide as an adjunct to suction thrombectomy for pulmonary embolism.

Pulmonary suction thrombectomy can be a successful interventional tool in the treatment of pulmonary thromboembolism. Removal of clot burden typically results in prompt recovery of hemodynamic stability and improved oxygenation. However, in rare cases, clot removal does not sufficiently improve the clinical situation. Herein, two patients with massive pulmonary thromboembolism are presented whose condition improved only after they received nitric oxide as an adjunct to pulmonary suction thrombectomy. The treatment with this inhalable vasodilator was based on the hypothesis that prolonged ischemia had induced microcirculatory vasospasm, persistent after removal of the central clot.

Administration, Inhalation↗
PubMed2003

The effect of hyperoxygenation on T1 relaxation time in vitro.

RATIONALE AND OBJECTIVES: Ventilation with high oxygen (O2) concentrations has been shown to decrease T1 in blood and tissues of patients. This study aims to assess the effect of hyperoxygenation on the T1 relaxation time of blood and other physiologic solutions. MATERIALS AND METHODS: Varied gaseous mixtures of O2 and air between 21% and 100% O2 were created using an experimental circuit at room temperature, and used to saturate human blood, plasma, or normal saline. The samples were studied using an 8.45-Tesla magnetic resonance (MR) system and a 1.5-Tesla clinical MR scanner. RESULTS: MR spectroscopy at 8.45 Tesla showed that the percentage of O2 chosen for saturation correlated negatively with T1 (R2 = 1.00 for blood, 0.99 for plasma, and 1.00 for normal saline). The reduction in T1 between solutions saturated with 21% and 100% O2 was 487 milliseconds (22% of the baseline T1 value) for blood, 391 milliseconds (15%) for plasma and 622 milliseconds (19%) for saline. Similarly, MR measurements at 1.5 Tesla showed T1 reduction with increasing O2 concentration. Conclusion. The decreasing T1 in blood depends strongly on the fraction of dissolved O2 in solution and is largely independent of the hemoglobin content.

In Vitro Techniques↗
PubMed2003

Adverse short-term effects of attention-control treatment on hypnotizability: a challenge in designing controlled hypnosis trials.

Characteristics of patients in test and attention-control groups should be comparable and be unaffected by the intervention to be tested in clinical trials. The authors assessed whether this is the case for measures of hypnotizability in the postoperative period. One hundred and forty-six patients undergoing percutaneous peripheral vascular or renal interventions were randomized into 2 groups. One group received structured empathic attention during their procedures; the other was guided to self-hypnotic relaxation. Hypnotizability was assessed postoperatively by the Hypnotic Induction Profile. The eye-roll scores, which measure the biological hypnotic potential, were not significantly different, but the average induction scores, which measure the expression of the hypnotic performance, were significantly lower in the attention group than the hypnosis group (4.9 vs. 5.9). The authors conclude that patients who were aided by an external focus intraoperatively are postoperatively less able or willing to follow suggestions measuring hypnotizability than patients who had guidance to self-hypnotic relaxation.

Adolescent↗
PubMed2003

Postprocedure pain management of interventional radiology patients.

Postprocedure pain management of patients after interventional procedures has to take into account residual drug actions from pre- and intraprocedure medications. A variety of sedatives, narcotics, local anesthetics, nonopioid analgesics, and nonsteroidal antiinflammatory agents can be adjusted to the patient's needs and risk factors. The article addresses the safe use of these agents in addition to reflections on assessment and the cognitive elements of the pain experience.

Analgesia, Patient-Controlled↗
PubMed2002

Shaping the experience of behavior: construct of an electronic teaching module in nonpharmacologic analgesia and anxiolysis.

RATIONALE AND OBJECTIVES: The authors' purpose was to develop an electronic teaching module in nonpharmacologic analgesia and anxiolysis for use in the radiology department. MATERIALS AND METHODS: The teaching document was derived from previous training courses validated by patient outcome. Skills in structured empathic attention and guidance of self-hypnotic relaxation were tested in a previous prospective, randomized study with 241 patients and shown to affect positively patients' perception of pain and anxiety. Patients undergoing hypnosis had the greatest relief and most hemodynamic stability. The skills applied also saved, on average, 17 minutes of procedure time and approximately $340 in sedation cost per case. With these validated behavioral skills, an electronic teaching module was constructed. RESULTS: The mode of teaching reflected the content of teaching, which was achieved through a multimedia format containing text, audio, video, pictures, and animation. Advanced navigation tools put the students in control of their learning experience. Inclusion of experiential components, congruity of language with Ericksonian syntax, and provision of an electronic journal catered to the development of greater biobehavioral awareness. CONCLUSION: Electronic teaching modules for biobehavioral skill training are feasible and promise to reduce the time need for life interactions with instructors.

Adaptation, Psychological↗
PubMed2002

Cost analysis of adjunct hypnosis with sedation during outpatient interventional radiologic procedures.

PURPOSE: To compare the cost of standard intravenous conscious sedation with that of sedation with adjunct self-hypnotic relaxation during outpatient interventional radiologic procedures. MATERIALS AND METHODS: Data were reviewed from a prospective randomized study in which patients undergoing vascular and renal interventional procedures underwent either standard sedation (n = 79) or sedation with adjunct hypnosis (n = 82). These data were used to construct a decision analysis model to compare the cost of standard sedation with the cost of sedation with adjunct hypnosis. Multiple sensitivity analyses were performed to assess the applicability of these results to other institutions with different cost structures with respect to the following variables: cost of the hypnosis provider, cost of room time for interventional radiologic procedure, hours of observation after the procedure, and frequency and cost of complications associated with over- or undersedation. RESULTS: According to data from this experience, the cost associated with standard sedation during a procedure was $638, compared with $300 for sedation with adjunct hypnosis, which resulted in a savings of $338 per case with hypnosis. Although hypnosis was known to reduce room time, hypnosis remained more cost-effective even if it added an additional 58.2 minutes to the room time. CONCLUSION: Use of adjunct hypnosis with sedation reduces cost during interventional radiologic procedures.

Adolescent↗