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Am Fam Physician. 2000;61(10):3097-3098

Relaxation Technique Reduces Patient Anxiety Before Surgery

(85th Scientific Assembly and Annual Meeting of the Radiological Society of North America) The use of hypnotic relaxation techniques before some medical procedures reduced patients' anxiety and pain during the procedures, decreased procedure time and cost, and, in nearly one half of the cases, eliminated the need for conscious sedation altogether. These were the findings of a study of 161 patients undergoing angiography, angioplasty or kidney drainage. The relaxation technique involved a specially trained nurse or team member reading a script telling the patient to close and relax their eyes, take deep breaths, feel a sensation of floating and go to a safe and comfortable place. The patients were given a bell to ring at any point during the procedure if they felt the need for more anesthesia. All of the patients were offered conscious sedation (a mixture of antipain and antianxiety medication). Fourteen of the 79 patients (18 percent) who did not undergo relaxation techniques requested no sedation, compared with 38 of the 82 patients (46 percent) who underwent relaxation techniques. Replacing or supplementing anesthesia with the relaxation techniques reduced the average procedure time by 17 minutes (20 percent of total procedure time) and reduced the average procedure cost by $130 per patient. This reduction in cost was primarily the result of fewer interruptions during the procedures, and avoiding over- or undersedation that usually results in the patient being admitted to the hospital overnight instead of being released within a few hours of the procedure.—elvira v. lang, m.d., Harvard Medical School, Boston, Massachusetts.

Annual CT Screening for Lung Cancer in Smokers Detects Tumors Earlier

(Radiological Society of North America) Results of two related studies in the Early Lung Cancer Action Program (ELCAP) found that annual screening with computed tomography (CT) for lung cancer in current and former smokers more than 60 years of age can save lives by detecting tumors earlier and can also help convince patients to quit or reduce smoking. In the first phase of the study, 1,000 current and former smokers had baseline screening using CT, which proved to be much more effective at detecting early cancers than standard chest radiography. In the second phase of the study, results were analyzed from multiple annual repeat screenings of 808 current and former smokers (1,398 person-years of annual CT screening). Results of these screenings showed that 78 patients (6 percent) had nodules. Nine of these subjects were found to have small tumors. The study defined those at risk for developing lung cancer as men and women 60 years of age or older who smoked at least one pack of cigarettes a day for at least 10 years, or at least two packs a day for at least five years. A related study showed that participation in ELCAP convinced 23 percent of those screened to quit smoking, compared with a national annual cessation rate of 6 percent. Another 23 percent of subjects were convinced to decrease the quantity of cigarettes they smoked.—claudia i. henschke, m.d., ph.d., et al., Weill Medical College of Cornell University, Ithaca, New York.

Exercise, Low-Fat Diet Can Prevent Side Effects of Menopause

(72nd American Heart Association Scientific Sessions) According to results of the Women's Healthy Lifestyle Project, physical activity and a low-fat, reduced-calorie dietary pattern can prevent weight gain and help avoid increases in risk factors associated with heart disease that often accompany menopause in middle-aged women. This five-year, randomized clinical trial tested the efficacy of a behavioral lifestyle intervention program in preventing increases in low-density lipoprotein (LDL) cholesterol levels and weight gain in women during the peri- to post-menopausal period. The study included 535 premenopausal women who were randomly assigned to a behavioral lifestyle intervention group or to an assessment-only group. The intervention included a behavioral program designed to reduce dietary fat intake (25 percent total fat, 7 percent saturated fat, 100 mg cholesterol), caloric intake (1,300 kcal per day), and increase physical activity to 1,000 to 1,500 kcal per week. After four and one-half years, twice as many women in the intervention group were at or below their entry weight, compared with the women in the control group who gained weight steadily over the course of the study. Patients in the intervention group were an average of 82.2 g (0.18 lb) below their entry weight at the end of the study, while the women in the control group had gained an average of 2,359 g (5.2 lb). Women in the intervention group also showed significantly lower levels of LDL cholesterol, glucose and triglycerides compared with the control group.—laurey simkin-silverman, ph.d., University of Pittsburgh, Pittsburgh, Pennsylvania.

Heart Scan Accurately Evaluates Chest Pain, Decreases Hospitalizations

(American Heart Association) Findings from the Emergency Room Assessment of Sestamibi for Evaluation (ERASE) of chest pain study suggest that the use of a noninvasive heart scan called Cardiolite (kit for the preparation of technetium Tc99m sestamibi for injection) can more accurately rule out myocardial infarction in the emergency department (ED) than standard evaluation techniques and could avoid nearly 250,000 unnecessary hospitalizations for Americans annually. Over a 20-month period, ERASE investigators studied 2,456 patients who presented at seven EDs with symptoms suggestive of a myocardial infarction or unstable angina, but without an obvious pattern of either on their initial electrocardiogram (ECG). One half of all patients were tested with Cardiolite as part of the ED evaluation, while the control group received the usual ED assessment. The patients were ethnically diverse, one half were women, and the average age was 53 years. Of the 2,127 patients whose condition was ultimately diagnosed as non-cardiac in origin, patients who received the Cardiolite scan were significantly more likely to be discharged safely from the ED. Use of the Cardiolite scan reduced unnecessary hospitalizations by 20 percent with no increase in hospital discharges among patients actually having a myocardial infarction. The most frequently reported adverse effects from the use of the Cardiolite test include headache, chest pain/angina, ST segment changes on ECG, nausea and abnormal taste and smell. The Cardiolite test has also been rarely associated with acute severe allergic event of angioedema and urticaria.—harry p. selker, m.d., and james e. udelson, m.d., New England Medical Center, Boston, Massachusetts.

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