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PubMed1998

Therapeutic touch: an extension of professional skills.

Therapeutic touch, developed 25 years ago by Dolores Krieger, RN, PhD, and Dora Kunz, continues to gain ever wider acceptance in the health care field for one reason--it works. In our high-tech dialysis world of invasive, often painful procedures, therapeutic touch offers a welcome reprieve for patients and staff alike. For patients it has decreased restlessness, anxiety, fear and the pain from cannulations and central venous catheter insertions. Besides helping the recipients, therapeutic touch also affects the practitioners, with most practitioners reporting a greater sense of calm and well-being, in addition to the personal satisfaction of being able to offer a treatment that brings such relief to stressed-out patients. This article will introduce therapeutic touch and its use in the clinical setting.

Clinical Competence↗
PubMed1980

The value of no-touch isolation technique for resection of cancer. The eye as a model.

The role of the no-touch technique was examined using retinoblastoma and primary choroidal malignant melanoma of the eye as a model. Choroidal invasion, tumor friability, and tumor vascularity are important factors that render these two tumors susceptible to metastasis secondary to intraorgan pressure increases. Animal studies on no-touch enucleation procedures show that increased intraocular pressure during enucleation decreases survival rates considerably providing the tumor has invaded the choroid but has not yet metastasized. This "critical stage" correlates well with earlier data on the no-touch technique studied in noneye models. In humans, standard enucleations create intraocular pressures measured up to 500 mm Hg. The no-touch technique is applicable to the therapy of retinoblastoma and primary choroidal malignant melanomas, but long-term clinical studies are needed to establish the true benefit.

Animals↗
PubMed1991

Touch preparation cytology of breast lumpectomy margins with histologic correlation.

Residual microscopic disease after lumpectomy for breast cancer may cause significant local recurrence. We evaluated one hundred fourteen consecutive breast lumpectomy margins in this study by touch preparation cytology. Cytologic preparations were intraoperatively correlated with gross and frozen section results and subsequently with permanent histologic sections of representative margins. Three specimens were cytologically unsatisfactory and 86 yielded benign findings, while material suggestive or diagnostic of malignancy was obtained from 25 specimens. Gross, frozen section, and permanent histologic margins were positive in 10, 17, and 22 cases, respectively. There were three false-positive touch preparation cytologic results, while frozen section specimens were false-negative in five cases. Sensitivity and specificity of touch preparation cytology were 100% and 96.6%, respectively, with a diagnostic accuracy of 97.3%. Touch preparation cytologic examination rapidly and reliably evaluates lumpectomy margins and overcomes sampling errors and artifacts related to frozen section evaluation. This technique currently complements frozen section evaluation of lumpectomy margins as part of a protocol aimed at reducing local recurrence of breast cancer.

Adult↗
PubMed1998

Role of touch imprint and core biopsy for detection of tumor metastases in bone marrow.

A total number of 248 bone marrow trephine biopsies were reviewed and 21 paired biopsy and touch imprints were identified to estimate the role of these two diagnostic methods for detection of tumor metastases from nonhematologic malignancies in the bone marrow. The study period ran between January 1, 1993, and June 1, 1996. Eight histology sections and eight touch imprints were prepared from every case and were reviewed by two pathologists independently. In 20 cases, tumor cells were present without a doubt both on cytologic and histologic preparations. In one touch imprint, single cells were suspicious for malignancy, and the final pathology report was prepared after examination of the histologic sections. There was no positive biopsy in which the imprint was negative for tumor cells, and no positive touch imprint in which the biopsy was negative for such cells. The results from our study show that every one of these approaches has advantages and disadvantages and that they have a complementary role for identification of solid malignancies in the bone marrow.

Bone Marrow Neoplasms↗
PubMed2002

Intraoperative touch imprint of sentinel lymph nodes in breast carcinoma patients.

BACKGROUND: Sentinel lymph node examination in patients with breast carcinoma has been gaining in popularity. Currently, there is no standard intraoperative assessment of sentinel lymph nodes. To assess the utility of an intraoperative touch imprint (TI) evaluation, the authors compared TI cytology with surface hematoxylin and eosin (H&E) histology in sentinel lymph nodes from patients with breast carcinoma. METHODS: Sixty five sentinel lymph node biopsy cases were identified. Diagnoses from TI and surface H&E histologic sections were compared. RESULTS: Touch imprint had a specificity of 100%, a negative predictive value of 88%, a sensitivity of 65%, and a false negative rate of 9% per sentinel lymph node biopsy case. Eighty three percent of the false negative TI cases were due to micrometastasis. Preoperative chemotherapy, primary tumor type, and primary tumor size did not significantly contribute to false negative events. Touch imprint identified 67% of the cases that required completion axillary dissection. CONCLUSIONS: Touch imprint is a reliable and accurate intraoperative technique, with the potential to save a significant number of patients morbidity and the cost of a second surgical procedure to remove axillary lymph nodes. The difficulty of identifying micrometastases appeared to be the major source of false negative events, a problem that is not unique to TI cytology.

Adult↗
PubMed2005

Effect of touch-stimulus on the expression of C-fos and TrkA in spinal cord following chronic constriction injury of the sciatic nerve in rats.

To study the mechanism of the innoxious touch-stimulus on the modulation of hyperalgesia and the expression of the C-fos and the nerve growth factor (NGF) receptor-TrkA in the spinal dorsal horn neurons following the chronic constriction injury (CCI) of the sciatic nerve in rats, 60 female Sprague-Dawley rats were randomly divided into sham-operation group and CCI group, with each group being further divided into 3 subgroups on the 7th, 14th and 28th day after operation (n = 10). The mechanical and the thermal withdrawal threshold were assessed following the touch stiumulation after the CCI, immunohistochemical methods were employed to observe the expression of the C-fos and TrkA in spinal dorsal horn. Our results showed that the hyperalgesia appeared on the 4th day and reached the maximal level on the 14th day after operation. The expression of the C-fos also increased significantly and reached its maximal level on the 14th day after the touch-stimulus. Meanwhile, the TrkA expression was elevated significantly in both groups, as compared with basic data, and the difference was statistically significant (P < 0. 05). It is concluded that the level of the C-fos expression changed with the paw withdrawal threshold variation and increased markedly following the innoxious touch-stimulus. The expression of the TrkA receptors also increased gradually following the development of the neuropathic pain. The results suggest that C-fos may play a crucial role in the development of the hyperalgesia in the earlier-time of the neuropathic pain, but TrkA receptors may be involved in the long-lasting adaptive changes of the central pathway in neuropathic pain.

Animals↗
PubMed1995

A no-touch technique protocol to diminish cerebrospinal fluid shunt infection.

BACKGROUND: Cerebrospinal fluid (CSF) shunts become infected primarily by bacterial organisms indigenous to the patient's skin flora, but bacteria from the operating room environment, hospital, or no obvious source may also infect a shunt. To decrease the incidence of shunt infection, a no-touch technique protocol was developed and utilized in a prospective manner. METHODS: A before-after trial analysis was performed to compare the infection rates between patients who had CSF shunts placed using the no-touch technique protocol versus patients who had surgery without the protocol. Patients were stratified by age, etiology of hydrocephalus, type of shunt surgery, and presence of a contaminated skin wound, namely, tracheostomy, gastrostomy-jejunostomy, colostomy, or halo. The differences in infection rates were analyzed with the Fisher exact test with midpoint value correction, and standard statistical methods were used to calculate the 90% confidence interval odds ratio and number to treat. RESULTS: The no-touch technique protocol resulted in a clinically significant threefold decrease in shunt infection rate from 9.1% to 2.9% (p = 0.058 at 0.10 level, odds ratio 0.305, confidence interval 0.084-1.11), and a near threefold decrease in the infection rate per patient from 11.3% to 3.9% (p = 0.032 at 0.10 level, odds ratio 0.243, confidence interval 0.065-0.906). CONCLUSIONS: The no-touch technique protocol as described herein is a useful method to decrease shunt infection. A larger prospective, randomized, multicenter clinical trial is encouraged to stringently assess the efficacy of the protocol.

Adolescent↗
PubMed2005

Non-touch fittings in hospitals: a procedure to eradicate Pseudomonas aeruginosa contamination.

Non-touch taps, now common in hospitals, can easily be contaminated with Pseudomonas aeruginosa. We report our experience with 87 non-touch taps in a newly built wing of our teaching hospital contaminated with P. aeruginosa from the central pipe water system. Serotyping and genotyping of strains revealed genetic diversity of isolates, but also showed that major clones were able to persist for long periods of time in non-touch taps despite chlorination. It is notoriously difficult to decontaminate such taps with biocides and disinfectants. We describe an easy and economical procedure for the eradication of P. aeruginosa contamination from non-touch taps that does not require their removal.

Equipment and Supplies, Hospital↗
PubMed2003

Spinal EP receptors mediating prostaglandin E2-induced mechanical hyperalgesia, thermal hyperalgesia, and touch-evoked allodynia in rats.

Intrathecal administration of prostaglandin E(2) (PGE(2)) produces mechanical hyperalgesia, thermal hyperalgesia, and touch-evoked allodynia in rats. Experiments were conducted to examine the effects of intrathecal administration of relatively selective PGE(2) receptor (EP receptor) agonists to establish which spinal EP receptors mediate these behavioral effects of spinally administered PGE(2). Administration of either sulprostone (EP(3) receptor agonist) or PGE(1) alcohol (EP(4) receptor agonist) produced marked mechanical and thermal hyperalgesia and touch-evoked allodynia. Neither 17-phenyl trinor PGE(2) (EP(1) receptor agonist) nor butaprost (EP(2) receptor agonist) produced any significant changes in behavioral response thresholds to mechanical or thermal stimuli. However, 17-phenyl trinor PGE(2) (EP(1) receptor agonist) did produce marked touch-evoked allodynia. These data suggest that in rats activation of spinal EP(3) and EP(4) receptors by PGE(2) is important for development of both mechanical and thermal hyperalgesia as well as for touch-evoked allodynia. PGE(2)-induced allodynia also appears to involve activation of spinal EP(1) receptors.

Alprostadil↗
PubMed1997

Residual moisture determines the level of touch-contact-associated bacterial transfer following hand washing.

We report here a new and critical determinant of the effectiveness of hand hygiene procedures, namely the amount of residual moisture left on the hands after washing and drying. When samples of skin, food and utilities were touched with wet, undried hands, microbial numbers in the order of 68000, 31000 and 1900 respectively translocated to these representative surfaces. Bacterial numbers translocating on touch contact decreased progressively as drying with an air or cloth towel system removed residual moisture from the hands. A 10 s cloth towel-20 s air towel protocol reduced the bacterial numbers translocating to skin, food and utilities on touch contact to 140, 655 and 28 respectively and achieved a 99.8, 94 and 99% reduction in the level of bacterial translocation associated with wet hands. Careful hand drying is a critical factor determining the level of touch-contact-associated bacterial transfer after hand washing and its recognition could make a significant contribution towards improving handcare practices in clinical and public health sectors.

Bacteria↗
PubMed2001

A comparative study of three techniques for the analysis of sperm recovery: touch-print cytology, wet preparation, and testicular histopathology.

PURPOSE: The aim of this study is to evaluate the efficacy of simultaneous testicular touch-print cytology, testicular histopathology, and wet preparation in nonobstructive azoospermic (NOA) males. METHODS: Three hundred and sixty-three males with NOA underwent a multiple testicular sampling prior to ICSI for histopathologic evaluation, diagnostic testicular sperm extraction, and simultaneous touch-print cytology to evaluate sperm presence or absence. A total of 979 testicular samples were taken. RESULTS: Sperm recovery was achieved in 106 cases (29.2%). Patients with hypospermatogenesis and focal spermatogenesis needed 2.8 and 5.9 biopsies, respectively, to retrieve spermatozoa, while in patients with germ cell aplasia and maturation arrest, even after eight to nine samples no spermatozoa were recovered. Neither the FSH levels nor the testicular volume was found to be significant in the prediction of sperm recovery. If only a single testis was to be biopsied, 25% of the cases with sperm recovery would have been missed. The combination of touch-print cytology with histopathology and wet preparation increased the accuracy of spermatozoa identification. CONCLUSION: Touch-print cytology was found to be more predictive than wet preparation in the diagnosis of spermatogenesis; moreover, it was found to be a quick and easy technique providing an accurate diagnosis in prediction of sperm recovery.

Adult↗
PubMed2002

The application of computer touch-screen technology in screening for psychosocial distress in an ambulatory oncology setting.

The objective of the study was to evaluate the acceptability and feasibility of computer touch-screen technology as a method for patients to report psychosocial functioning in an ambulatory cancer clinic. Patients participating in a randomized trial evaluating the use of self-reported psychosocial information in the clinical encounter were surveyed. The patients completed the Cancer Needs Questionnaire (CNQ), European Organization for the Research and Treatment of Cancer quality of life questionnaire (EORTC QLQ-C30) and the Beck Depression Inventory - Short Form (BDI) using a touch-screen computer. The time taken to complete the questionnaires was recorded electronically. Patients completed a seven-item pen and paper survey to assess acceptability of the process. Of the 450 patients, 244 (54%) were 60 years or older. Although over half the patients had no prior computer experience, nearly all found the touch screen easy to use and the instructions easy to understand. Each question was answered by at least 447 (99.3%) patients. The average time to complete the CNQ was 9.1 min, EORTC QLQ-C30 4.0 min and BDI 3.1 min. Factors influencing time to completion were prior use of computers, physical condition, education and overall level of needs. The study found that the use of computer touch-screen technology is an acceptable and efficient method for obtaining self-reported information on quality of life, cancer needs and psychological distress.

Adaptation, Psychological↗
PubMed1988

[Gas-no touch-enucleation].

The gas not touch enucleation procedure described in the present paper was prompted by Zimmerman's theory that the increase in the rate of metastasization following enucleation of eyes with melanomas is due to intraoperative fluctuations in IOP. Prior to surgery the blood circulation in the affected eye is interrupted by a kind of "invisible hemostatic clamp ab interno." In practice this is accomplished by an intravitreal gas injection. From July 1984 to December 1987 this technique was used in 22 enucleations performed because of large choroidal melanomas. The average base diameter of the (histologically verified) tumors was 15.1 mm and their height 9.9 mm. In each of 11 patients air or an expanding perfluorocarbon gas (4 x CF4, 4 x C2F6, 3 x C3F8) was injected through a 30-gauge needle via the pars plana. IOP was subsequently maximally elevated, the eye "rock hard," the central artery not perfused, and the entire blood circulation in the affected eye interrupted. The volume of gas injected ranged from 0.8 to 2.2 ml (average 1.4 ml). IOP remained maximally elevated throughout the enucleation procedure, even persisting in the enucleated eye. No special instruments are needed for gas no touch enucleation, it is easy to perform and the duration of surgery is not increased. It can be performed by any eye surgeon in any operating room when an eye with a malignant melanoma has to be "no touch" enucleated, i.e., avoiding fluctuations in IOP in order to minimize the chances of tumor cell seeding into the bloodstream. For "no touch" enucleations the gas technique thus represents a viable alternative to Fraunfelder's freezing technique.

Choroid Neoplasms↗
PubMed2004

Standing at a kiosk: effects of key size and spacing on touch screen numeric keypad performance and user preference.

Touch screen input keys compete with other information for limited screen space. The present study estimated the smallest key size that would not degrade performance or user satisfaction. Twenty participants used finger touches to enter one, four or 10 digits in a numeric keypad displayed on a capacitive touch screen, while standing in front of a touch screen kiosk. Key size (10, 15, 20, 25 mm square) and edge-to-edge key spacing (1, 3 mm) were factorially combined. Performance was evaluated with response time and errors, and user preferences were obtained. Spacing had no measurable effects. Entry times were longer and errors were higher for smaller key sizes, but no significant differences were found between key sizes of 20 and 25 mm. Participants also preferred 20 mm keys to smaller keys, and they were indifferent between 20 and 25 mm keys. Therefore, a key size of 20 mm was found to be sufficiently large for land-on key entry.

Adolescent↗
PubMed1984

Active and passive touch: the influence of exploration time on form recognition.

In a study of the effect of self-produced movement on tactual form recognition 30 male and 30 female college students actively or passively touched cooky -cutter forms with the preferred index finger to identify the shapes. In a static passive condition, the forms were pressed on the fingers. Ss were limited to either 5 or 30 sec of stimulus exposure time. Results indicate that active touch was superior to either passive static or passive sequential touch. Adding stimulus change failed to improve performance. Recognition accuracy was greater with 30 sec of exposure, but 5 sec of active touch produced accuracy equivalent to that produced by longer periods of passive stimulation.

Adult↗
PubMed1990

DNA quantitation by image cytometry of touch preparations from fresh and frozen tissue.

Using formalin-fixed, paraffin-embedded tissue for DNA quantitation has several disadvantages, including sacrifice of tissue and relatively poor resolution. DNA quantitation of touch preparations by image cytometry correlates well with flow cytometry, and analysis of touch preparations made from frozen tissue may offer an alternative method for retrospective studies. The authors compared the results of DNA quantitation of fresh and frozen tissue touch preparations in 59 solid tumors. For 54 cases there was excellent correlation. In three cases with multiple aneuploid peaks, the same populations were identified by each method, but different proportions of cells from each stemline were present in the fresh and frozen samples. In two cases there was a discrepancy between the DNA indices; the imprints showed different cell morphologic characteristics, suggesting different stemlines or areas of tumor differentiation. The authors conclude that DNA quantitation from touch preparations of frozen tissue by image cytometry provides a desirable alternative to sacrificing formalin-fixed tissue.

Cell Separation↗
PubMed1999

Embryo transfer: ultrasound-guided versus clinical touch.

In this prospective control study, the pregnancy and implantation rates were compared between ultrasound-guided and clinical touch uterine embryo transfers. In addition, a subset of patients was sought that would particularly benefit from embryo transfer under ultrasound guidance. A total of 187 patients (93 ultrasound and 94 clinical touch) was enrolled. Allocation was random and depended on whether their embryo transfers were done during the 1 h each day in which the ultrasound was available. Pregnancy and implantation rates of 37.8 and 20.4% respectively were achieved when ultrasound was used, compared with 28.9 and 16.2% respectively with clinical touch. This difference was not statistically significant. There was no significant difference in the pregnancy rate when the number of embryos transferred was controlled. Older women (>/=37 years old) had an apparently higher pregnancy rate (38.1 versus 20.4%; not significant) with ultrasound guidance during embryo transfer. In the subgroup where the clinician rated the transfer procedure as difficult, there appeared to be a substantial improvement in the pregnancy rate in the group that used ultrasound (54.5 versus 10.0%; not significant). Although our results were not statistically significant, we believe that ultrasound-guided embryo transfers should be used in clinically difficult embryo transfers and in older women, as it appears to improve the pregnancy rate over clinical touch transfers.

Adult↗
PubMedDate not supplied

Web-based touch-screen computer assessment of chronic low back pain: a pilot study.

The objective of this study was to evaluate the acceptability and feasibility of a Web-based touch-screen computer questionnaire as a data collection method for patients experiencing chronic low back pain in a tertiary spine clinic. Participants completed the Oswestry Low Back Pain Disability Index, SF-36, and Beck Depression Inventory using a touch-screen computer. The time taken to complete the questionnaire was recorded electronically (M = 27.4 minutes; SD = 13.8). Prior computer experience and perceptions of computer use were also assessed. Low back pain was evaluated before and after completing the touch-screen computer questionnaire. Observations of sitting and standing tolerances were made. Participants completed a nine-item paper-and-pencil satisfaction survey after completing the computer questionnaire. Overall satisfaction level with this mode of data collection was high, supporting a larger study using touch-screen technology in patients with chronic low back pain. Important factors influencing satisfaction were the computer environment, ease of use, security, and the ability to interrupt the questionnaire process to allow for changes in sitting or standing posture.

Activities of Daily Living↗