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This article explores the use of touch in patient care in radiology departments. Touch can work positively in many ways, however, radiologic technology articles have failed to explore its possibilities. This article reviews literature from other fields and describes how some authors view how touch can improve patient care.
Therapeutic touch now has a 25-year history of practice and research. Based on the idea that within all living things there is a drive toward growth, order and wholeness--and that healing is a natural part of this process--therapeutic touch has been shown to induce relaxation, decrease anxiety and speed healing. It also enables caregivers to embrace their compassion and to touch people with effect.
Despite the widespread importance of mechanotransduction in biology, remarkably little is known about the nature of the molecules that mediate mechanical signaling. Mechanosensation in the nematode Caenorhabditis elegans is mediated by six mechanosensory neurons called touch receptor cells. Genetic analysis has resulted in the identification of over 400 mutations that disrupt the function of the touch receptors. Molecular characterization of the genes revealed has identified subunits of a candidate mechanosensory ion channel, tubulins expressed specifically in the touch receptors, and extracellular matrix proteins needed for mechanotransduction. mec-4 and mec-10 encode members of a C. elegans gene family related to the vertebrate epithelial Na+ channel that are hypothesized to encode subunits of a mechanosensory channel. mec-6 may encode another channel subunit. Inside the cell, alpha-tubulin MEC-12, beta-tubulin MEC-7 and a candidate linker protein MEC-2 may interact with the mechanotransducing channel to deliver gating tension. In the extracelluar matrix, collagen MEC-5 and MEC-9 and MEC-1 may interact with extracellular channel domains. A molecular model for mechanotransduction is discussed.
Fifty healthy term neonates delivered at All India Institute of Medical Sciences Hospital were assessed by three pediatricians for skin temperature to the nearest +/- 0.5 degrees C at the three body sites, i.e., mid-forehead, abdomen and dorsum of right foot by touch. The predicted temperatures at different sites were compared with simultaneously recorded temperatures at the same sites with the help of an electronic thermometer having a sensitivity of +/- 0.1 degree C. Rectal temperature was also recorded in all the babies with a rectal thermister to compare the variations between the core and skin temperatures. There was a good correlation between the skin temperatures of the babies as perceived by touch and values recorded with the help of an electronic thermometer. All the hypothermic babies were correctly picked up by all the observers. There was good correlation between core temperature and skin temperature at different sites except forehead. It is amazing that even during the month of May, when ambient temperature was maintained between 26-28 degrees C, nearly one fifth of the healthy term babies were under cold stress as evidenced by greater than 2 degrees C difference between the core and peripheral skin temperatures. It is recommended that health professionals and mothers should be explained the importance of evaluating the core and peripheral skin temperature by touch for early identification of babies under cold stress in order to prevent occurrence of life threatening hypothermia.
Touch, described as the most important of all the senses (Clement, 1987), confirms the reality perceived through the other senses and is a central part of the communication process (Montague, 1971; Mintz, 1969). Touch can be a tremendously supportive nursing technique. A pat on the shoulder, a hug, or a squeeze of the hand can create warmth and closeness that facilitates communication, decreases anxiety, and enables patients to tolerate discomfort. However, touch needs to be used deliberatively, with empathy, and with close attention to each person's unique needs. It is a nursing intervention that needs to be tailored to the patient's needs and responses.
Therapeutic touch (TT) is a modern derivative of the laying on of hands that involves touching with the intent to help or heal. This study investigated the effects of TT on tension headache pain in comparison with a placebo simulation of TT. Sixty volunteer subjects with tension headaches were randomly divided into treatment and placebo groups. The McGill-Melzack Pain Questionnaire was used to measure headache pain levels before each intervention, immediately afterward, and 4 hours later. A Wilcoxon signed rank test for differences indicated that 90% of the subjects exposed to TT experienced a sustained reduction in headache pain, p less than .0001. An average 70% pain reduction was sustained over the 4 hours following TT, which was twice the average pain reduction following the placebo touch. Using a Wilcoxon rank sum test, this was statistically significant, p less than .01. Study results indicated that TT may have potential beyond a placebo effect in the treatment of tension headache pain.
Sixty female college students were exposed to a stressful stimulus and treated by therapeutic or physical touch. Groups were compared on levels of physiological response through electromyographic, skin conductance, and peripheral skin temperature measures. The hypotheses predicted that the therapeutic touch group would remain more relaxed than the physical touch group. None of the hypotheses were confirmed using a one-way analysis of covariance.
The six experiments reported here stemmed from Weber's (E. H. Weber, In R. Wagner (Ed.), Handwnörterbuch der Physiologie, 1846. Vol. 3, pp. 481-588) report that cold objects on the forehead feel heavier than warm ones, implying an effect of temperature on the touch modality. The experiments arrived at first-order answers to how temperature, force of stimulation, areal size of stimulation, and body locus might influence the magnitude of touch sensation. Typically, concomitant cooling greatly intensifies touch magnitude as perceived via the forehead and the forearm. Warning has little or no effect via the forehead but gives a significant intensification (less pronounced than that of cooling) on the forearm. When the areal size of the stimulation becomes very small, the intensification effects cannot be reliably demonstrated. The findings are reviewed in the light of what is known about the physiology of the cutaneous nerves.
We examined two aspects of the response to siphon stimulation in an attempt to test the hypothesis that the Aplysia CNS functions as a distributed system. First, we estimated the number of central neurons that respond to a light touch to the siphon skin. We made voltage-sensitive dye recordings from the abdominal, pleural, pedal, and cerebral ganglia. From these recordings we estimated that 220 abdominal neurons, 110 pleural neurons, and 650 pedal neurons were affected by the light touch. Thus, the information about this mild and localized stimulus is very widely distributed within the Aplysia CNS. This result allows the possibility that the Aplysia CNS functions as a distributed system. If only a small number of neurons had responded to the touch, it would have supported the conclusion that the gill-withdrawal reflex could be generated by a small, dedicated circuit. Second, we searched for correlations between the spike times of the individual abdominal ganglion neurons. Two time scales were examined: a millisecond time scale corresponding to the duration of a fast synaptic potential and a seconds time scale corresponding to the duration of the gill-withdrawal movement. Neuron pairs with highly correlated spike activity on a millisecond time scale must be connected by (or have a common input that uses) relatively powerful, fast, excitatory synapses. We expected that this kind of synaptic interaction would be relatively rare in nervous systems that functioned in a distributed manner. Indeed, only 0.3% of the neuron pairs had correlation coefficients of 0.15 or greater. These correlations accounted for approximately 2% of the action potentials generated in response to siphon stimulation. Thus, large, fast excitatory synaptic interactions appear to be relatively unimportant. This result is consistent with the hypothesis that the abdominal ganglion functions as a distributed system. When the longer time scale was used for the cross-correlograms, a large fraction of the cell pairs had correlated activity because many neurons are activated by the stimulus. It was not possible to interpret the slow correlations in terms of actual synaptic interactions between individual neurons. Our results are consistent with the possibility that the abdominal ganglion functions in a distributed manner. However, this evaluation is indirect and thus only tentative conclusions can be drawn. Evidence from several sources suggests that the neuronal interactions for generating the Aplysia gill-withdrawal reflex are complex.
Touch is a powerful medium of social validation. Patients with skin disorders often experience social rejection when people avoid touching them, possibly fearing contagion or filth. We examined the psychologic impact of the stigma experience among 137 patients with moderate to severe psoriasis; 26.3 percent of patients reported that during the previous month they had experienced an episode when "people made a conscious effort not to touch them" because of their psoriasis. The stigmatized group did not have greater psoriasis severity than the non-stigmatized control group. However, in contrast to the non-stigmatized group, the stigmatized group had higher (P = 0.0003) depression scores (in the range for clinical depression, as measured by the Carroll Rating Scale for Depression), by stepwise logistic regression analysis using a wide range of psychopathologic measures as the independent variables. These findings underline the profound impact of the stigma experience in psoriasis, and possibly other dermatologic conditions that are associated with social stigma.
The frequency of touching in nursing care situations increases with patients who are in poor condition. Patients in long-term care often require help from nurses in all their daily activities. Touching is also an important form of communication in situations where the individual is no longer capable of reciprocal verbal communication. In this study, 10 nursing care situations were video recorded in a long-term care institution. The patients needed much help and had problems with verbal communication. Data analysis was inspired by Ricoeur's philosophy (1976) and involved three steps: naive understanding, structural analysis and comprehensive understanding. The findings show that each nurse-patient pair had its own distinct patterns of interaction that had taken shape over the years. Some nurses stood very close to their patients and frequently hugged, patted and stroked them; others remained at a greater physical distance and did not touch their patients more than was necessary to perform their tasks. In spite of their different patterns, all the nurses were highly competent and skilful in their jobs.
BACKGROUND AND OBJECTIVES: Removal of the entire tumor by breast-conserving surgery is important, but the determinants of adequate excision have not been established. METHODS: A prospective study of 55 consecutive lumpectomies for early breast cancer was performed to study the correlation between touch preparation cytology and histologic margins and the determinants of positive histologic margins and residual disease after the initial excision. RESULTS: The correlation between touch preparation cytology and histologic margins was poor: sensitivity and specificity were 37.5% and 85.1%, respectively. The histologic margins were positive in 8 cases (14.5%) and were related to the presence of intraductal carcinoma and to the large pathologic size of the index tumor. Re-excision specimen of the tumor bed (34 of 55 cases) contained residual cancer in seven cases (20.6%). Multifocal and nonpalpable index tumors predicted residual cancer. Residual disease was found in 37.5% of the cases (3 of 8) with positive and in 15.4% of the cases (4 of 26) with negative histologic margins. CONCLUSIONS: Touch preparation cytology cannot be recommended as a method of assessing lumpectomy margins for early breast cancer. Histologic margins are misleading in predicting residual cancer in re-excision specimens. To minimize the risk of residual cancer, wide excision or mastectomy should be considered in the management of multifocal and nonpalpable tumors.
We describe a technique for measuring dynamic motion at the low back along with the major lower limb joints during the toe touching maneuver. This type of motion analysis was carried out on eight normal volunteers. Flexion during the toe touching maneuver involves not only low back and hip movement but also ankle plantar flexion and a varying degree of knee movement. The low back and ankle movements were highly correlated within each subject to an extent that suggests a functional connection between the lower limb and low back movements. The significance of our work is two-fold. First, we emphasize that the toe touching test represents a combined movement of the low back, the hips, the knees, and the ankles and it is reasonable to suggest that abnormalities of these joints may affect the clinical relevance of the test as an indicator of back movement. Second, we point out that the guidelines of the American Medical Association in using the test to determine hip movement are incorrect as they do not take into account the effect of knee and ankle movements on the estimation of hip movement.
BACKGROUND: Neoadjuvant chemotherapy (NC) reportedly downstages axilla in approximately one-third of patients with locally advanced breast carcinoma (LABC). Postchemotherapy axillary lymph node status is an important prognostic factor. In the current study, the authors evaluated the reliability of touch imprint cytology (TIC) in detecting axillary lymph node metastasis after NC and identified chemotherapy-induced changes that may influence this assessment. METHODS: Thirty-three patients with LABC were studied. Seventeen patients had received chemotherapy before surgery (NC group) and 16 patients had not (non-NC group). Touch imprints were made from either the largest axillary lymph node (in 13 patients from the NC group and 16 patients from the non-NC) or the sentinel lymph node (in 4 patients from the NC group). Imprints from the NC group were evaluated for metastasis and were correlated with histopathology. Touch imprints from both groups were compared for cellularity, tumor load, necrosis/degeneration, and histiocytes. RESULTS: Cytologic evaluation for metastasis was 100% concordant with histopathology in all 17 patients from the NC group (9 positive results [53%] and 8 negative results [47%]). The presence of few tumor cells in sparsely cellular imprints that exhibited necrosis (two patients) and the presence of only degenerating/necrotic tumor cells (two patients) were two cytologic patterns unique to post-NC imprints that may have influenced their accurate assessment. CONCLUSIONS: TIC was found to be reliable for the intraoperative evaluation of axillary lymph node metastasis after NC. However, a careful examination is warranted in sparsely cellular imprints, because there is the possibility of overlooking a small group of tumor cells. To the authors' knowledge, the significance of finding extensive necrosis in axillary lymph nodes after NC is not known and may be investigated.
A new motif of three-dimensional (3D) protein structure is described, called the cis-Pro touch-turn. In this four-residue, three-peptide motif, the central peptide is cis. Residue 2, which precedes the proline, has phi, psi values either in the "prePro region" of the Ramachandran plot near -130 degrees, 75 degrees or in the Lalpha region near +60 degrees, +60 degrees. The Calpha(1)-Calpha(4) distance is 4-5 A and the two flanking peptides lie parallel to one another, making van der Waals contact rather than a hydrogen bond. Apparently, this arrangement is locally unfavorable and therefore rare, usually occurring only if needed for biological function. Of the 12 examples in a 500-protein database, cis-Pro touch-turns are found at the catalytic sites of pectate lyase, Ni-Fe hydrogenase, glucoamylase, xylanase, and opine dehydrogenase and at the primary binding sites of ribonuclease H, type I DNA polymerase, ribotoxin, and phage gene 3 protein. In each of these protein families, the touch-turns serve different roles; their functional importance is supported by conservation and mutagenesis data. In analyzing the conservation patterns of these 3D motifs, new methods for in-depth quality evaluation of the structural bioinformatic data are employed to distinguish between significant exceptions and errors
Eight genomic clones of potato calmodulin (PCM1 to 8) were isolated and characterized. Sequence comparisons of different genes revealed that the deduced amino acid sequence of PCM1 had several unique substitutions, especially in the fourth Ca(2+)-binding area. The expression patterns of different genes were studied by northern analysis using the 3'-untranslated regions as probes. The expression of PCM1, 5, and 8 was highest in the stolon tip and it decreased during tuber development. The expression of PCM6 did not vary much in the tissues tested, except in the leaves, where the expression was lower; whereas, the expression of PCM4 was very low in all the tissues. The expression of PCM2 and PCM3 was not detected in any of the tissues tested. Among these genes, only PCM1 showed increased expression following touch stimulation. To study the regulation of PCM1, transgenic potato plants carrying the PCM1 promoter fused to the beta-glucuronidase (GUS) reporter gene were produced. GUS expression was found to be developmentally regulated and touch-responsive, indicating a positive correlation between the expression of PCM1 and GUS mRNAs. These results suggest that the 5'-flanking region of PCM1 controls developmental and touch-induced expression. X-Gluc staining patterns revealed that GUS localization is high in meristematic tissues such as the stem apex, stolon tip, and vascular regions.
Although image analysis (IA) is increasingly being used to quantitate nuclear DNA, comparative data between fluorescence methods of IA and flow cytometry (FCM) is limited. In this study fluorescence IA was compared with FCM data in a series of Wilms' tumour touch preparations. Airdried touch imprints that had previously been Giemsa stained were restained with ethidium bromide. Confocal fluorescence images were obtained with a confocal laser scanning microscope and assessed by a fully automated IA package. Data was collected from 400 nuclei per imprint. The resulting DNA histograms were analysed and ploidy status and DNA indices determined using standard criteria. Results were compared with those derived from FCM analysis of nuclear suspensions. Ten of twelve tumours were concordant by both techniques. However in two cases assessed as diploid by FCM, IA identified aneuploidy. Excellent correlation between DNA indices as assessed by both techniques was observed (r = 0.987). In the three cases for which both unstained and Giemsa stained touch imprints were available for IA, the histogram configurations did not differ significantly. Fluorescence IA is an accurate and sensitive technique for DNA quantitation, which appears at least comparable to FCM assessment and which has a number of important advantages.
The mec-3 gene is essential for proper differentiation of the set of six touch receptor neurons in C. elegans. In mutants lacking mec-3 activity, the touch receptors express none of their unique differentiated features and appear to be transformed into other types of neurons. We cloned the mec-3 gene by transposon tagging and showed that a mec-3 mutant can be rescued by germ line transformation using a 5.6 kb genomic DNA fragment. In a strain in which transforming mec-3 DNA is present in about 50 copies per haploid genome, additional cells express a mec-3-dependent phenotype. The putative coding sequence of mec-3 contains a homeobox, suggesting that the mec-3 protein specifies the expression of touch cell differentiation by binding to DNA and regulating transcription of genes that encode the differentiated features of these cells.