Kiecolt-Glaser, J.K., Bennett, J.M., Andridge, R., Peng, J., Shapiro, C.L., Malarkey, W.B., . . . Glaser, R. (2014). Yoga’s impact on inflammation, mood, and fatigue in breast cancer survivors: A randomized controlled trial. Journal of Clinical Oncology. Advance online publication.
To assess the effects of yoga on inflammation, mood, and fatigue and to test the hypothesis that yoga would decrease inflammation, depressive symptoms, and fatigue in breast cancer survivors
Women were randomly assigned to the intervention group or a wait-list control group. The intervention consisted of two 90-minute Hatha yoga sessions per week for 12 weeks delivered in a group setting. Sessions were audiotaped, and 50% were randomly assessed for differences from predetermined poses to assess fidelity of the intervention. Yoga teachers called anyone who missed a class. Home practice was encouraged, and all practice times were recorded by participants in weekly logs. Data were collected at baseline, immediately after the intervention, and after three months post-treatment.
Single-blinded, randomized, controlled trial
Patients attended a median of 79% of yoga classes and reported an average of 24.69 minutes of practice per day at home and in class over 12 weeks. Immediately after the intervention, there were no differences between the groups in fatigue; however, in the yoga group, fatigue was significantly lower at three months (Cohen’s d = -0.36, p = 0.002). Vitality in the yoga group was significantly higher immediately post-treatment and at three months (p = 0.01). There were no differences between the groups in depressive symptoms. Immediately postintervention, there were no differences between groups in cytokine levels; however, at three months, the yoga group had significantly lower cytokine levels compared to the control group (p < 0.05). Yoga participants reported improved sleep compared to patients in the control group (p = 0.03).
Yoga was associated with reduced fatigue, increased vitality, improved sleep, and reduced cytokine levels. Yoga did not appear to have an effect on depressive symptoms in this study.
The findings of this study demonstrated that yoga practice was effective in reducing fatigue and improving vitality and sleep in this patient population. Nurses can suggest that patients become involved in yoga practice as a way to manage fatigue and sleep disturbance. These findings also suggest that yoga can have an impact on subclinical inflammation, which may be a mechanism that fuels fatigue and the decline of physical function.
Kidd, F., Buttner, C., & Kressel, A.B. (2007). Construction: A model program for infection control compliance. American Journal of Infection Control, 35, 347–350.
This study describes a five-year expansion project to build a nine-story employee garage, a new post-anesthesia care unit, a new cardiothoracic intensive care unit, and expansion of existing operating room space to include eight new operating rooms. The construction plan included demolition of five circa 1910 mostly unused buildings.
One infection control practitioner (ICP) attended a University of Minnesota Health Care Facility Construction Management Indoor Air Quality Workshop.
An infection control education program for contractors was developed that all construction workers were required to complete the training prior to working on the construction project and annually thereafter.
The infection control training takes 30 minutes. The lesson plan is organized by sections that include precautions to take before, during, and after construction work. There also is an audiovisual program about Aspergillus and its transmission and the susceptibility of immunosuppressed patients.
An infection control team including the general contractor, project manager, ICP, and operating room nurse planner make rounds weekly or daily on all projects to monitor for compliance and answer questions. In addition, other precautions were implemented since patients could not be relocated away from the area of greatest activity.
Members of the design and construction department are engineers and architects and have attended classes on construction and infection control.
During the first four years of demolition and renovation, the University Hospital had no nosocomial Aspergillus infections.
In the fifth year, of construction, two patients who had possible hospital-acquired infections were identified. An industrial hygienist was brought in to evaluate intervention and make recommendations, but nothing of concern was found.
Particle sampling remained the same from pre-construction to post-construction.
Both possible nosocomial Aspergillus infections occurred after a building that was connected to the hospital and shared air space began a large renovation project without using infection control prevention.
Hospitals must be aware not only of what is happening inside their own facilities, but also what is happening outside. ICPs must establish collegiality with contractors, architects, maintenance, and engineering personnel to produce an effective, comprehensive infection-prevention atmosphere during construction and renovation.
Khurana, H., Pandey, R., Saksena, A., & Kumar, A. (2012). An evaluation of vitamin E and pycnogenol in children suffering from oral mucositis during cancer chemotherapy. Oral Diseases.
Evaluate and compare effectiveness of topical vitamin E and pycnogenol (pine bark extract) in treatment of chemotherapy-induced oral mucositis.
Children were randomly assigned to the use of vitamin E, pycnogenol, or sterile water rinses. All were also to follow a uniform oral care protocol, including brushing with a soft tooth brush and chlorhexidine mouth rinse 3 times/day. All study interventions were applied topically three times a day using a dropper. Medications were stored in a refrigerator before usage. The medication was kept in the patient’s mouth for 30 seconds and then swallowed. Patients were blinded to the treatment group. Patients were followed for seven days.
The study was comprised of 72 patients, with a mean age of 9.25 and a range of 6-15 years.
MALES 79%, FEMALES 21%
KEY DISEASE CHARACTERISTICS: All had hematological cancers, including ALL, AML, and NHL, and all were in induction or intensification phases of treatment.
SITE: Single site
SETTING TYPE: Multiple settings
LOCATION: India
PHASE OF CARE: Active antitumor treatment
APPLICATIONS: Pediatrics
Single, blind, randomized placebo controlled
Mucositis grades in those receiving either vitamin E or pine bark extract were significantly lower than those on placebo (p </= 0.006). OMAS scores declined significantly and consistently across days 1-7, while these scores remained the same in the placebo group. There was significant improvement in pain scores in both intervention groups from day 4 onward, compared to placebo. There were no significant differences in study outcomes between those treated with vitamin E or pine bark.
Topical vitamin E and pine bark extract (pycnogenol) were of benefit in reducing severity of mucositis and pain associated with mucositis in these patients.
Topical vitamin E and pine bark extract may have some promise for the management of oral mucositis. Further research on these interventions is warranted.
Khouri, V.Y., Stracieri, A.B., Rodrigues, M.C., Moraes, D.A., Pieroni, F., Simoes, B.P., & Voltarelli, J.C. (2009). Use of therapeutic laser for prevention and treatment of oral mucositis. Brazilian Dental Journal, 20(3), 215–220.
To evaluate the frequency and evolution of oral mucositis (OM) among stem cell transplant recipients subjected to therapeutic laser versus mucositis formula
Patients (n = 22) were randomly assigned to control or low level laser therapy (LLLT) daily. The treatment phase for both groups began with the initial clinical manifestations of mucositis with follow up until day +15 after transplant. Two types of laser were used on alternate days, one indicated for tissue repair and the other for analgesia.
This was a single-site conducted in the bone marrow transplant unit (BMTU) of the University Hospital School of Medicine of Ribeirao Preto (UHSMRP) at the University of São Paulo in Brazil.
The study was a randomized controlled trial.
The laser treatment group had lower frequency of oral mucositis (p = 0.02) and a lower mean grade of mucositis (p < 0.01).
The inclusion of LLLT was effective in lowering the frequency and treating oral mucositis in patients being treated with high dose myeloablative chemotherapy in preparation for stem cell transplant.
Laser therapy is effective in the treatment of mucositis, but it is very high tech and requires special equipment and highly trained personnel.
Khojasteh, N.H., Zakerinia, M., Ramzi, M., & Haghshenas, M. (2000). A new regimen of MESNA (2-mercaptoethanesulfonate) effectively prevents cyclophosphamide-induced hemorrhagic cystitis in bone marrow transplant recipients. Transplantation Proceedings, 32, 596.
Mesna was given to patients undergoing allogeneic bone marrow transplantation and administered high-dose chemotherapy. Doses were administered at 400 mg/m2 at hours 0, 1, 3, 5, 8, 11, 14, 17, and 20. Fluid also was administered at 3,000 mL/m2.
Three patients developed transient but asymptomatic hemorrhagic cystitis. One patient developed late onset but moderate hemorrhagic cystitis.
Khedr, E.M., Kotb, H.I., Mostafa, M.G., Mohamad, M.F., Amr, S.A., Ahmed, M.A., . . . Kamal, S.M. (2015). Repetitive transcranial magnetic stimulation in neuropathic pain secondary to malignancy: A randomized clinical trial. European Journal of Pain, 19, 519–527.
To evaluate the effects of transcranial magnetic stimulation on neuropathic pain
Patients with neuropathic pain by standardized assessment were randomized to receive either transcranial magnetic stimulation or sham stimulation. After the identification of optimal scalp location, electrodes were used to apply 20 Hz in pulses every day for 10 consecutive days. Procedures for the actual and sham procedures were the same. Study measurements were done before and after the first, fifth, and tenth sessions, and at 15 days and one month later.
Randomized, sham-controlled trial
An analysis showed pain reductions in both groups over time, but there were significantly greater pain reductions in the actual stimulation group compared to the sham procedure (p = 0.0001). T tests between groups at each time point showed that there was no real effect of the actual stimulation procedure after the first session. At this point, pain declined and remained stable over time. These effects remained at 15 days but did not remain at one month.
Transcranial stimulation resulted in significant reductions in neuropathic pain. Because the main change occurred after the first session, it was not clear if repeated sessions were beneficial.
The findings of this study suggested that transcranial stimulation can reduce neuropathic pain in patients with cancer. This is a noninvasive technique that may provide an important alternative for pain control. Additional research is needed to determine most effective dosing, timing, and efficacy in comparison to other interventions.
Khan, F., Amatya, B., Pallant, J.F., Rajapaksa, I., & Brand, C. (2012). Multidisciplinary rehabilitation in women following breast cancer treatment: A randomized controlled trial. Journal of Rehabilitation Medicine, 44, 788–794.
To assess effectiveness of an ambulatory rehabilitation program for women with breast cancer
A sample of patients referred to a rehabilitation center was selected based on criteria of diagnosis of breast cancer, considered to be disease free. Patients were then randomly assigned to an intervention group or a control group that continued with usual activity in the community. The rehabilitation program was conducted three to five days per week for up to eight weeks and was aimed at improving activity and participation in activities. Interventions included physiotherapy, lymphedema care, occupational therapy, and clinical psychology for counseling and support. Study assessments were done at baseline and at four months after program completion.
Patients were undergoing multiple phases of care.
A randomized, single-blind, controlled trial design was used.
Out of 42 patients, 31 completed the rehabilitation program. Over the study period, more patients in the treatment group showed a decrease in depression scores compared with the control group (p = 0.02). Intervention group patients also showed significant differences in impact profile scores (p = 0.05). There were no differences between groups in anxiety or FIM scores.
Findings suggest that comprehensive multidisciplinary rehabilitation may improve depression among women with breast cancer.
Some patients may benefit from a multidisciplinary rehabilitation program after breast cancer treatment. This study provides some evidence in support of this approach, but has several limitations. Further research is needed to determine the benefit versus cost of such programs.
Khan, F., Amatya, B., Drummond, K., & Galea, M. (2014). Effectiveness of integrated multidisciplinary rehabilitation in primary brain cancer survivors in an Australian community cohort: A controlled clinical trial. Journal of Rehabilitation Medicine, 46, 754–760.
To evaluate the effectiveness of a multidisciplinary rehabilitation program for individuals after treatment for primary brain tumors
Patients were assigned to treatment or wait-list control comparison groups according to an assessment of their needs by the clinical provider. The rehabilitation treatment team was blinded to study group assignment. The intervention included individualized 30-minute therapy sessions with social, psychological, occupational, and physical therapy in half-hour sessions two to three times a week for as many as eight weeks. The individualized intervention incorporated elements of education, health promotion, intensive mobilization, and task reacquisition programs as determined appropriate by the rehabilitation team. Study assessments were done at baseline and at three and six months. Functional independence measures were the primary outcomes of the study.
Prospective trial
At three months, FIM Motor (self-care, sphincter, location, and mobility subscales) and FIM Cognition (communication and psychosocial subscales) scores were significantly improved in the treatment group compared to the control group. At six months, the FIM Motor (sphincter subscale) and FIM Cognition (communication, psychosocial, and cognition subscales) scores were significantly improved in the treatment group compared to the control group. There were no significant differences between groups in DASS measures of anxiety or depression from baseline to three or six months. There also were no differences observed between groups in PIPP results from baseline to three or six months, which measured the impact of functional areas also on the FIM. The greatest improvements seen were at the three-month follow-up date.
The findings of this study demonstrated that multicomponent rehabilitation can improve measures of self-care and some specific areas of motor and cognitive function.
The findings of this study showed some functional benefits of multicomponent rehabilitation for patients with primary brain tumors. This study was limited by its design and the clinical nature of rehabilitation aimed to provide individualized interventions on the basis of needs assessed by care providers. This suggests that patients may benefit in the areas of self-care. The degree to which these benefits are maintained over time is not clear from this study.
Khamales, S., Bethune-Volters, A., Chidiac, J., Bensaoula, O., Delgado, A., & Di Palma, M.. (2006). A randomized, double-blind trial assessing the efficacy and safety of sublingual metopimazine and ondansetron in the prophylaxis of chemotherapy-induced delayed emesis. Anticancer Drugs, 17(2), 217-224.
To compare the efficacy and safety of sublingual metopimazine to ondansetron orally disintegrating tablet (ODT) in patients receiving highly emetogenic chemotherapy (HEC) for the prevention of delayed (not acute) chemotherapy-induced nausea and vomiting (CINV)
Participants were randomized to one of two treatment arms. In group 1, patients received 7.5 mg sublingual metopimazine every eight hours on days 2–6, and, in group 2, patients received ODT ondansetron on days 2–6.
No significant differences were found between the two groups in control of delayed CINV, quality of life (QOL), or safety; however, control of delayed CINV was inferior compared to other studies.
Keyhanian, S., Taziki, O., Saravi, M.M., & Fotokian, Z. (2009). A randomized comparison of granisetron plus dexamethasone with granisetron alone for the control of acute chemotherapy-induced emesis and nausea. International Journal of Hematology-Oncology and Stem Cell Research, 3, 27–30.
To compare granisetron plus dexamethasone to granisetron alone in the prevention of acute emesis
Patients were randomly assigned to receive either granisetron alone or in combination with dexamethasone. One group received a single IV dose of 3 mg granisetron and the other group received 3 mg IV granisetron and 8 mg IV dexamethasone 30 minutes prior to chemotherapy. Patients were evaluated for 24 hours. Efficacy was determined according to a scale established by investigators.
The study was conducted at a single setting in Iran.
All patients were in active treatment.
This was a randomized, single-blind, prospective study.
The number of emetic episodes was recorded. Complete response was defined as no emetic episodes.
The investigators developed a scale to record efficacy of the intervention with \"moderately effective\" defined as \"did not interfere with daily life,\" \"slightly effective\" as \"interfered with normal daily life,\" and \"not effective\" as \"bedridden due to nausea.\"
A higher percentage of patients (66.7%) in the group receiving both granisetron and dexamethasone had 0 emesis episodes, compared to fewer than half (42.8%) of patients who received granisetron alone (p < 0.0001).
The combination of granisetron plus dexamethasone was superior to granisetron alone for prevention of acute emesis.
Findings indicate that dexamethasone should be included in antiemetic regimens, which is consistent with current care standards.