Clinical effectiveness of mindfulness-based music therapy on improving emotional regulation in blind older women: A randomized controlled trial.

Background: This study aimed to investigate clinical effectiveness of a structured eight-week mindfulness-based music therapy (MBMT) program on improving mood regulation in older women with blindness. This investigation compared a MBMT group with a mindfulness intervention (MI) group and a control group. Methods: Ninety-two older females with blindness from a residential setting in Hong Kong were recruited and randomly allocated to a MBMT (n = 31), MI (n = 30), or control (n = 31) group. Psychological measurements regarding mood regulation and general mood states (namely, Difficulties in Emotion Regulation Scale [DERS], Geriatric Depression Scale [GDS], and Depression Anxiety Stress Scales-21), were taken at pretest and posttest. Outcome assessors were blinded to group assignment. Results: Data was analyzed based on intention-to-treat basis. At posttest, DERS scores in the MBMT group (mean differences and 95% confidence interval: 12.1, 5.5 to 18.8) and the MI group (7.2, 0.5 to 13.8) were lower than that in the control group. GDS scores in the MBMT group (2.9, 1.7 to 4.0) and the MI group (1.7, 0.6 to 2.9) were lower than those in the control group. Compared with the MI group, the MBMT group improved emotional awareness sub-scores in DERS (2.1, 0.2 to 4.1) and appeared to lower depression in GDS scores (1.1, -0.0 to 2.3; p = 0.053). Conclusion: MBMT seems more beneficial than MI alone for improving emotional regulation in older women with blindness. The combination of mindfulness and music can generate a synergetic effect by enhancing both attention and appraisal components within the emotional-regulation process. Trial registration: ClinicalTrials.gov, NCT05583695.

Mood disturbance in glioma patients.

Patients diagnosed with primary brain tumors such as glioma experience psychological distress throughout the illness trajectory. Determining which patient characteristics are associated with more severe mood disturbance throughout the illness trajectory can help identify patients at risk and assist in developing targeted interventions based on these factors. Adult glioma patients were eligible for participation. Data collection tools included an investigator completed clinician assessment tool, patient completed demographic form and the Profile of mood states-short form. A multiple regression model was used to describe the relationship between the patient groups and clinical factors. The study enrolled 186 glioma patients of various tumor grades, who were categorized in three groups (newly diagnosed, on-treatment, follow-up) based on disease status at time of visit. Newly diagnosed patients experienced more total mood disturbance than all the other groups. Characteristics associated with more severe mood disturbance varied by patient group: newly diagnosed patients who were not on corticosteroids and were not married were more likely to have higher mood disturbance [R(2) = 0.27, F (2, 29) = 5.31, p < 0.02]. For those on treatment, the use of concomitant medications, having more than 1 recurrence and low income predicted higher mood disturbance [R(2) = 0.417, F (4, 67) = 11.98, p < 0.001]. For those not on active treatment, female sex, anti-depressant use and having a lower income was associated with higher mood disturbance [R(2) = 0.183, F (3, 55) = 4.11, p < 0.02]. Additionally, when compared to other cancer groups, glioma patients reported similar mood disturbance to those with breast cancer. Factors other than disease characteristics are associated with higher mood disturbance and vary according to current disease status. The use of concomitant medications, demographic factors, recurrence and income are associated with mood disturbance and interventions may need to be tailored to these underlying factors.

Validation of the M.D. Anderson Symptom Inventory Brain Tumor Module (MDASI-BT).

BACKGROUND: Symptom occurrence has been shown to predict treatment course and survival in patients with solid tumors. Primary brain tumor (PBT) patients are unique in the occurrence of neurologic symptoms. Currently, no instrument exists that measures both neurologic and cancer-related symptoms. METHODS: Patients diagnosed with PBT participated in this study. Data was collected at one point in time and included demographic and clinical factors, and the M.D. Anderson Symptom Inventory-Brain Tumor Module (MDASI-BT). The study evaluated the reliability and validity of the MDASI-BT in primary brain tumor patients. RESULTS: Two hundred and one patients participated in this study. Mean symptom severity of items as well as cluster analysis was used to reduce the number of total items to 22 (13 core, 9 brain tumor items). Regression analysis showed more than half (56%) of the variability in symptom severity was explained by brain module items. The MDASI-BT measures six underlying constructs including affective, cognitive, focal neurologic deficit, constitutional, generalized symptom, and a gastrointestinal related factor. The internal consistency (reliability) of the instrument was 0.91. The MDASI-BT was sensitive to disease severity based on performance status (P<0.001), tumor recurrence (P<0.01), and mean symptom interference (P<0.001). CONCLUSIONS: The 22 item MDASI-BT demonstrated validity and reliability in patients with PBT. This instrument can be used to identify symptom occurrence throughout the disease trajectory and to evaluate interventions designed for symptom management.

Sevoflurane (12% and 8%) inhalational induction in children.

BACKGROUND: Sevoflurane induction of anesthesia is frequently used in children. Rapidly performed inhalational induction may reduce excitation during early anesthesia. Increasing the total anesthetic MAC delivered to patients can be achieved by increasing volatile concentration or adding nitrous oxide. The latter reduces inspired oxygen concentration delivered, which may not be desirable. Even 8% sevoflurane induction is associated with excitation. A system capable of delivering 12% sevoflurane using two tandem vaporizers has been developed. METHODS: A randomized double blind study was undertaken to assess whether 12% sevoflurane offered any advantage over 8% in time and quality of induction. Sixty children aged 5-10 years were recruited and received either 12 or 8% sevoflurane. Time to loss of eyelash reflex, central pupils, incidence of adverse events, induction quality, systolic blood pressure and heart rate were recorded. RESULTS: Twelve percent sevoflurane reduced time to loss of eyelash reflex compared with 8% [mean (sd): 35 (12) and 46 (14) P<0.05], but the reduction was only 10% higher than the error in the measurement (assessment every 10 s). Twelve percent sevoflurane offered significantly better quality of induction (P<0.05). There was no difference in cardiovascular stability between groups, although heart rate rose significantly in both groups. Maintaining sevoflurane at 12% for 4 min caused significant amounts of apnea (69% with 12% and 38% with 8%, P<0.05). CONCLUSION: Twelve percent sevoflurane offers a smoother anesthesia induction than 8% in children of this age with no additional consequences for the cardiovascular system.

Metastatic brain tumors: diagnosis, treatment, and nursing interventions.

Metastatic tumors are by far the most common cause of brain cancer, with an incidence rate higher than all other types of primary brain tumors combined. Cancer cells can spread to the brain from other sites via the blood supply, lymphatic system, or direct extension. Neurologic symptoms, which are dependent on tumor location, often include headache, weakness, or cognitive deficits. Although the standard of care is evolving, treatment often includes some combination of surgery and radiation therapy. Newer treatments, including radiosurgery and novel chemotherapy approaches, currently are being investigated. These treatment advances have markedly altered the prognosis for patients with brain metastases. Consequently, the status of the systemic components of the malignancy often may be the determinant of outcome.

Which women want food during labour?: results of an audit in a Scottish DGH.

OBJECTIVE: To assess the proportion of women who would want to eat during labour and to identify any distinguishing characteristics of this group. DESIGN: Audit questionnaire, completed within 36 hours of delivery. SUBJECTS: One hundred and forty nine post-natal women, over a five-week period. RESULTS: A significant minority (30%) of women would wish to eat during labour. A quarter of these feel that eating would have significantly enhanced their satisfaction during the event. In addition, some of these women admitted to eating secretly during labour. CONCLUSIONS: Clinicians involved in the care of pregnant women should be aware of the arguments for and against allowing food during labour, in order to help these women reach an informed decision.

Return of the internal jugular vein--development of collateral drainage following neonatal ligation of the vein.

The development of collateral venous drainage in the neck of a child, who as a neonate had undergone ligation and cannulation of the right internal jugular vein, is described. The resultant vessels were of sufficient calibre to be considered as potential sites for vascular access, although it is possible that their course in the thorax may preclude correct placement of a central venous catheter. Nevertheless, we feel that this case further illustrates the benefit of hand-held ultrasonography in visualizing the vascular structures of the neck. Moreover, ligation of a vein in the neonatal period should not be a contraindication to subsequent assessment of that site for vascular access.

Chemotherapy of astrocytomas: an overview.

OBJECTIVES: To provide an overview of the use of chemotherapy in the treatment of malignant brain tumors, with an emphasis on malignant gliomas. DATA SOURCES: Published articles, research studies, and reference books. CONCLUSIONS: Chemotherapy has primarily been used in a adjuvant setting after radiation therapy for primary brain tumors. This focus has not had a significant effect on survival. In an effort to more effectively treat the tumor, innovative chemotherapy treatments have been developed. These include the use of neoadjuvant chemotherapy, changes in timing of administration, new classes of chemotherapeutic agents, new routes of delivery, and augmentation of the body's own immune system to treat the tumor. IMPLICATIONS FOR NURSING PRACTICE: It is the challenge of the oncology nurse caring for the patient with a malignant brain tumor to gain knowledge of the disease process, side effect management, and the most up-to-date treatment regimens.

Glial neoplasms: classification, treatment, and pathways for the future.

PURPOSE/OBJECTIVES: To provide a review of glial neoplasms including histologic classification, signs and symptoms, diagnostic evaluation, treatment options, and nursing care. DATA SOURCES: Articles, books, proceedings of national meetings. DATA SYNTHESIS: Glial neoplasms vary according to prognosis and treatment options based on histologic classifications. Prediction of deficits and potential complications of disease and treatment can prepare the patient and healthcare provider in management. Treatment options include surgery, radiation therapy, and chemotherapy or combinations of these options. New treatment regimes currently are being investigated. CONCLUSIONS: Despite advances in the diagnosis and treatment of malignant gliomas, the outlook remains poor. As new combination treatment regimens become available, nursing care will significantly affect outcome and quality of life. IMPLICATIONS FOR NURSING PRACTICE: Goals of nursing care include prevention and education related to tumor- and treatment-related side effects, providing support and coordinating referrals to appropriate services during the disease process, and helping the patient and family cope with this devastating disease.

Management of seizures in the adult patient with cancer.

Seizures are a frequent neurologic complication of cancer. Seizures may develop as a consequence of direct extension of cancer into the brain or surrounding meninges, an underlying metabolic imbalance from treatment or the tumor, or the neurotoxic effects of cancer therapy. Emergency treatment is essential for status epilepticus and seizures that occur frequently to prevent permanent neurologic sequelae. In all cases, a diagnostic evaluation is required to discover the underlying cause of the seizures. Often, an easily reversible process will be uncovered, and the complete resolution of the seizure disorder can occur. In other circumstances, determining the cause of the seizure may allow early diagnosis and treatment of brain lesions or may disclose neurotoxicity, thereby modifying future treatment. This article reviews the causes, diagnostic evaluation, and treatment of seizures in adult patients with cancer, providing an overview of the medical and nursing aspects of patient management.

Stomatitis in the bone marrow transplant patient. An overview and proposed oral care protocol.

Bone marrow transplantation (BMT) is a treatment modality associated with a wide spectrum of gastrointestinal complications. One effect is painful stomatitis. Stomatitis is defined as an inflammatory and ulcerative reaction of the oral cavity. Stomatitis in the transplant patient is attributable to one, several, or all of the following: effects of high-dose chemotherapy and/or radiotherapy delivered pretransplant; infection; acute or chronic graft-versus-host disease (in the allogeneic transplant recipient); the condition of the oral cavity pretransplant; and side effects of other medications or treatments used during the transplant process. Frequency of oral complications in the BMT population has been looked at in several studies. Most studies showed changes beginning immediately before transplant day, peaking 1-2 weeks posttransplant, and gradually improving. Published studies have not included colony-stimulating factors in the treatment regime, nor have they addressed the effect of these agents on oral complications. A survey of BMT centers showed that no standard protocol is in place for stomatitis prevention and management. The literature shows that no agent has been shown to be superior to any other. Frequency of care given and reinforcement of care needed have been shown to be related to improvement in oral condition. Based on the review of the literature, a protocol for oral care is proposed. This protocol would then establish a program to which other agents can be compared.