Use of acupuncture with acupressure in addition to standard-of-care cryotherapy to decrease chemotherapy-associated neuropathy in patients with gastrointestinal malignancies receiving oxaliplatin-based chemotherapy: Study protocol for a randomized, controlled pilot and feasibility study.

BACKGROUND: Oxaliplatin is a key chemotherapeutic agent in the treatment of local and metastatic gastrointestinal (GI) malignancies. Dose density and treatment adherence can be limited by chemotherapy-induced peripheral neuropathy (CIPN). Early research suggests CIPN incidence and severity may be mitigated by acupuncture, but rigorous data in GI oncology patients is limited. Here, we describe the protocol of a randomized, waitlist-controlled pilot study testing the use of preemptive of acupuncture plus acupressure to decrease CIPN and chemotherapy-related toxicities. METHODS: Patients with a GI malignancy (n = 56) with planned 5-fluorouracil (5-FU) and oxaliplatin IV (FOLFOX, FOLFIRINOX) every 2 weeks are being recruited. Additional concurrent anti-neoplastic agents may be used. Enrolled patients are randomized 1:1 to a 3-month intervention of Arm A: acupuncture with acupressure and standard-of-care treatment, or Arm B: standard-of-care alone. In Arm A, on days 1 and 3 of each chemotherapy cycle a standardized acupuncture protocol is administered and patients are taught self-acupressure to perform daily between chemotherapy treatments. Patients in both arms are given standard-of-care oral and peripheral (hands/feet) ice chip cryotherapy during oxaliplatin administration. CIPN and other symptoms are assessed at baseline, 6 weeks, and 3 months from registration. The primary endpoint is CIPN severity at 3 months (EORTC-CIPN 20). Additional endpoints evaluate CIPN incidence (CTCAE, Neuropen, tuning fork); incidence of pain, fatigue, nausea, oral dysesthesia, and anxiety; and feasibility (recruitment, retention, adherence, acceptability). If warranted, trial results will inform the design of a multi-center trial to expand testing of the intervention to a larger patient cohort.

Diverging Discourses: Animal Health Challenges and Veterinary Care in Northern Uganda.

People in northern Uganda are currently rebuilding their lives after a lengthy period of conflict. To facilitate this, the Ugandan government and donors have promoted investment in pigs as an important strategy for generating income quickly and ensuring livelihood security. In this context, animal health issues are an acknowledged challenge, creating uncertainty for animal owners who risk losing both their animals and income. This paper draws on policy documents guiding the veterinary sector, interviews with faculty staff at Makerere University and with veterinarians and paraprofessionals in northern Uganda, and ethnographic fieldwork in smallholder communities. The aims of this study were to contribute to an understanding of the structure of veterinary support and its dominant development narratives in policy and veterinary education and of the way in which dominant discourses and practices affect smallholders' ability to treat sick animals. Particular attention was paid to the role of paraprofessionals, here referring to actors with varied levels of training who provide animal health services mainly in rural areas. The results suggest that veterinary researchers, field veterinarians and government officials in agricultural policy share a common discourse in which making smallholders more business-minded and commercializing smallholder production are important elements in reducing rural poverty in Uganda. This way of framing smallholder livestock production overlooks other important challenges faced by smallholders in their livestock production, as well as alternative views of agricultural development. The public veterinary sector is massively under-resourced; thus while inadequately trained paraprofessionals and insufficient veterinary support currently present a risks to animal health, paraprofessionals fulfill an important role for smallholders unable to access the public veterinary sector. The dominant discourse framing paraprofessionals as "quacks" tends to downplay how important they are to smallholders by mainly highlighting the negative outcomes for animal healthcare resulting from their lack of formalized training. The conclusions of this study are that both animal health and smallholders' livelihoods would benefit from closer collaboration between veterinarians and paraprofessionals and from a better understanding of smallholders' needs.