Acupuncture-related interventions improve chemotherapy-induced peripheral neuropathy: A systematic review and network meta-analysis.

BACKGROUND: The previous effects of acupuncture-related interventions in improving chemotherapy-induced peripheral neuropathy (CIPN) symptoms and quality of life (QoL) remain unclear in terms of pairwise comparisons. AIMS: This systematic review and network meta-analysis aimed to determine the hierarchical effects of acupuncture-related interventions on symptoms, pain, and QoL associated with CIPN in cancer patients undergoing chemotherapy. METHODS: Nine electronic databases were searched, including PubMed, Embase, Cochrane Library, EBSCO, Medline Ovid, Airiti Library, China National Knowledge Infrastructure (CNKI), China Journal full-text database (CJFD), and Wanfang. Medical subject heading terms and text words were used to search for eligible randomized controlled trials published from database inception to May 2023. RESULTS: A total of 33 studies involving 2,027 participants were included. Pairwise meta-analysis revealed that acupuncture-related interventions were superior to usual care, medication, or dietary supplements in improving CIPN symptoms, CIPN pain, and QoL. Furthermore, network meta-analysis indicated that acupuncture plus electrical stimulation (acupuncture-E) had the greatest overall effect among the various interventions. The surface under the cumulative ranking curve (SUCRA) revealed that acupuncture-E ranked the highest in improving CINP symptoms. Acupuncture alone was most effective in reducing CIPN pain, and acupuncture plus moxibustion (acupuncture-M) ranked highest in enhancing QoL. CONCLUSION: This finding suggests that acupuncture-related interventions can provide patients with benefits in improving CIPN symptoms, pain, and QoL. In particular, acupuncture-E could be the most effective approach in which the provided evidence offers diverse options for cancer patients and healthcare professionals. IMPLICATION FOR THE PROFESSION AND/OR PATIENT CARE: These findings provide valuable insights into the potential benefits of acupuncture-related interventions for managing symptoms, pain, and QoL associated with CIPN in patients undergoing chemotherapy. Among the various interventions studied, overall, acupuncture-E had the most significant impact and was effective for a minimum duration of 3 weeks. On the other hand, transcutaneous electrical acupoint/nerve stimulation (TEAS) was identified as a noninvasive and feasible alternative for patients who had concerns about needles or the risk of bleeding. It is recommended that TEAS interventions should be carried out for a longer period, preferably lasting 4 weeks, to achieve optimal outcomes. TRIAL REGISTRATION: The study protocol was registered in the International Prospective Register of Systematic Reviews. REGISTRATION NUMBER: CRD42022319871.

[Application and Development of a Chinese Medicine Meridian and Acupoint Intervention in Nursing Practice].

Chinese medicine advocates a holistic and comprehensive approach that emphasizes differential diagnosis, treatment, and nursing as well as a diverse range of healthcare options. Within Chinese medicine, acupuncture techniques targeting meridians and acupoints are recognized as a suitable healthcare modality for promoting health, preventing diseases, and managing existing conditions. This article was designed to explore the practical application and advancement of acupuncture related to meridians and acupoints in the field of nursing. After introducing the development and current landscape of Chinese medicine healthcare, the application of acupoint stimulation within the context of Chinese medicinal nursing is discussed, taking into account clinical expertise, patient preferences, and safety concerns. Next, empirical findings on the impact of acupoint stimulation interventions are presented in hopes of translating clinical knowledge into evidence-based practice. Lastly, future prospects and investments in Chinese medicinal nursing are outlined. Within the realm of professional nursing practice, attaining proficiency in meridian and acupoint interventions requires comprehensive expertise and skills. Healthcare professionals in the nursing field should contemplate enhancing their knowledge and competencies in Chinese medicinal nursing. By providing the best evidence-based care, possessing specialized expertise, and taking patient preferences into account, the quality and completeness of evidence-based healthcare may be improved.

Corrigendum to Acupoint stimulation improves pain and quality of life in head and neck cancer patients with chemoradiotherapy: A randomized controlled trial [Asia-Pacific Journal of Oncology Nursing 9 (2022) 61-68].

[This corrects the article DOI: 10.1016/j.apjon.2021.11.002.].

Translating and Validating the Vietnamese Version of the Health Sciences Evidence-Based Practice Questionnaire.

No validated instrument is available for assessing the evidence-based practice capacity of Vietnamese health professionals. This study aimed to translate and validate the Health Sciences Evidence-Based Practice questionnaire (HS-EBP) from English to Vietnamese and ascertain its psychometric properties. Data were collected from two obstetric hospitals in Vietnam. Participants: A total of 343 midwives were randomly selected. The HS-EBP questionnaire was translated by a group of bilingual experts into Vietnamese (HS-EBP-V). Content validity was assessed by two experts. Internal consistency and test-retest reliabilities were assessed using Cronbach's α and intraclass correlation (ICC), respectively. Construct validity was assessed using the contrasted groups approach. As a result, the content validity index of the HS-EBP-V reached 1.0. For the individual subscales, Cronbach's α was 0.92-0.97 and ICC was between 0.45 and 0.66. The validity of the contrasted-groups approach showed discrimination by a significant difference in the subscale scores among diploma holders compared with bachelor's degree holders (p < 0.001). The validation of the HS-EBP questionnaire indicated satisfactory psychometric properties. The results indicate that the HS-EBP is a reliable and valid instrument which assesses the competencies of as well as facilitators of and barriers to the five steps of EBP among midwives. The HS-EBP-V was deemed a reliable and validated tool for assessing the competency and application of EBP among Vietnamese healthcare professionals.

Chan-Chuang qigong with breathing meditation improves quality of life and interoceptive awareness in patients with breast cancer: a randomised controlled trial.

PURPOSE: To evaluate the effect of Chan-Chuang qigong with breathing meditation on quality of life (QoL) and interoceptive awareness in patients with breast cancer during chemotherapy. METHODS: This was a randomised controlled trial. Participants were randomly assigned to a qigong group (n = 30), which practised Chan-Chuang qigong with breathing meditation for 15 weeks, and a control group (n = 30), which received routine care. Outcomes were measured by using the European Organization for Research and Treatment of Cancer QoL Questionnaire (EORTC QLQ-C30) and Multidimensional Assessment of Interoceptive Awareness (MAIA-C). RESULTS: The qigong group, when compared with the control group and baseline, exhibited significantly improved emotional function (p = 0.01) and decreased role function (p = 0.04) at week 15. The MAIA-C indicated a significant difference between groups in self-regulation at week 15 (p = 0.04). Within the qigong group, changes were found in attention regulation (p = 0.03), emotional awareness (p = 0.04), self-regulation (p = 0.01), and body listening (p = 0.002). CONCLUSIONS: A 15-week programme of Chan-Chuang qigong with breathing meditation is a simple and safe intervention for patients with breast cancer to improve their emotional function and adjust to their role identity. Participants who practised qigong achieved increased awareness of their own bodies and were able to better regulate their emotion and attention. TRIAL REGISTER: ClinicalTrials.gov Identifier: NCT05385146.

Laser acupuncture combined with auricular acupressure improves low-back pain and quality of life in nurses: A randomized controlled trial.

BACKGROUND: Low-back pain (LBP) in nurses is a major health concern that affects their quality of life and ability to work, with consequences for their economic status. OBJECTIVE: This study evaluates the effect of low-level laser acupuncture combined with auricular acupressure (LAA) on pain intensity, pain interference and quality of life in nurses with LBP. DESIGN, SETTING, PARTICIPANTS AND INTERVENTIONS: This randomized controlled trial recruited a convenience sample of hospital-based nurses from one teaching hospital in Taiwan, China. Participants were randomly assigned to the LAA group (n = 38) receiving low-level laser acupuncture and auricular acupressure for 4 weeks, and the control group (n = 38) receiving only sham laser acupuncture treatment without laser energy output. MAIN OUTCOME MEASURES: Data were collected for the primary pain outcome using the Short Form of the Brief Pain Inventory, while the secondary outcome, quality of life, was evaluated using the Roland-Morris Disability Questionnaire. Both primary and secondary outcomes were scored before the intervention, and after 2-week and 4-week intervention. The rate of LBP recurrence was evaluated at the 4th week and 8th week after the end of intervention. RESULTS: After controlling for prior pain, the result of linear mixed model analysis showed trends in significant between-group differences in the level of current pain occurring in week 4 (P < 0.001), worst pain in week 2 (P < 0.001) and week 4 (P < 0.001), least pain in week 2 (P = 0.032) and week 4 (P < 0.001), pain interference in week 2 (P = 0.009) and week 4 (P < 0.001), and in the life dysfunction in week 2 (P < 0.001) and week 4 (P < 0.001). Recurrence rates of LBP at the 4th and 8th weeks after the end of intervention were 0% and 36.89% in the LAA group, and 69.44% and 36.11% in the control group. CONCLUSION: This study shows that 4-week LAA intervention reduced pain intensity and pain interference, and improved quality of life for hospital-based nurses with LBP. These effects were maintained continuously for at least 4 weeks after the intervention. The nonpharmacological intervention, LAA, may be another efficacious, feasible, noninvasive, analgesic intervention for LBP. TRIAL REGISTRATION: This study is registered at Clinicaltrials.gov (registration number NCT04423445).

Acupoint stimulation improves pain and quality of life in head and neck cancer patients with chemoradiotherapy: A randomized controlled trial.

Objective: This study aimed to evaluate the effect of acupoint stimulation on pain, negative moods, and quality of life for head and neck cancer (HNC) patients who underwent concurrent chemoradiotherapy (CCRT). Methods: This randomized controlled trial recruited participants from a medical center and randomly assigned using a permuted block randomization list with computer-generated random serial numbers into the AcuCare group (n â€‹= â€‹46) receiving acupoint stimulation with transcutaneous acupoint electrical stimulation (TAES) and auricular acupressure (AA) or the control group (n â€‹= â€‹46) without any acupoint stimulation. Outcomes were repeatedly assessed pain intensity using the visual analogue scale, negative moods using the hospital anxiety and depression scale, and quality of life (QoL) using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Head and Neck 35. Results: After adjusting varying mucositis grades and time-dependent growth effects, the generalized estimating equations showed a significantly increase in pain intensity at weeks 1, 2, 3, and 6 (P â€‹< â€‹0.05), but not in negative moods (P â€‹> â€‹0.05), compared to baseline and control group. Analysis of covariance showed a significant group-difference in the senses problems of QoL (F â€‹= â€‹7.33, P â€‹= â€‹0.01) at Week 6. Conclusions: This study supports that acupoint stimulation could effectively reduce pain and improve senses problem of QoL for patients with HNC. Trial registration: This study was registered at https://clinicaltrials.gov/NCT03640195.

Low-level laser acupuncture reduces postoperative pain and morphine consumption in older patients with total knee arthroplasty: A randomized placebo-controlled trial.

BACKGROUND: Patients commonly develop postoperative pain after total knee arthroplasty (TKA). Acupuncture-related techniques and low-level laser therapy could be beneficial for pain management for older individuals. OBJECTIVE: To examine the effect of low-level laser acupuncture (LA) in reducing postoperative pain, pain-related interference in daily life, morphine consumption, and morphine-related side effects in older patients with knee osteoarthritis who underwent TKA. DESIGN, SETTING, PARTICIPANTS AND INTERVENTION: A single-blind randomized placebo-controlled trial was conducted. Patients (N = 82) were recruited and randomly assigned via a computer-generated list to the LA group or a placebo group. The LA group received low-level laser therapy at Sanyinjiao (SP6), Taixi (KI3), Kunlun (BL60), Fengshi (GB31), Futu (ST32) and Neiguan (PC6) after TKA, while the placebo acupuncture group received the same treatment procedure without laser energy output. MAIN OUTCOME MEASURES: The primary outcome was postoperative pain intensity, and it was measured at baseline and hours 2, 6, 10, 24, 48 and 72 after TKA. The secondary outcomes, including relative pain, postoperative pain-related interference in daily life and morphine consumption, were measured at hours 24, 48 and 72 after TKA. RESULTS: Generalized estimating equations revealed significant between-group differences in pain intensity (P = 0.01), and trend differences in pain intensity for the LA group starting at hours 10 to 72 (P < 0.05) and morphine consumption at hours 48 and 72 (P < 0.05). The changes in pain-related interference in daily life were significant (P < 0.05) at 72 h, with the exception of the parameters for worst pain, mood, and sleep. Nausea and vomiting side effects from morphine had significant between-group differences at hours 10 and 24 (P < 0.05). CONCLUSION: Low-level LA gradually reduced older patients' postoperative pain intensity and morphine consumption within the first 72 h after their TKA for osteoarthritis. Low-level LA may have benefits as an adjuvant pain management technique for clinical care. TRIAL REGISTRATION: ClinicalTrials.gov registration number NCT03995446.

Acupuncture-related treatments improve cognitive and physical functions in Alzheimer's disease: A systematic review and meta-analysis of randomized controlled trials.

OBJECTIVE: To determine acupuncture-related treatments' effects and duration on improving cognitive function, physical function, and quality of life in patients with Alzheimer's disease. DATA SOURCES: Eight electronic databases were searched for eligible randomized controlled trials from database inception to January 2021, including Medline, PubMed, EBSCO, Embase, Cochrane, Airiti Library, China National Knowledge Infrastructure, and China Journal Full-text Database. REVIEW METHODS: A systematic review and meta-analysis were conducted on acupuncture types, cognitive function, activity of daily life, muscle strength and quality of life. RESULTS: Sixty-six studies in total with 4191 participants, the overall risk of bias was classified 60% as low and 24% as high. Acupuncture-related treatments for cognitive function and self-care ability revealed a moderate effect size, with a significant difference in noninvasive and invasive remedies (p < 0.001). Cognitive function showed significant differences in 6, 8, 12, and 24 weeks while self-care ability in the latter two weeks (p < 0.001). Meta-regression analysis showed cognitive function increased by 0.05 points (p = 0.002) and self-care ability decreased by 0.02 points (p = 0.04) after weekly treatment. There was a significant difference in muscle strength (p = 0.0003). CONCLUSION: Acupuncture-related treatments effectively improved cognitive function with the treatment lasted 6 weeks at least, but self-care ability started showing effects after 12 weeks of treatment. The improvement of muscle strength was also confirmed. Acupuncture-related treatments, particularly noninvasive ones, have few complications and high safety, perhaps providing patients and caregivers diversified choices and clinical care guidelines for reference.

Three-month Chan-Chuang qigong program improves physical performance and quality of life of patients with cognitive impairment: A randomized controlled trial.

This randomized controlled trial was conducted to evaluate the effects of a 3-month-long Chan-Chuang qigong program on patients' physical performance and quality of life while excluding the influence caused by the progression of their cognitive impairment. Patients with mild to moderate cognitive impairment were recruited from two dementia daycare centers in Taiwan. The control group (n = 41) received the standardized plan of treatment, and the qigong group (n = 39) received the standardized plan of treatment plus the Chan-Chuang qigong program. The outcomes were muscle strength, muscle endurance, exercise capacity, and quality of life. After controlling for the progression of cognitive impairment, the qigong group showed significant improvements over the control group and baseline in muscle strength and exercise capacity at Months 2 and 3 (p < 0.05) and in muscle endurance at Months 1, 2, and 3 (p < 0.05). The Cognitron test scores were significantly associated with muscle strength (p = 0.03), whereas the Corsi block-tapping test scores were significantly associated with exercise capacity (p = 0.001). Furthermore, a significant between-group difference was detected in the physical (p = 0.01), not mental (p = 0.83), component of quality of life. The 3-month Chan-Chuang qigong program can be applied for patients with mild to moderate cognitive impairment as complementary therapy to improve their muscle strength, muscle endurance, exercise capacity, and physical quality of life. This program should be practiced for at least 2 months to achieve satisfactory results.

Trajectory of growth in Taiwanese nursing students' professional self-concept over two years and its association with critical thinking and class climate.

BACKGROUND: Nursing is a practice-oriented profession, and the goal of education is to cultivate confidence and assertiveness for future clinical practice. Nurturing a professional self-concept at school is expecting to help students to approach their success in the nursing profession. PURPOSE: Using a hierarchical model associated with critical thinking, academic achievement, class climate, and work experience, this longitudinal correlational study explored the growth trajectory of professional self-concept over two years in students attending 2- or 4-year baccalaureate nursing programs. METHOD: This was a longitudinal and correlational study with five repeated measurements. Questionnaire data were collected by using the Chinese version of the Nurses Self-Concept Instrument (NSCI-C) and the California Critical Thinking Disposition Inventory (CCTDI). RESULTS: Scores for overall professional self-concept ranged from 84.51 (standard deviation [SD] 12.34) when the students began this study to 89.28 (SD 11.23) at graduation. Hierarchical linear modeling yielded the growth trajectory of professional self-concept was significantly associated with time (ß = 0.93, p < .01), CCTIDI (ß = 0.13, p < .001), and class climate (ß = 5.20, p < .01). An intraclass correlation coefficient was 55.48%. CONCLUSION: This study confirmed the positive growth trajectory of the professional self-concept in the nursing students' two academic years. The continuous development of the professional self-concept of nursing students is encouraged. Development of critical thinking through their studies, feelings of belonging in their classes, and campus culture all contributed to this trend. To construct a comprehensive hierarchical model, future investigations should use large sample sizes from various classes and conduct multisite evaluations.

Breathing-based leg exercises during hemodialysis improve quality of life: A randomized controlled trial.

OBJECTIVE: To evaluate the effect of a 12-week breathing-based leg exercises program on quality of life under stabilizing heart rate variability and reducing fatigue in regular hemodialysis patients. DESIGN: Randomized controlled trial. SETTING: A 94-bed hemodialysis department at a medical center in northern Taiwan. PARTICIPANTS: Eighty-six patients with end-stage renal disease undergoing hemodialysis were recruited and randomly assigned to the ExBr or control groups. INTERVENTIONS: The breathing-based leg exercises program comprised abdominal breathing and low-intensity leg exercise, including leg lifts, quadriceps femoris contraction and knee flexion, and lasted for 15 minutes at one time, three times a week for 12 weeks. MAIN MEASURE: Data was collected by using the World Health Organization quality of life assessment-brief, physiological signal recorder for heart rate variability and hemodialysis-related fatigue scale at baseline and on Week 4, Week 8, and Week 12. RESULTS: Average (standard deviation) age was 53.70 (10.04) years in the ExBr group and 61.19 (10.19) years in the control group. The linear mixed model with adjusted age, creatinine, heart rate variability and fatigue revealed that the ExBr group had significantly higher quality of life than did the control group (P = 0.01), especially on Week 12 (P = 0.04). Fatigue was significantly correlated with quality of life (P < 0.001). CONCLUSION: This study supported the benefits of the continued breathing-based leg exercises during hemodialysis for at least 12 weeks, which improved the quality of life of patients with end-stage renal disease and did not affect the stability of their vital signs.

Walking and mindfulness improve the exercise capacity of patients with chronic obstructive pulmonary disease: A randomised controlled trial.

OBJECTIVE: To evaluate the effects of mindful walking practice on the exercise capacity of patients with chronic obstructive pulmonary disease (COPD). DESIGN: A randomised controlled trial with four repeated measurements. SETTING: Outpatient departments of a medical centre in northern Taiwan. PARTICIPANTS: Patients with mild to severe COPD. INTERVENTION: The control group received usual care, whereas the mindful walking group received usual care plus undertook a mindful walking practice. OUTCOME MEASURES: The main outcome was the six-minute walk distance. And the Global Initiative for Chronic Obstructive Lung Disease classification, dyspnoea, heart rate variability and interoceptive awareness were control factors. RESULTS: Compared with the control group (n = 40), the mindful walking group (n = 38) achieved a significantly longer six-minute walk distance (longer by 45.57 m; P = 0.04). The interaction effect of the six-minute walk distance significantly increased on Week 4 (P = 0.01), Week 8 (P = 0.002) and Week 12 (P = 0.02). Participants in Global Initiative for Chronic Obstructive Lung Disease class A exhibited significantly improved six-minute walk distance compared with those in class D (P = 0.001). Moreover, scores on the emotional awareness scale of interoceptive awareness were significantly associated with the six-minute walk distance (P = 0.02). CONCLUSION: The eight-week mindful walking practice improved the exercise capacity of patients with COPD, and its effect was sustained for at least four weeks after the end of the practice. This study suggest that this practice improved COPD symptoms, reduced COPD risk and increased the interoceptive awareness of this population.

A randomised controlled trial of laser acupuncture improves early outcomes of osteoarthritis patients' physical functional ability after total knee replacement.

BACKGROUND AND PURPOSE: Total knee replacement is the most effective intervention for late-stage osteoarthritis; however, a major concern is postoperative recovery of physical function. This randomised controlled trial evaluated the effects of acupuncture with low-level laser therapy (ALLLT) on early outcomes of physical function after total knee replacement. MATERIALS AND METHODS: Eighty-two osteoarthritis patients were recruited and randomly assigned to the experimental group receiving ALLLT or the control group receiving sham ALLLT without laser beam output. Physical function was evaluated by assessing knee joint flexion and stiffness on days 1, 2, and 3 after total knee replacement. RESULTS: Generalised estimating equations revealed a significant difference between the two groups in joint flexion. The experimental group displayed better joint flexion and less stiffness on days 2 and 3 than did the control group. CONCLUSION: ALLLT can facilitate the recovery of physical function, as evidenced by knee joint flexion and stiffness, in patients receiving total knee replacement.

Twelve-week intradialytic cycling exercise improves physical functional performance with gain in muscle strength and endurance: a randomized controlled trial.

OBJECTIVE: To evaluate the effect of intradialytic cycling exercise on physical functional performance with gain in muscle strength and endurance in end-stage renal disease patients with haemodialysis. DESIGN: Randomized controlled trial, with repeated measurements at baseline and after 4, 8, and 12 weeks of intradialytic cycling exercise. SETTING: A 50-bed haemodialysis centre in a regional hospital in Taiwan. SUBJECTS: Seventy-six regular haemodialysis patients, recruited and equally and randomly assigned to exercise and control groups. INTERVENTION: The intradialytic cycling exercise was performed for 12 weeks and comprised warm-up, main, and cool-down exercise phases. A stationary cycling equipment was used, which involved aerobic and resistance modalities. The intensity was maintained at somewhat hard exertion. Each intradialytic cycling exercise was implemented for 30 minutes, starting at the second hour of treatment. MAIN MEASURE: Measured outcomes were 6-minute walk distance, time taken to complete 10 sit-to-stand-to-sit cycles and number of sit-to-stand-to-sit cycles in 60 seconds. RESULTS: Average (standard deviation) participant age was 55.47 (13.00) years. Therefore, the 6-minute walk distance was significantly different at weeks 8 (P = 0.01) and 12 (P < 0.001) in the exercise group compared with that in the control group at baseline. Notably, sit-to-stand-to-sit outcomes (P = 0.01) significantly influenced the 6-minute walk distance. Sit-to-stand-to-sit outcomes significantly improved in the exercise group (P < 0.05). CONCLUSION: Twelve-week intradialytic exercise for patients on haemodialysis can improve physical functional performance with gain muscle strength and endurance. This is a safe and effective method for improving health.

[Effect of Aromatherapy on Menopausal Symptoms, Heart Rate Variability, and Sleep Quality in Women].

BACKGROUND: Studies have shown that aromatherapy improve health problems related to anxiety, depression, heart rate variability (HRV), and sleep. However, the effect of aromatherapy in women who suffer from menopausal syndrome and its specific effects on HRV and sleep quality are unknown. PURPOSE: This study designed an aromatherapy intervention and evaluated its effect on menopausal syndrome, HRV, and sleep quality in women. METHODS: This double-blinded randomized controlled trial was conducted at a medical center hospital. A total of 84 participants who met the study criteria were randomly assigned using permuted block randomization. The experimental group received a 20-min inhalation of essential oil and the control group received a 20-min inhalation of sweet almond oil every night for 4 weeks. Posttest data was collected at 2 weeks after completion of the intervention. Data were collected using the Green Menopausal Symptom Scale, HRV device, and Pittsburgh Sleep Quality Index. RESULTS: After adjusting for age, the results of the generalized estimation equations (GEE) showed that all outcomes were significantly different in both the experimental group and the control group (p < .05) for the interaction effect of group and time, and that the outcome of sleep quality on the 2nd week in the control group was not significantly different (p < .066). CONCLUSIONS / IMPLICATIONS FOR PRACTICE: This study supports that the 4-week aromatherapy intervention improves menopausal symptoms, the activity of autonomic nervous systems, and sleep quality in women with no adverse side effects. In the future, this intervention may be applied in outpatient departments to promote the health of menopausal women.

Transcutaneous Electrical Nerve Stimulation on Acupuncture Points Improves Myofascial Pain, Moods, and Sleep Quality.

PURPOSE: The aim of this study was to evaluate the effects of transcutaneous electrical nerve stimulation at acupuncture points versus trigger points on myofascial pain, moods, and sleep quality. DESIGN: A randomized controlled study recruited 64 patients with spinal cord injury with myofascial pain. METHODS: Outcomes of pain, moods, and sleep quality were measured and analyzed by the generalized estimation equation, analysis of covariance, and paired t test. Transcutaneous electrical nerve stimulation was applied for seven consecutive days at Hegu (LI4) and Daling (PC7) acupuncture points or myofascial trigger points. FINDING: Significant differences were found in pain intensity from Day 3 forward, after controlling for confounders. Significant within-group differences were found in pain, moods, and sleep quality. CONCLUSIONS: Transcutaneous electrical nerve stimulation at acupuncture and trigger points effectively improved pain, moods, and sleep quality in patients with spinal cord injury with myofascial pain. Acupuncture points had superior improvement in pain intensity and slight improvement in sleep quality than did trigger points. CLINICAL RELEVANCE: Transcutaneous electrical nerve stimulation at acupuncture points could be applied for improving myofascial pain.

A Hierarchical Model of Occupational Burnout in Nurses Associated With Job-Induced Stress, Self-Concept, and Work Environment.

BACKGROUND: Nurses may experience different levels of occupational burnout in different unit and hospital settings. However, pooling multilevel data in an analysis ignores independent, environmental, and sociocultural contexts of ecological validity. PURPOSE: This study aimed to explore a hierarchical model of occupational burnout that is associated with job-induced stress, nurse self-concept, and practice environment in nurses working in different units and hospitals. METHODS: A cross-sectional study was conducted, and 2,605 nurses were recruited from seven hospitals. The outcomes were measured using the Maslach Occupational Burnout Inventory-Human Services Survey, Nurses' Self-Concept Instrument, Nurse Stress Checklist, and Nursing Work Index-Revised. Hierarchical Linear Modeling 6.0 software was used to conduct hierarchical analysis on the study data. RESULTS: On the nurse level, job-induced stress was a significant factor affecting emotional exhaustion (ß = 0.608, p < .001) and depersonalization (ß = 2.439, p < .001), whereas nurse self-concept was a significant factor affecting emotional exhaustion (ß = -0.250, p < .001), depersonalization (ß = -1.587, p < .001), and personal accomplishment (ß = 4.126, p < .001). Furthermore, emotional exhaustion and depersonalization were significantly related to level of education (ß = 0.111, p < .01; ß = 0.583, p < .05). No significant unit-level associations were identified between occupational burnout and the factors of job-induced stress, nurse self-concept, and practice environment (p > .05). The intragroup correlation coefficient for emotional exhaustion was 2.86 (p < .001). CONCLUSIONS/IMPLICATIONS FOR PRACTICE: The findings of this study confirm that individual nurse characteristics are strong predictors of emotional exhaustion, depersonalization, and personal accomplishment as these relate to occupational burnout. In addition, nurse self-concept was identified as the most important predictor of all three aspects. In clinical practice, self-concepts about nursing may reduce occupational burnout. Nursing managers formulating new policies should consider nursing background and offer autonomous control over practice.

Using Traditional Chinese Medicine to Relieve Asthma Symptoms: A Systematic Review and Meta-Analysis.

Studies have demonstrated the effect of acupoint-based interventions in relieving the clinical symptoms of asthma. However, the effect of meridian-based interventions in asthma symptom relief is unknown. This systematic review and meta-analysis determined the effect of multiplex meridian interventions in asthma symptom relief. Eight electronic databases were searched for relevant randomized controlled trials (RCTs) that involved patients with asthma, were published before March 2018, used acupoint stimulation interventions targeting acupoints that correspond to meridians, and considered asthma symptom relief as an outcome. In 204 RCTs that were identified and used in a meta-synthesis, meridians were used 521 times, with the bladder meridian being the most frequently used. Furthermore, 23 RCTs were included in the meta-analysis. Egger's and inconsistency tests revealed no significant differences among the studies (P>0.05). However, the interventions differed significantly in terms of asthma symptom relief effect, as demonstrated by pairwise (odds ratio [OR]=0.28, 95% confidence interval=0.21-0.37) and network (OR=0.18, 95% credibility interval=0.08-0.41) meta-analyses. Surface under the cumulative ranking (SUCRA) revealed that the bladder-conception vessel-governor vessel-stomach multiplex meridian intervention was more effective than non-meridian interventions in relieving asthma symptoms. Additionally, either bladder-conception vessel-stomach or bladder-conception vessel-governor vessel-kidney multiplex meridians may be selected in interventions. This study suggests that practitioners target multiplex meridians, especially the meridians of the bladder and conception vessel, to effectively relieve asthma symptoms.

Respiratory training interventions improve health status of heart failure patients: A systematic review and network meta-analysis of randomized controlled trials.

BACKGROUND: Prior studies indicate that doing breathing exercises improves physical performance and quality of life (QoL) in heart failure patients. However, these effects remain unclear and contradictory. AIM: To determine the effects of machine-assisted and non-machine-assisted respiratory training on physical performance and QoL in heart failure patients. METHODS: This was a systematic review and network meta-analysis study. A literature search of electronic databases was conducted for randomized controlled trials (RCTs) on heart failure. Respiratory training interventions were grouped as seven categories: IMT_Pn (inspiratory muscle training without pressure or < 10% maximal inspiratory pressure, MIP), IMT_Pl (inspiratory muscle training with low pressure, 10%-15% MIP), IMT_Pm (inspiratory muscle training with medium pressure, 30%-40% MIP), IMT_Ph (inspiratory muscle training with high pressure, 60% MIP or MIP plus aerobics), Aerobics (aerobic exercise or weight training), Qi_Ex (tai chi, yoga, and breathing exercise), and none. The four outcomes were heart rate, peak oxygen uptake (VO2 peak), 6-min walking distance test (6MWT), and Minnesota Living with Heart Failure QoL. The random-effects model, side-splitting model, and the surface under the cumulative ranking curve (SUCRA) were used to test and analyze the data. RESULTS: A total of 1499 subjects from 31 RCT studies were included. IMT_Ph had the highest effect sizes for VO2 peak and 6MWT, IMT_Pm highest for QoL, and Qi_Ex highest for heart rate. Aerobics had the second highest for VO2 peak, Qi_Ex second highest for 6MWT, and IMT_Ph second highest for heart rate and QoL. CONCLUSION: This study supports that high- and medium-intensity machine-assisted training improves exercise capacity and QoL in hospital-based heart failure patients. After hospital discharge, non-machine-assisted training continuously improves cardiac function.