Randomized Controlled Trial of Isha Kriya versus Observation to Improve Quality of Life in Hematopoietic Cell Transplantation Recipients.

Hematopoietic cell transplantation (HCT) impacts recipients' quality of life (QoL). Few mindfulness-based interventions (MBI) in HCT recipients have shown feasibility, but heterogeneous practices and outcome measures have called into question the actual benefit. We hypothesized that self-guided isha kriya, a 12-minute guided meditation based on the principles of yoga focusing on breathing, awareness, and thought, as a mobile app would improve QoL in the acute HCT setting. This single-center, open-label, randomized controlled trial was conducted in 2021 to 2022. Autologous and allogeneic HCT recipients age ≥18 years were included. The study was approved by our Institutional Ethics Committee and registered at the Clinical Trial Registry of India, and all participants provided written informed consent. HCT recipients without access to smartphones or regular practitioners of yoga, meditation, or other mind-body practices were excluded. Participants were randomized to the control arm or the isha kriya arm at a 1:1 ratio stratified by type of transplantation. Patients in the isha kriya arm were instructed to perform the kriya twice daily from pre-HCT to day +30 post-HCT. The primary endpoint was QoL summary scores as assessed by the Functional Assessment of Cancer Therapy-Bone Marrow Transplantation (FACT-BMT) and the Patient-Reported Outcomes Measurement Information System Global Health (PROMIS-GH) questionnaires. The secondary endpoints were the differences in QoL domain scores. The validated questionnaires were self-administered before the intervention and at days +30 and +100 post-HCT. The analysis of endpoints was done on an intention-to-treat basis. Domain and summary scores were calculated for each instrument as recommended by the developers. A P value < .05 was considered to indicate statistical significance, and Cohen's d effect size was used to determine clinical significance. A total of 72 HCT recipients were randomized to the isha kriya and control arms. Patients in the 2 arms were matched for age, sex, diagnosis, and type of HCT. The 2 arms showed no differences in pre-HCT QoL domain, summary, and global scores. At day +30 post-HCT, there was no difference between the arms in the mean FACT-BMT total score (112.9 ± 16.8 for the isha kriya arm versus 101.2 ± 13.9 for the control arm; P = .2) or the mean global health score (global mental health, 45.1 ± 8.6 versus 42.5 ± 7.2 [P = .5]; global physical health, 44.1 ± 6.3 versus 44.1 ± 8.3 [P = .4]) in the 2 groups. Similarly, there were no differences in physical, social, emotional, and functional domain scores. However, the mean bone marrow transplantation (BMT) subscale scores, which addresses BMT-specific QoL concerns, were statistically and clinically significantly higher in the isha kriya arm (27.9 ± 5.1 versus 24.4 ± 9.2; P = .03; Cohen's d = .5; medium effect size). This effect was transient; mean day +100 scores showed no difference (28.3 ± 5.9 versus 26.2 ± 9.4; P = .3). Our data indicate that the isha kriya intervention did not improve the FACT-BMT total and global health scores in the acute HCT setting. However, practicing isha kriya for 1 month was associated with transient improvement in the FACT-BMT subscale scores on day +30 but not on day +100 post-HCT.

The epidemiology of multidrug-resistant Acinetobacter baumannii: does the community represent a reservoir?

OBJECTIVE: To explore the role of the community as a potential reservoir for Acinetobacter baumannii. DESIGN: Antimicrobial resistance patterns and genotypes of A. baumannii isolates from patients in two Manhattan hospitals were compared with those of A. baumannii isolates from the hands of community members. RESULTS: A total of 103 isolates from two hospitals (hospital A, 81; hospital B, 22) and 23 isolates from community residents were studied. Of the hospital isolates, 36.6% were multidrug resistant (hospital A, 68.2%; hospital B, 27.8%). In contrast, there were no multidrug-resistant isolates from the community (P < .005 between hospital and community). The prevalence of A. baumannii on the hands of community residents was 10.4% (23 of 222). By molecular typing, 42 strains of A. baumannii were identified. Of the isolates from hospital A and hospital B, 55.6% (45 of 81) and 68.2% (15 of 22), respectively, were indistinguishable or closely related. In contrast, most community (83.3%) isolates were unrelated (P = .001 between hospital and community). CONCLUSION: Acinetobacter isolates from the community, characterized by a large variety of unrelated strains (83.3%), were distinct from the hospital isolates, of which 58.3% were closely related. The absence of multidrug-resistant strains in the community compared with 36.8% prevalence among hospital isolates suggests that the reservoir for epidemic strains resides in the hospital environment itself. To our knowledge, this is the first study to examine the community as a potential reservoir for hospital strains of A. baumannii.

Prevalence and antimicrobial patterns of Acinetobacter baumannii on hands and nares of hospital personnel and patients: the iceberg phenomenon again.

OBJECTIVE: To determine the prevalence and antimicrobial susceptibility patterns of Acinetobacter baumannii on the hands and nares of health care workers and patients from intensive care and rehabilitation units at two hospitals in northern Manhattan, New York. DESIGN: Prevalence survey of Acinetobacter on the hands and anterior nares of staff (n = 184) and patients (n = 98) in rehabilitation and intensive care units of two hospitals. RESULTS: Twenty subjects (7.1%) had positive test results for A baumannii (6 staff [3.3%] and 14 patients [14.3%]). Five patients had positive test results at both sites, four in the nares only, and 11 on hands only. Among patients, four significant predictors of A baumannii were days on unit (P = .003), location (hospital A or B) (P = .01), surgery (P = .04), and receiving an antifungal agent (P = .02; OR, 5.6; 95% CI, 1.25-24.52). Among staff, predictors were skin damage (P = .02) and employment in hospital B (P = .03). Nine of the 20 subjects (45%) had positive test results for multiresistant strains, one from a staff member and eight from patients. CONCLUSION: Patients whose conditions are not clinically symptomatic for A baumannii, as well as staff, are often colonized. Staff with damaged skin are more likely to be colonized. Control of this organism will only be possible when the principle of the iceberg phenomenon--all patients (and staff) treated with standard, Universal Precautions--is strictly followed. Further, the endemic prevalence of multiresistant strains may be higher than previously appreciated.