Rapid deployment of virtual mind-body interventions during the COVID-19 outbreak: feasibility, acceptability, and implications for future care.

INTRODUCTION: COVID-19 increased stress levels while reducing access to mind-body services in patients with cancer. We describe the rapid deployment of remotely delivered mind-body services to people with cancer during COVID-19, rates of participation, and acceptability from patients' perspectives. METHODS: Eligible participants were patients with cancer age ≥ 18 years enrolled in a single academic cancer center's online patient portal. Interventions included mind-body group therapy sessions in fitness, meditation, yoga, dance, tai chi, and music delivered using Zoom video conferencing. Sessions were 30-45 min and led by an integrative medicine clinician. Following each session, participants were asked to complete a three-item questionnaire assessing (1) satisfaction with the class session, (2) reduction in stress/anxiety, and (3) likelihood of recommending the class to others. Patients could also provide comments in real-time using the Zoom chat function. RESULTS: Among 5948 unique visits, the most frequently attended classes were fitness (n = 2513, 42.2%) followed by meditation (n = 1176, 19.8%) and yoga (n = 909, 15.3%). Of these visits, 3902 (65.6%) had an associated completed questionnaire. Across class types, a large majority of participants reported being extremely satisfied (n = 3733, 95.7%), experiencing extreme reductions in anxiety/stress (n = 3268, 83.8%), and being extremely likely to recommend the class to others (n = 3605, 92.4%). Fitness had the highest endorsement among class types (all p values < 0.001). Themes from the chat responses included gratitude, expressions of helpfulness, and feelings of connection. CONCLUSION: High utilization of and satisfaction with these virtual mind-body services demonstrate the significant potential of remote delivery to facilitate patient access to services.

International perspectives on the pediatric nurse practitioner role.

INTRODUCTION: Advanced pediatric nurse practitioners (APNPs) working in acute settings are represented in pediatric hospitals, clinics, and wards around the world. They work independently and autonomously. The aim of this study was to compare the role of APNPs in four different countries to gain knowledge on the qualifications and experience of the practitioners and their impact on pediatric patients and families. METHOD: A qualitative design with semistructured keyinformant interviews with four nurses from Sweden, Norway, England, and the United States was conducted. Analyses were performed using thematic analysis. RESULTS: Three themes were identified: 1) Qualification and Competencies, illustrated parallels within the four educations and daily practice. 2) Responsibility and Autonomy, highlighted differences. The informants experienced a mutual understanding of the concepts of advanced practice. Interprofessional collaboration with aphysician was crucial to ensure best practice. 3) Holistic Nurse Perspective highlighted the importance of APNPs having competencies to make holistic and family-centered decisions at a higher level. CONCLUSION: From the perspective of four APNPs, advanced pediatric nursing practice is beneficial to the patient, family, and professionals. The formal education varies in the countries studied, but the basic tenets of practice are the same. Family-centered practice and holism are basic to the APNP role.

Mindfulness-based cognitive therapy (MBCT) for multiple chemical sensitivity (MCS): Results from a randomized controlled trial with 1 year follow-up.

OBJECTIVE: Multiple chemical sensitivity (MCS) is a medically unexplained condition characterized by symptoms from multiple organ systems following the perception of common odorants. The condition can cause severe functional impairment for afflicted individuals. The aim of this study was to assess the effects of mindfulness-based cognitive therapy (MBCT) for individuals with MCS. METHODS: The intention-to-treat sample (ITT) included 69 individuals who had been randomized to either MBCT or treatment as usual (TAU). The primary outcome measure was the Quick Environmental Exposure and Sensitivity Inventory (QEESI), which measures the following aspects of MCS: impact of MCS on daily life, symptoms, and reactions following chemical exposures. Secondary outcome measures included the Brief Illness Perception Questionnaire (BIPQ) and the anxiety and depression subscales of the symptom checklist 92 (SCL-92). Participants were assessed at baseline and post treatment, and at follow-up periods of 6- and 12-months. RESULTS: We found no effect of MBCT on the primary outcome, nor did we find an effect on levels of depression or anxiety. We did, however, find positive changes in illness perceptions, which were sustained at 12-month follow-up. Dropout rates were low, suggesting MBCT was well received and regarded as an acceptable intervention by individuals with MCS. CONCLUSIONS: Overall, these results suggest that MBCT does not change overall illness status in individuals with MCS, but that MBCT positively changes emotional and cognitive representations. Possible explanations for these results are discussed.

Effect of transcutaneous electrical muscle stimulation on muscle volume in patients with septic shock.

OBJECTIVE: Intensive care unit admission is associated with muscle wasting and impaired physical function. We investigated the effect of early transcutaneous electrical muscle stimulation on quadriceps muscle volume in patients with septic shock. DESIGN: Randomized interventional study using a single-legged exercise design with the contralateral leg serving as a paired control. SETTING: A mixed 18-bed intensive care unit at a tertiary care university hospital. PATIENTS: Eight adult male intensive care unit patients with septic shock included within 72 hrs of diagnosis. INTERVENTIONS: After randomization of the quadriceps muscles, transcutaneous electrical muscle stimulation was applied on the intervention side for 7 consecutive days and for 60 mins per day. All patients underwent computed tomographic scans of both thighs immediately before and after the 7-day treatment period. The quadriceps muscle was manually delineated on the computed tomography slices, and muscle volumes were calculated after three-dimensional reconstruction. MEASUREMENTS AND MAIN RESULTS: Median age and Acute Physiology and Chronic Health Evaluation II score were 67 years (interquartile range, 64-72 years) and 25 (interquartile range, 20-29), respectively. During the 7-day study period, the volume of the quadriceps muscle on the control thigh decreased by 16% (4-21%, p=.03) corresponding to a rate of 2.3% per day. The volume of the stimulated muscle decreased by 20% (3-25%, p=.04) corresponding to a rate of 2.9% per day (p=.12 for the difference in decrease). There was no difference in muscle volume between the stimulated and nonstimulated thigh at baseline (p=.10) or at day 7 (p=.12). The charge delivered to the muscle tissue per training session (0.82 [0.66-1.18] coulomb) correlated with the maximum sequential organ failure assessment score. CONCLUSIONS: We observed a marked decrease in quadriceps volume within the first week of intensive care for septic shock. This loss of muscle mass was unaffected by transcutaneous electrical muscle stimulation applied for 60 mins per day for 7 days.