The Effect of Complementary and Alternative Medicines on Quality of Life in Patients with Breast Cancer: A Systematic Review.

BACKGROUND: Breast cancer disease and its classic treatment lead to decrease in patients' quality of life (QOL). This systematic review aimed to compare the effectiveness of complementary and alternative medicines (CAMs) categories on the QOL of women with breast cancer. METHODS: English clinical trials from PubMed, Emabase, Scupos, and Google Scholar databases were searched electronically by the end of 2018 with the Cochrane Collaboration protocol. Two researchers independently extracted data such as participants' characteristics, CAM methods, QOL assessment tools. CAMs were classified into three categories of dietary supplements, herbal medicine, and mind-body techniques. RESULTS: During the initial search, 1186 articles were found. After reviewing titles, abstracts, and full texts based on inclusion and exclusion criteria, 28 clinical trials were included in the systematic review, 18 of which was randomized controlled trial (RCT). Participants included women with breast cancer who were undergoing the first three phases of breast cancer or postcancer rehabilitation. Among CAM interventions, one article used a dietary supplement, and the other 27 articles included a variety of mind-body techniques. Twenty-seven studies showed improved QOL (P > 0.05). CONCLUSION: The findings may indicate the potential benefits of CAMs, especially mind-body techniques on QOL in breast cancer patients. Further RCTs or long-term follow-up studies are recommended. Moreover, the use of similar QOL assessment tools allows for more meta-analysis and generalizability of results, especially for the development of clinical guidelines.

Legal complaints about midwives and the impact on the profession.

INTRODUCTION:: Midwives play an important role in maintaining and increasing women's health and well-being. Training professional midwives is one of the main policies of any healthcare system. Since the number of complaints against midwives has increased recently, this study was conducted to explore the perspectives of midwives regarding patients' complaint to authorities and their impacts on the profession of midwifery. METHODS:: Being conducted in 2013, this qualitative study was the first of its type in Iran. Data were collected through in-depth semi-structured interviews with 14 midwives working in different cities across the country. The participants were selected using a purposive sampling method. Interviews were transcribed verbatim and analyzed following a qualitative content analysis approach. Written text was then coded, and themes were extracted from the data. Ethical considerations: The study was conducted with midwives' free informed consent and was approved by Ethics Committee of Tehran University of Medical Sciences. FINDINGS:: By analyzing the data, four main themes regarding the impact of complaint on midwifery profession were developed. These included the following: "dissatisfied of midwifery, professional deviation, obsession with work, and weakening of the professional status." CONCLUSION:: The experience of patients' complaint to legal authorities against midwives was described, by participants, as a painful experience. Lack of midwives' knowledge about professional rules and litigation process created many problems for them and could negatively affect their practice and the society's attitude toward midwifery. Thus, we suggest that in order to prevent such problems, midwives and midwifery students should be educated regarding factors that have the potential to create such problems and also prevention strategies.

The Experience of Litigation From the Perspective of Midwives in Iran.

INTRODUCTION: Errors and notices to appear in court are a reality of life for many midwives and exert significant effects on both their professional and personal lives. Given the increasing population policies in place, this study was conducted to examine midwives' experiences of litigation in Iran. METHODS: A qualitative study was conducted in 2014 using an interpretive phenomenological approach. The interviews were recorded and transcribed and were then analyzed using the Diekelmann method. FINDINGS: Midwives who participated had professional experience ranging from 3 to 22 years at the time of the complaints. Five participants had received more than one complaint, and 10 participants were judged as guilty creating/leaving significant effects on various dimensions of their lives. CONCLUSION: The present research disclosed four main themes from the interviews including feeling ruined by the complaints, being conflicted between denial and belief, having shattered hopes of release, and experiencing the slowed-down rhythm of midwifery. From these, a basic pattern of "living in despair" was extracted. Litigation is a painful experience for midwives. Anxiety regarding compensation for the patients' losses, public judgment, prolonged litigations, and undermined professional dignity create physical and psychological ramifications for these midwives. Negative feelings about litigation, compounded by the lack of legal support from the authorities, cause a sense of hopelessness regarding the future of the midwifery profession.

Effects of music therapy on pain responses induced by blood sampling in premature infants: A randomized cross-over trial.

BACKGROUND: Premature infants are subjected to many painful procedures during care and treatment. The aim of this study was to assess the effect of music therapy on physiological and behavioral pain responses of premature infants during and after blood sampling. MATERIALS AND METHODS: This study was a cross-over clinical trial conducted on 20 infants in a hospital affiliated to Tehran University of Medical Sciences for a 5-month period in 2011. In the experimental group, Transitions music was played from 5 min before until 10 min after blood sampling. The infants' facial expressions and physiological measures were recorded from 10 min before until 10 min after sampling. All steps and measurements, except music therapy, were the same for the control group. Data were analyzed using SAS and SPSS software through analysis of variance (ANOVA) and Chi-square tests. RESULTS: There were significant differences between the experimental and control groups (P = 0.022) in terms of heart rate during needle extraction and at the first 5 min after sampling (P = 0.005). Considering the infant's sleep-wake state in the second 5 min before sampling, the statistical difference was significant (P = 0.044). Difference was significant (P = 0.045) during injection of the needle, in the first 5 min after sampling (P = 0.002), and in the second 5 min after sampling (P = 0.005). There were significant difference in infants' facial expressions of pain in the first 5 min after sampling (P = 0.001). CONCLUSIONS: Music therapy reduces the physiological and behavioral responses of pain during and after blood sampling.

Nurses' Perceptions of Futile Care: A Qualitative Study.

Health care professionals believe that futile care must not be provided; however, there is no clear agreement over the definition and the manifestations of futile care. The aim of this study was to explore Iranian nurses' perceptions of futile care. In this qualitative exploratory study, the conventional content analysis approach was used for collecting and analyzing the study data. Three main themes were extracted from the data: nonfutility of care: care tantamount with outcome; sense of burnout; and subjectivity and relativity of medical futility concept.

The social well-being of nurses shows a thirst for a holistic support: A qualitative study.

INTRODUCTION: Social well-being is one of the important aspects of health. In fact, this is a reflection of experience in a social environment, indicating how social challenges are determined. In other words, social well-being is an explanation of people's perception and experience of being in a good situation, satisfaction with the structure, and social interaction. This qualitative study intended to explore nurses' experience of social well-being. METHODS: Qualitative content analysis was used to conduct the study. Through purposive sampling, a total of 18 nurses with various clinical experiences participated in semi-structured interviews. The data were analysed using the five-step, qualitative content analysis introduced by Graneheim and Lundman. RESULTS: The main theme extracted from the data analysis was "thirst for a holistic support" in nurses. It consisted of two subthemes including internal support (family's support, colleague's support, and organizational support) and external support (society's support and media's support). CONCLUSIONS AND DISCUSSION: Nurses' experiences in shaping their social well-being show that nurses need support in order to rebuild their social well-being. It is supported in partnership with the media, the community, health-related organizations, and by nurses and family. This improves job satisfaction, hope, motivation, commitment, and confidence so as to ultimately facilitate improvement of social well-being of nurses.

The coping process in adults with acute leukemia undergoing hematopoietic stem cell transplantation.

BACKGROUND: The increasing numbers of leukemia cancer survivors treated with hematopoietic stem cell transplantation (HSCT) face numerous challenges after their transplant procedure. Little information has been published regarding the coping process of this population. Understanding how they cope with this life-threatening disease can assist healthcare professionals to provide holistic care. PURPOSE: This study was designed to elicit the coping process of adults experiencing acute leukemia who underwent HSCT therapy. METHODS: This longitudinal qualitative study and grounded theory took place during 2009-2011. Ten adults with acute leukemia scheduled for HSCT were recruited from Shariati Hospital in Tehran, Iran. A series of pretransplant and posttransplant interviews were held in the hospital's HSCT units. Final interviews took place 2-6 months posttransplant in the hospital's outpatient clinic. RESULTS: The five categories that emerged from the data included perceived threat, suspension between fear and hope, rebirth, contextual factors, and coping strategies. Although patients vacillated within the coping spectrum (i.e., the "buffer zone" between fighting and acquiescing), "finding meaning" was identified as the final outcome of their experience that indicated effective coping. CONCLUSIONS/IMPLICATION FOR PRACTICE: Each patient perceives leukemia and HSCT therapy uniquely. This life-threatening disease can significantly affect patient perception and change patient lives both temporarily and permanently. Nurses can apply effective interventions to help patients cope with their unique situation, find meaning and hope, and allay fear and stress.