The impact of a mindfulness-based stress reduction program on university students' mental health: A mixed-methods evaluation.

Objective: To evaluate an eight-week Mindfulness-Based Stress Reduction (MBSR) program's impact on university students' mental health. Participants: Undergraduate and graduate students. Methods: Ninety participants completed pre-, mid-, and post-program surveys. Mindfulness, Satisfaction with Life, Psychological Distress, and Perceived Stress scores were analyzed using repeated measures ANOVA and pairwise comparisons. Additionally, 115 participants completed post-survey open-ended responses addressing their subjective experiences, which were thematically examined. Results: Participants showed significant improvements in all outcome measures from pre- to post- [p < 0.001] and mid- to post-program [p < 0.05]. All measures, except Satisfaction with Life, showed significant improvement from pre- to mid-program. Participants reported high program satisfaction. Facilitators of the participants' practice included program structure, perception of outcomes, and group setting; however, busy schedules posed a prominent barrier. Conclusion: This evaluation supports MBSR as a public health, group-based approach to improving students' mental health and building a more positive campus community.

Assessing the Impact of Acupuncture on Pain, Nausea, Anxiety, and Coping in Women Undergoing a Mastectomy.

PURPOSE/OBJECTIVES: To compare the effect of acupuncture to a standard-of-care (control) group on pain, nausea, anxiety, and ability to cope. 
. DESIGN: Pilot randomized, controlled trial. 
. SETTING: Abbott Northwestern Hospital, a large, urban, tertiary care hospital in Minneapolis, Minnesota.
. SAMPLE: 30 adult women undergoing surgery for breast cancer.
. METHODS: Women were randomly assigned to two hospital-based acupuncture treatments versus usual care after breast cancer surgery. Pain, nausea, anxiety, and the patient's ability to cope pre- and post-treatment were compared within and between groups at two different time points postoperatively.ʉ۩. MAIN RESEARCH VARIABLES: Mean change in pain, nausea, anxiety, and ability to cope by treatment group.
. FINDINGS: Compared to women assigned to the control group, women who received acupuncture reported a statistically significant greater reduction in pain, nausea, anxiety, and increase in ability to cope on the first postoperative day and in pain on the second postoperative day following mastectomy surgery.
. CONCLUSIONS: Acupuncture delivered postoperatively in the hospital after mastectomy can reduce the severity of symptoms experienced, as well as increase the patient's ability to cope with her symptoms. However, before implementation as a standard of care, further research needs to be conducted.
. IMPLICATIONS FOR NURSING: Acupuncture adds a nonpharmacologic intervention for symptom management in women undergoing mastectomies for breast cancer.

The effectiveness of nurse-delivered aromatherapy in an acute care setting.

OBJECTIVE: To examine the use and effectiveness of essential oil therapeutic interventions on pain, nausea, and anxiety, when provided by nurses to patients in acute hospital settings across a large health system. This study expands upon the limited body of literature on aromatherapy use among inpatients. DESIGN: Retrospective, effectiveness study using data obtained from electronic health records. SETTING: Ten Allina Health hospitals located in Minnesota and western Wisconsin. INTERVENTIONS: Nurse-delivered aromatherapy. MAIN OUTCOME MEASURES: Change in patient-reported pain, anxiety, and nausea, rated before and after receiving aromatherapy using a numeric rating scale (0-10). RESULTS: There were 10,262 hospital admissions during the study time frame in which nurse-delivered aromatherapy was part of patient care. The majority of admissions receiving aromatherapy were females (81.71%) and white (87.32%). Over 75% of all aromatherapy sessions were administered via inhalation. Lavender had the highest absolute frequency (49.5%) of use regardless of mode of administration, followed by ginger (21.2%), sweet marjoram (12.3%), mandarin (9.4%), and combination oils (7.6%). Sweet marjoram resulted in the largest single oil average pain change at -3.31 units (95% CI: -4.28, -2.33), while lavender and sweet marjoram had equivalent average anxiety changes at -2.73 units, and ginger had the largest single oil average change in nausea at -2.02 units (95% CI: -2.55, -1.49). CONCLUSIONS: Essential oils generally resulted in significant clinical improvements based on their intended use, although each oil also showed ancillary benefits for other symptoms. Future research should explore use of additional essential oils, modes of administration, and different patient populations.

Development of a Health System-Based Nurse-Delivered Aromatherapy Program.

Healthcare systems are increasingly looking to integrate aromatherapy (essential oils) as a safe, low-cost, and nonpharmacologic option for patient care to reduce pain, nausea, and anxiety and to improve sleep. This article describes the development and implementation of a healthcare system-wide program of nurse-delivered essential oil therapeutic interventions to inpatients throughout an acute care setting. In addition, we provide lessons learned for nursing administrators interested in developing similar nurse-delivered aromatherapy programs.

Resilience Training: A Pilot Study of a Mindfulness-Based Program with Depressed Healthcare Professionals.

CONTEXT: Mindfulness-based programs have been primarily used to target anxiety or the prevention of relapse in recurrent depression; however, limited research has been conducted on the use of mindfulness programs for relief of current depressive symptoms. OBJECTIVE: To investigate the potential effect of resilience training (RT) on symptom relief for current or recurrent depression, and other psychological/behavioral outcomes. DESIGN: Wait-list comparison pilot study. SETTING: Penny George Institute for Health and Healing, Allina Health, Minneapolis, MN. PARTICIPANTS: A total of 40 actively working healthcare professionals age 18-65 years. INTERVENTION: RT is an eight-week mindfulness-based program that synergizes elements of mindfulness meditation with nutrition and exercise. The first 20 consecutive individuals meeting all eligibility criteria were assigned to the RT group. The next 20 consecutive eligible individuals were placed into the wait-list control group and had an eight-week waiting period before starting the RT program. OUTCOME MEASURES: Psychological/behavioral outcomes were measured before and after completion of the RT program and two months after completion. Wait-list participants also had measures taken just before starting on the wait-list. RESULTS: The RT group exhibited a 63-70% (P ≤ .01) reduction in depression, a 48% (P ≤ .01) reduction in stress, a 23% (P ≤ .01) reduction in trait anxiety, and a 52% (P ≤ .01) reduction in presenteeism (a per-employee savings of $1846 over the eight-week program). All outcomes were statistically significantly different from the wait-list group. Most improvements persisted up to two months after completion of the RT program. CONCLUSIONS: Further replication with a larger sample size, and enhanced control group is warranted.

Outcomes of a Multimodal Resilience Training Program in an Outpatient Integrative Medicine Clinic.

OBJECTIVE: To investigate the outcomes of resilience training (RT) in an outpatient clinical setting on symptom relief for current or recurrent depression, as well as perceived stress and state and trait anxiety. DESIGN: Observational effectiveness study. SETTINGS/LOCATION: Penny George Institute for Health and Healing, Allina Health, Minneapolis, MN. PARTICIPANTS: A total of 728 men and women age 18 years and older who participated in the RT program between December 1, 2007, and November 31, 2012. Of these individuals, 371 were considered study contributors and completed at least one questionnaire both before (pre-RT) and after (post-RT) completion of the program. The remaining participants were considered study non-contributors and did not complete any questionnaires. INTERVENTIONS: RT is a mindfulness-based program that synergizes elements of mindfulness meditation with nutrition and exercise into a cohesive intervention. OUTCOME MEASURES: Depressive symptoms, as well as state and trait anxiety and perceived stress. RESULTS: Among the 371 RT participant contributors, depressive symptoms, perceived stress, and state and trait anxiety improved significantly from pre-RT to post-RT. Furthermore, among participants with depression at baseline, Center for Epidemiologic Studies Depression Scale-10 scores decreased by a mean of 44.0% (from 17.5 to 9.8), a value below the cutoff for significant depressive symptoms. Baseline perceived stress scores were the most predictive of program success. CONCLUSIONS: This study provides evidence that a multimodal RT program delivered in a real-world clinical setting improves symptoms of depression, anxiety, and stress. Limitations of this effectiveness study include a homogeneous population of mostly white women and a large amount of randomized, imputed, and missing data. Future work should include a randomized controlled trial and potentially studies to separate RT into the three components to determine which may be primarily responsible for the improved outcomes.

Acupuncture provides short-term pain relief for patients in a total joint replacement program.

OBJECTIVE: Given the risks of opioid medications, nonpharmacological strategies should be considered for total joint replacement patients. We investigated acupuncture as an adjunct therapy for postsurgical pain management in a total joint replacement program by examining which total hip and knee replacement patients elected to receive acupuncture and the effect of acupuncture on short-term pain. DESIGN: A total joint replacement program using fast-track physiotherapy offered elective postsurgical acupuncture to all patients, at no additional cost, as an adjunct therapy to opioids for pain management. SETTING: The Joint Replacement Center at Abbott Northwestern Hospital, a 630-bed teaching and specialty hospital in Minneapolis, Minnesota from 2010 to 2012. SUBJECTS: Our sample included 2,500 admissions of total hip (THR) and total knee replacement (TKR) patients. METHODS: Self-reported pain was assessed before and after acupuncture using a 0-10 scale and categorized as none/mild (0-4) and moderate/severe pain (5-10). RESULTS: Seventy-five percent of admissions included acupuncture. Women (Odds Ratio: 1.48, 95% Confidence Interval (CI): 1.22, 1.81) had higher odds of receiving acupuncture compared to men, and nonwhite patients (Odds Ratio: 0.55, 95% CI: 0.39, 0.78) had lower odds of receiving acupuncture compared to white patients. Average short-term pain reduction was 1.91 points (95% CI: 1.83, 1.99), a 45% reduction from the mean prepain score. Forty-one percent of patients reported moderate/severe pain prior to receiving acupuncture, while only 15% indicated moderate/severe pain after acupuncture. CONCLUSIONS: Acupuncture may be a viable adjunct to pharmacological approaches for pain management after THR or TKR.

The effectiveness of integrative medicine interventions on pain and anxiety in cardiovascular inpatients: a practice-based research evaluation.

BACKGROUND: Pain and anxiety occurring from cardiovascular disease are associated with long-term health risks. Integrative medicine (IM) therapies reduce pain and anxiety in small samples of hospitalized cardiovascular patients within randomized controlled trials; however, practice-based effectiveness research has been limited. The goal of the study is to evaluate the effectiveness of IM interventions (i.e., bodywork, mind-body and energy therapies, and traditional Chinese medicine) on pain and anxiety measures across a cardiovascular population. METHODS: Retrospective data obtained from medical records identified patients with a cardiovascular ICD-9 code admitted to a large Midwestern hospital between 7/1/2009 and 12/31/2012. Outcomes were changes in patient-reported pain and anxiety, rated before and after IM treatments based on a numeric scale (0-10). RESULTS: Of 57,295 hospital cardiovascular admissions, 6,589 (11.5%) included IM. After receiving IM therapy, patients averaged a 46.5% (p-value < 0.001) decrease in pain and a 54.8% (p-value < 0.001) decrease in anxiety. There was no difference between treatment modalities on pain reduction; however, mind-body and energy therapies (p-value < 0.01), traditional Chinese medicine (p-value < 0.05), and combination therapies (p-value < 0.01) were more effective at reducing anxiety than bodywork therapies. Each additional year of age reduced the odds of receiving any IM therapy by two percent (OR: 0.98, p-value < 0.01) and females had 96% (OR: 1.96, p-value < 0.01) higher odds of receiving any IM therapy compared to males. CONCLUSIONS: Cardiovascular inpatients reported statistically significant decreases in pain and anxiety following care with adjunctive IM interventions. This study underscores the potential for future practice-based research to investigate the best approach for incorporating these therapies into an acute care setting such that IM therapies are most appropriately provided to patient populations.

Effects of integrative medicine on pain and anxiety among oncology inpatients.

BACKGROUND: Few studies have investigated the effectiveness of integrative medicine (IM) therapies on pain and anxiety among oncology inpatients. METHODS: Retrospective data obtained from electronic medical records identified patients with an oncology International Classification of Diseases-9 code who were admitted to a large Midwestern hospital between July 1, 2009 and December 31, 2012. Outcomes were change in patient-reported pain and anxiety, rated before and after individual IM treatment sessions, using a numeric scale (0-10). RESULTS: Of 10948 hospital admissions over the study period, 1833 (17%) included IM therapy. Older patients had reduced odds of receiving any IM therapy (odds ratio [OR]: 0.97, 95% confidence interval [95% CI] = 0.96 to 0.98) and females had 63% (OR: 1.63, 95% CI = 1.38 to 1.92) higher odds of receiving any IM therapy compared with males. Moderate (OR: 1.97, 95% CI = 1.61 to 2.41), major (OR: 3.54, 95% CI = 2.88 to 4.35), and extreme (OR: 5.96, 95% CI = 4.71 to 7.56) illness severity were significantly associated with higher odds of receiving IM therapy compared with admissions of minor illness severity. After receiving IM therapy, patients averaged a 46.9% (95% CI = 45.1% to 48.6%, P <.001) reduction in pain and a 56.1% (95% CI = 54.3% to 58.0%, P <.001) reduction in anxiety. Bodywork and traditional Chinese Medicine therapies were most effective for reducing pain, while no significant differences among therapies for reducing anxiety were observed. CONCLUSIONS: IM services to oncology inpatients resulted in substantial decreases in pain and anxiety. Observational studies using electronic medical records provide unique information about real-world utilization of IM. Future studies are warranted and should explore potential synergy of opioid analgesics and IM therapy for pain control.

Temporal clinical exacerbation of summer pasture-associated recurrent airway obstruction and relationship with climate and aeroallergens in horses.

OBJECTIVE: To describe the seasonal pattern of clinical exacerbation of summer pasture-associated recurrent airway obstruction (SPA-RAO) in relation to climate and aeroallergens in horses. ANIMALS: 19 horses with SPA-RAO and 10 nonaffected horses. PROCEDURES: Daily examinations were performed on all horses while they were kept on pasture for 3 years. Onset and progression of clinical exacerbation based on a clinical score of respiratory effort were evaluated in relation to changes in maximum temperature, minimum temperature, mean temperature, maximum dew-point temperature, minimum dew-point temperature, and delta dew-point temperature. Seasonal pattern of clinical exacerbation was evaluated in relation to aeroallergen counts (20 types of fungal spores and 28 types of pollen). RESULTS: Seasonal pattern of clinical exacerbation of SPA-RAO was associated with increases in temperature (heat) and dew-point temperature (humidity), counts of fungal spores, and counts of grass pollen grains. Seasonal pattern of clinical exacerbation paralleled and was associated with increases in counts of specific types of fungal spores, particularly Basidiospore, Nigrospora, and Curvularia spp. CONCLUSIONS AND CLINICAL RELEVANCE: Although a causal relationship could not be determined, the seasonal pattern of clinical exacerbation of SPA-RAO was associated with hot and humid conditions and high environmental counts for fungal spores and grass pollen grains. It is not known yet whether these are aeroallergens that cause clinical exacerbation of the disease.