Virtual reality for management of cancer pain: Study rationale and design.

BACKGROUND: Patients with cancer commonly experience acute and/or chronic moderate to severe pain related to disease, treatment, or both. While pain management strategies typically focus on drug therapies, non-pharmacological interventions may prove beneficial without risk of significant clinical side effects or contraindications. One novel strategy, virtual reality, has been shown to improve pain control in addition to usual pharmacological interventions. METHODS: This is a prospective, two-armed, single center randomized controlled study of a virtual reality intervention in 128 hospitalized subjects with cancer reporting pain rated at least 4/10 compared to an active control intervention, two-dimensional guided imagery. The primary outcome is change in self-reported pain score. Secondary end points include changes in self-reported distress, quality of life, and satisfaction with pain management. We will also explore patient preferences for distraction therapy content and themes through quantitative analysis of survey data, semi-structured interviews, and a collaging exercise. CONCLUSION: This randomized controlled study aims to provide empiric data to support application and expansion of novel technologies such as virtual reality to augment usual pharmacological pain management strategies in hospitalized patients with cancer.

Virtual reality for pain management in advanced heart failure: A randomized controlled study.

BACKGROUND: Hospitalized patients with advanced heart failure often experience acute and/or chronic pain. While virtual reality has been extensively studied across a wide range of clinical settings, no studies have yet evaluated potential impact on pain management on this patient population. AIM: To investigate the impact of a virtual reality experience on self-reported pain, quality-of-life, general distress, and satisfaction compared to a two-dimensional guided imagery active control. DESIGN: Single-center prospective randomized controlled study. The primary outcome was the difference in pre- versus post-intervention self-reported pain scores on a numerical rating scale from 0 to 10. Secondary outcomes included changes in quality-of-life scores, general distress, and satisfaction with the intervention. SETTING/PARTICIPANTS: Between October 2018 and March 2020, 88 participants hospitalized with advanced heart failure were recruited from an urban tertiary academic medical center. RESULTS: Participants experienced significant improvement in pain score after either 10 minutes of virtual reality (change from pre- to post -2.9 ± 2.6, p < 0.0001) or 10 minutes of guided imagery (change from pre- to post -1.3 ± 1.8, p = 0.0001); the virtual reality arm experienced a 1.5 unit comparatively greater reduction in pain score compared to guided imagery (p = 0.0011). Total quality-of-life and general distress scores did not significantly change for either arm. Seventy-eight participants (89%) responded that they would be willing to use the assigned intervention again. CONCLUSION: Virtual reality may be an effective nonpharmacologic adjuvant pain management intervention in hospitalized patients with heart failure. TRIAL REGISTRATION: ClinicalTrials.gov database (NCT04572425).

Virtual reality for pain management in patients with heart failure: Study rationale and design.

BACKGROUND: Patients with advanced heart failure commonly experience acute and/or chronic moderate to severe pain related to disease, treatment, or both. While pain management strategies typically focus on drug therapies, non-pharmacological interventions may prove beneficial without risk of significant clinical side effects or contraindications. One novel strategy, virtual reality, has been shown to improve pain control in addition to usual pharmacological interventions. METHODS: This is a prospective, two-armed, single center randomized controlled pilot study of a virtual reality intervention in 128 hospitalized subjects with ACC/AHA stage C or stage D heart failure who self-report pain rated 4/10 or greater compared to an active control, two-dimensional guided imagery. The primary outcome is change in self-reported pain score measured by the Brief Pain Inventory (Short Form). Secondary end points include changes in self-reported distress, quality of life, and satisfaction with pain management. CONCLUSION: This randomized controlled study aims to provide empiric data to support application and expansion of novel technologies such as virtual reality to augment usual pharmacological pain management strategies in hospitalized patients with heart failure.

Comparison of RNA extraction kits for the purification and detection of an enteric virus surrogate on green onions via RT-PCR.

Real-time reverse transcriptase-polymerase chain reaction (RT-PCR) offers a rapid and sensitive molecular method for detection of enteric viruses. Unfortunately, these assays are often hampered by the low virus titre found in foods and PCR inhibition due to matrix carryover during RNA extraction. Four commercial RNA extraction kits (Qiagen's QIAamp Viral RNA Mini and UltraSens Virus kits, MoBio UltraClean Tissue & Cells RNA Isolation kit, and Ambion MagMAX Viral RNA Isolation kit) were evaluated for their ability to extract and purify MS2 bacteriophage RNA, an enteric virus surrogate, from inoculated green onions, a food which has been associated with viral gastroenteritis outbreaks. Inoculated green onion wash concentrates and green onion pieces with and without Qiagen QIAshredder homogenization were assayed in the kit comparison. MS2 detection and PCR inhibition were evaluated using a duplex real-time RT-PCR for MS2 and an exogenous internal amplification control (IAC) assay. Without homogenization, MS2 inoculated at 40pfu/g was detected in at least 4 lots of green onion wash concentrates using the silica-membrane spin-column kits. Inhibition was a factor for the magnetic silica-based MagMAX kit, which resulted in detection of MS2 in 1 of 5. Addition of QIAshredder homogenization prior to extraction did not adversely affect the silica-membrane kit results but improved the MS2 detection by MagMAX to 5 of 5 lots. Use of a 1:10 dilution of primary RNA extracts also improved detection. The QIAamp Viral RNA Mini and MagMAX kits were further compared for detection of MS2 from green onion pieces inoculated at 20 and 5pfu/g. Using homogenization, the MagMAX kit detected 20pfu/g in only 1 of 2 green onion lots, whereas the QIAamp Viral RNA kit detected 2 of 2 lots at 5 pfu/g without homogenization.

Nonjudging facet of mindfulness predicts enhanced smoking cessation in Hispanics.

Although most smokers express interest in quitting, actual quit rates are low. Identifying strategies to enhance smoking cessation is critical, particularly among underserved populations, including Hispanics, for whom many of the leading causes of death are related to smoking. Mindfulness (purposeful, nonjudgmental attention to the present moment) has been linked to increased likelihood of cessation. Given that mindfulness is multifaceted, determining which aspects of mindfulness predict cessation could help to inform interventions. This study examined whether facets of mindfulness predict cessation in 199 Spanish-speaking smokers of Mexican heritage (63.3% male, mean age of 39 years, 77.9% with a high school education or less) receiving smoking cessation treatment. Primary outcomes were 7-day abstinence at weeks 3 and 26 postquit (biochemically confirmed and determined using an intent-to-treat approach). Logistic random coefficient regression models were utilized to examine the relationship between mindfulness facets and abstinence over time. Independent variables were subscales of the Five Facet Mindfulness Questionnaire (Observing, Describing, Acting With Awareness, Nonjudging, and Nonreactivity). The Nonjudging subscale (i.e., accepting thoughts and feelings without evaluating them) uniquely predicted better odds of abstinence up to 26 weeks postquit. This is the first known study to examine whether specific facets of mindfulness predict smoking cessation. The ability to experience thoughts, emotions, and withdrawal symptoms without judging them may be critical in the process of quitting smoking. Results indicate potential benefits of mindfulness among smokers of Mexican heritage and suggest that smoking cessation interventions might be enhanced by central focus on the Nonjudging aspect of mindfulness.

Testing a Moderated Mediation Model of Mindfulness, Psychosocial Stress, and Alcohol Use among African American Smokers.

Mindfulness-based strategies have received empirical support for improving coping with stress and reducing alcohol use. The present study presents a moderated mediation model to explain how mindfulness might promote healthier drinking patterns. This model posits that mindfulness reduces perceived stress, leading to less alcohol use, and also weakens the linkage between stress and alcohol use. African American smokers (N = 399, 51% female, Mage = 42) completed measures of dispositional mindfulness, perceived stress, quantity of alcohol use, frequency of binge drinking, and alcohol use disorder symptoms. Participants with higher levels of dispositional mindfulness reported less psychosocial stress and lower alcohol use on all measures. Furthermore, mindfulness moderated the relationship between perceived stress and quantity of alcohol consumption. Specifically, higher perceived stress was associated with increased alcohol use among participants low, but not high, in mindfulness. Mindfulness may be one strategy to reduce perceived stress and associated alcohol use among African American smokers.

Mindfulness predicts lower affective volatility among African Americans during smoking cessation.

Recent research suggests that mindfulness benefits emotion regulation and smoking cessation. However, the mechanisms by which mindfulness affects emotional and behavioral functioning are unclear. One potential mechanism, lower affective volatility, has not been empirically tested during smoking cessation. This study examined longitudinal associations among mindfulness and emotional responding over the course of smoking cessation treatment among predominantly low-socioeconomic status (SES) African American smokers, who are at high risk for relapse to smoking and tobacco-related health disparities. Participants (N = 399, 51% female, mean age = 42, 48% with annual income <$10,000) completed a baseline measure of trait mindfulness. Negative affect, positive affect, and depressive symptoms were assessed at five time points during smoking cessation treatment (up to 31 days postquit). Volatility indices were calculated to quantify within-person instability of emotional symptoms over time. Over and above demographic characteristics, nicotine dependence, and abstinence status, greater baseline trait mindfulness predicted lower volatility of negative affect and depressive symptoms surrounding the quit attempt and up to 1 month postquit, ps < 0.05. Although volatility did not mediate the association between greater mindfulness and smoking cessation, these results are the first to show that mindfulness is linked to lower affective volatility (or greater stability) of negative emotions during the course of smoking cessation. The present study suggests that mindfulness is linked to greater emotional stability and augments the study of mindfulness in diverse populations. Future studies should examine the effects of mindfulness-based interventions on volatility and whether lower volatility explains effects of mindfulness-based treatments on smoking cessation.

Mindfulness Ameliorates the Relationship between Weight Concerns and Smoking Behavior in Female Smokers: A Cross-Sectional Investigation.

Weight concerns are common among female smokers and may interfere with smoking cessation. It is imperative to identify protective factors to lessen the likelihood that smoking-related weight concerns prompt smoking and hinder cessation efforts. Mindfulness is one potential protective factor that might prevent weight concerns from triggering smoking. In the current study, relationships among facets of trait mindfulness, smoking-related weight concerns, and smoking behavior were examined among 112 young adult female smokers (70.5% daily smokers; 83% Caucasian; mean age 20 [SD = 1.69]). After controlling for demographic variables, the Describing facet of trait mindfulness predicted lower smoking-related weight concerns. The mindfulness characteristics of Acting with Awareness, Nonreactivity, and Describing moderated the relationship between smoking-related weight concerns and smoking frequency, such that smoking-related weight concerns predicted greater smoking frequency in female smokers with low and medium levels of these mindfulness characteristics but did not in those with higher levels of mindfulness. These results suggest that mindfulness-based interventions may be effective for weight-concerned smokers.

Unique relationships between facets of mindfulness and eating pathology among female smokers.

Female smokers often have higher levels of eating disorder symptoms than non-smokers, and concerns about eating and weight might interfere with smoking cessation. Thus, it is critical to identify factors to promote healthier eating and body image in this population. Initial research suggests that specific aspects of trait mindfulness predict lower body dissatisfaction and eating disorder symptoms among non-smokers. However, these relationships are unknown among smokers. The current study examined associations between facets of trait mindfulness and eating disorder symptoms in 112 college female smokers (83% Caucasian; mean age 20 years, SD=1.69). After controlling for relevant sociodemographic variables, Describing and Nonjudging facets of mindfulness predicted lower bulimic symptoms and body dissatisfaction (ps<.05), while Acting with Awareness predicted lower bulimic and anorexic symptoms, ps<.05. Observing predicted higher anorexic symptoms, p<.05. These results suggest that specific mindfulness facets are related to lower eating disorder symptoms among smokers, whereas other facets are not associated or have a positive relationship with these symptoms. Mindfulness-based interventions focusing on Describing, Nonjudging, and Acting with Awareness may help to reduce eating pathology among female smokers, which could potentially improve smoking cessation rates in this population.

Cannabis and psychometrically-defined schizotypy: use, problems and treatment considerations.

Cannabis use is associated with onset of psychosis in individuals vulnerable for developing schizophrenia-spectrum disorders. The present study addressed three knowledge gaps pertaining to this issue: 1) clarifying the incidence of cannabis use in schizotypal individuals, 2) examining how cannabis use is related to psychosocial and physiological problems in schizotypy and interest in treatment, and 3) examining how cannabis use is associated with positive, negative and disorganization features of schizotypy. Scores from a measure of schizotypal traits were used to trichotomize 1665 young adults into schizotypy (top 5% of scorers), non-schizotypy (bottom 50% of scorers) and "unconventional" (scorers within the 50th to 85th percentile) groups. Nearly a quarter of the schizotypy group endorsed cannabis use at least weekly, a rate nearly two to four times that of the other groups. The schizotypy group also reported a much greater frequency of cannabis-related problems compared to the other groups. Despite this, interest in treatment for cannabis use in the schizotypy group was not elevated. Interestingly, 85% of individuals in the schizotypy group reported interest in psychological/psychiatric treatment more generally. Cannabis use was not associated with abnormal patterns of positive or disorganized schizotypy traits in the schizotypy group relative to the other groups. However, cannabis use was associated with lower severity of negative traits. Implications of these results are discussed.