The mindfulness trajectories of addressing suicidal behaviour: A systematic review.

BACKGROUND AND OBJECTIVES: Suicidal behaviour has been a persistent concern in medical as well as general settings. Many psychotherapeutic approaches have tried to address suicidal behaviour in different ways. Mindfulness-based interventions (MBIs) have garnered much attention in the last decade because of their treatment efficacy. This systematic review aimed to examine evidence-based research regarding the effectiveness of MBIs as a psychotherapy intervention on suicidality and to deliver suggestions that might help future research. METHOD: The identification of literature was made through an extensive search of the electronic databases, to extract studies relating to the efficacy of MBIs on addressing suicidal behaviour. Additional researches based on library sources were searched manually. The studies' selection was based on a pre-determined inclusion and exclusion criteria as well as the quality of the studies. RESULTS: The present review helped us identify 13 studies, including six randomised controlled trials, two controlled studies and five pre-post observational studies. The findings reported in the studies were mostly favourable to MBIs as an effective intervention strategy for suicidal behaviour. CONCLUSION: MBIs show promising effects as an intervention for suicidal behaviour. However, large scale, high-quality trials with active control, and long term intervention efficacy studies are needed to understand the mechanisms through which MBIs reduce suicidal behaviour.

A novel nucleic acid extraction method from aromatic herbs and dried herbal powders using cow skim milk.

Authenticity of dried aromatic herbs and herbal powders for the ASU (ayurvedic, siddha, unani) drug formulations is a key of their clinical success. The DNA based authentication is an answer; however, extraction of PCR quality DNA from such material is often problematic due to the presence of various co-extracted PCR inhibitors. Here, we report a novel DNA isolation and purification method utilizing cow skim milk that successfully yields PCR quality DNA from the aromatic herbs and dried herbal powders. The improved method presented in this study could be used as an alternative to successfully extract PCR quality DNA from such plant materials. Further, we present a set of robust matK primers which could be used as plant barcoding resource in future studies.

Effectiveness of mindfulness based cognitive behavior therapy on life satisfaction, and life orientation of adolescents with depression and suicidal ideation.

Suicide and depression are among the most alarming phenomena prevalent throughout the world. Various approaches have tried to explain the intricacies in depression and suicide, as a consequence of faulty psychological adjustment of the individual. Several therapeutic approaches have been developed to strengthen one's coping process, among which cognitive behaviour therapy has shown promising results. Also, mindfulness-based approaches to cognitive behavioural therapy have further accelerated the well-being of such individuals. This study was conducted with an aim to see the effect of mindfulness-based cognitive behaviour therapy on life satisfaction and life orientation in adolescents with depression and suicidal behaviour. A sample of 30 adolescents who scored high on scales of depression and suicidal tendencies were administered pre-test measures on life satisfaction and life orientation. After that they were exposed to an eight weeks programme on mindfulness-based cognitive behaviour therapy, followed by a post-assessment on the same measures. The analysis of pre and post test revealed a significant enhancement in life satisfaction, life orientation, and family functioning as well as a reduction in depressive symptoms and suicidal ideation. It is concluded that mindfulness-based cognitive behaviour therapy serves as an effective medium to enhance the psychological functioning of depressive and suicidal adolescents.

Selective recurrent laryngeal nerve stimulation using a penetrating electrode array in the feline model.

OBJECTIVES/HYPOTHESIS: Laryngeal muscles (LMs) are controlled by the recurrent laryngeal nerve (RLN), injury of which can result in vocal fold (VF) paralysis (VFP). We aimed to introduce a bioelectric approach to selective stimulation of LMs and graded muscle contraction responses. STUDY DESIGN: Acute experiments in cats. METHODS: The study included six anesthetized cats. In four cats, a multichannel penetrating microelectrode array (MEA) was placed into an uninjured RLN. For RLN injury experiments, one cat received a standardized hemostat-crush injury, and one cat received a transection-reapproximation injury 4 months prior to testing. In each experiment, three LMs (thyroarytenoid, posterior cricoarytenoid, and cricothyroid muscles) were monitored with an electromyographic (EMG) nerve integrity monitoring system. Electrical current pulses were delivered to each stimulating channel individually. Elicited EMG voltage outputs were recorded for each muscle. Direct videolaryngoscopy was performed for visualization of VF movement. RESULTS: Stimulation through individual channels led to selective activation of restricted nerve populations, resulting in selective contraction of individual LMs. Increasing current levels resulted in rising EMG voltage responses. Typically, activation of individual muscles was successfully achieved via single placement of the MEA by selection of appropriate stimulation channels. VF abduction was predominantly observed on videolaryngoscopy. Nerve histology confirmed injury in cases of RLN crush and transection experiments. CONCLUSIONS: We demonstrated the ability of a penetrating MEA to selectively stimulate restricted fiber populations within the feline RLN and selectively elicit contractions of discrete LMs in both acute and injury-model experiments, suggesting a potential role for intraneural MEA implantation in VFP management. LEVEL OF EVIDENCE: NA. Laryngoscope, 128:1606-1614, 2018.

Is Nebulized Lidocaine Adequate Topical Anesthesia for Diagnostic Transnasal Tracheoscopy?

OBJECTIVES: To evaluate if nebulized 4% lidocaine alone provides adequate laryngopharyngeal anesthesia for office-based diagnostic transnasal tracheoscopy (TNT). METHODS: A retrospective chart review (January 2011 to June 2014) and a prospective case series (July 2014 to December 2014) of patients who underwent diagnostic TNT were performed at a university voice and swallowing center. TNT cases were categorized by method of topical laryngopharyngeal anesthesia: nebulized 4% lidocaine and 4% lidocaine drip (phase I) and nebulized 4% lidocaine only (phase II). RESULTS: TNT was performed a total of 59 times on 38 patients. Eleven (69%) of 16 phase I TNT procedures involved significant patient discomfort and severe cough following the lidocaine drip. Forty-two (98%) of 43 phase II TNT procedures were completed comfortably; 1 case required additional anesthesia by lidocaine drip. Retrospectively, 100% (n=8) of patients who underwent both phase I and phase II TNTs were noted to prefer anesthesia with nebulizer alone. In a prospective case series of 14 phase II TNT cases, 6 (86%) of 7 patients who previously underwent phase I TNT reported preference for anesthesia with nebulizer alone. CONCLUSIONS: Nebulized lidocaine appears to provide sufficient laryngopharyngeal anesthesia for diagnostic TNT. It is preferred by patients over laryngeal drip.

Decalepisarayalpathra (J. Joseph & V. Chandras.) Venter, an endemic and endangered ethno medicinal plant from Western Ghats, India.

Decalepis arayalpatra is an endemic and critically endangered plant of India. May 2014 issue of Natural Products Research publishes the findings of R. S. Verma et al. on the chemical composition of D. arayalpatra. This study was conducted to characterise the root aroma of this plant for possible industrial applications. The authors suggest that due to its peculiar vanilla flavour, the plant could be explored as a potential substitute of vanillin-aroma in the flavour industry. Owing to the fact that D. arayalpatra is a critically endangered plant species, and its habitat is now limited to only the protected areas and reserve forest in southern part of India, and that collecting any plant from such reserve forests for commercial activities is illegal as per the law of the country, this specific conclusion of the authors is totally un-substantiated by the law of land, hence, calls for further review.

Transnasal tracheoscopy.

OBJECTIVES/HYPOTHESIS: Unsedated transnasal tracheoscopy (TNT) has emerged as a technique in otolaryngology-head and neck surgery for an awake airway examination in the office setting. This study investigates the safety, procedural success rate, indications, and findings of TNTs performed over a 3-year period at an academic medical center. STUDY DESIGN: Retrospective chart review. METHODS: After institutional review board approval, billing records were reviewed for patients who underwent TNT from 2007-2009 in the University of Wisconsin-Madison Department of Otolaryngology-Head and Neck Surgery. Hospital charts for these patients were obtained, and data regarding patient demographics, complications, procedural success rate, indications, and findings were recorded. RESULTS: Sixty-eight TNTs were performed on 44 patients over the last 3 years (25 males, 19 females; age range, 16-91 years). No complications were noted. Ninety-one percent of procedures were able to be completed. Indications for TNT were to: 1) detect airway stenosis or pathology, 2) evaluate the larynx and trachea prior to airway surgery, 3) monitor postoperative results of airway interventions, and 4) evaluate the airway prior to tracheotomy tube decannulation. CONCLUSIONS: TNT is a safe procedure that can be performed on the unsedated patient using only topical anesthesia and is an attractive alternative to rigid bronchoscopy. The procedural success rate was high, indicating good patient tolerance. The indications for TNT, including its use as a tool for surgical planning, have become better defined. TNT has become a standard tool in the management of patients with airway pathology in our practices.

Comparing guidelines for adjuvant endocrine therapy in postmenopausal women with breast cancer: a coming of age.

Following surgery for early breast cancer, the standard of care for postmenopausal women is adjuvant therapy with any combination of radiation therapy, endocrine therapy, chemotherapy and/or targeted therapy. Clinicians rely on many tools, including guidelines, to make these treatment decisions. Such guidelines include the St Gallen consensus statement, the American Society of Clinical Oncology guidelines and the National Comprehensive Cancer Network guidelines, as well as various regional and national guidelines. Recommendations may vary, because different methods and criteria were used to assess the strength of supporting data. This article provides an overview of global guidelines for the adjuvant treatment of breast cancer and points out the major differences. Ongoing changes are highlighted, particularly those regarding the adjuvant endocrine treatment of postmenopausal women with breast cancer. While previous guidelines recommended tamoxifen alone, all major guidelines now recommend using third-generation aromatase inhibitors either in sequence with tamoxifen or as upfront treatment.

The development and validation of a prediction tool for chemotherapy-induced anemia in patients with advanced nonsmall cell lung cancer receiving palliative chemotherapy.

BACKGROUND: In this study, the development and validation of a cycle-based prediction model for severe anemia [i.e., a hemoglobin (Hb) of or=8 to <10 was identified as the optimal cut off to maximize the sensitivity (83.1%) and specificity (67.8%) of the prediction tool. Patients with a score of >or=8 would be considered at high risk for developing anemia after a particular cycle of chemotherapy. DISCUSSION: We developed and validated an anemia prediction tool for advanced stage NSCLC patients receiving palliative chemotherapy. To make the model available for easy use and access, we have incorporated it on to our risk prediction website: http://www.PredictPatientEvents.com . It is hoped that this risk model will enhance patient care by optimizing the frequency of Hb testing and/or the use of preventative therapies.

Phase II trial evaluating the palliative benefit of second-line zoledronic acid in breast cancer patients with either a skeletal-related event or progressive bone metastases despite first-line bisphosphonate therapy.

PURPOSE: This study evaluated whether additional palliative benefits could be derived from the second-line use of the more potent bisphosphonate zoledronic acid in metastatic breast cancer patients with either progressive bone metastases or skeletal-related events (SRE), despite first-line therapy with either pamidronate or clodronate. PATIENTS AND METHODS: This prospective study evaluated the impact of second-line zoledronic acid on pain, quality of life, and markers of bone turnover (for example, urinary N-telopeptide [NTX]). Patients received monthly zoledronic acid (4 mg) for 3 months. Study evaluations were made weekly during the first month and again at week 8. No changes in chemotherapy or endocrine therapy were allowed in the month before or after commencing study treatment. RESULTS: Thirty-one women completed this study. By week 8, patients had experienced significant improvements in pain control (P < .001). There was a downward trend in urinary NTX levels over the same time period (P = .008). Overall, there was a trend towards a positive correlation between improvement in pain control and reduction in week one urinary NTX relative to baseline (Spearman's rho r = 0.27; P = .15). CONCLUSION: This is the first study to demonstrate that patients with either progressive bone metastases or SREs while on clodronate or pamidronate can have relevant palliative benefits with a switch to the more potent bisphosphonate zoledronic acid. This is reflected by significant improvements in pain control and bone turnover markers. If confirmed in randomized trials, these findings have major implications to the use of bisphosphonates in both the metastatic and adjuvant settings.

The use of complementary and alternative medicines among patients with locally advanced breast cancer--a descriptive study.

BACKGROUND: Complementary and alternative medicine (CAM) use is common among cancer patients. This paper reviews the use of CAM in a series of patients with locally advanced breast cancer (LABC). METHODS: Women with LABC attending a specialist clinic at a single Canadian cancer centre were identified and approached. Participants completed a self-administered survey regarding CAM usage, beliefs associated with CAM usage, views of their risks of developing recurrent cancer and of dying of breast cancer. Responses were scored and compared between CAM users and non-users. RESULTS: Thirty-six patients were approached, 32 completed the questionnaire (response rate 89%). Forty-seven percent of LABC patients were identified as CAM users. CAM users were more likely to be younger, married, in a higher socioeconomic class and of Asian ethnicity than non-users. CAM users were likely to use multiple modalities simultaneously (median 4) with vitamins being the most popular (60%). Motivation for CAM therapy was described as, "assisting their body to heal" (75%), to 'boost the immune system' (56%) and to "give a feeling of control with respect to their treatment" (56%). CAM therapy was used concurrently with conventional treatment in 88% of cases, however, 12% of patients felt that CAM could replace their conventional therapy. Psychological evaluation suggests CAM users perceived their risk of dying of breast cancer was similar to that of the non-Cam group (33% vs. 35%), however the CAM group had less severe anxiety and depression. CONCLUSION: The motivation, objectives and benefits of CAM therapy in a selected population of women with LABC are similar to those reported for women diagnosed with early stage breast cancer. CAM users display less anxiety and depression and are less likely to believe they will die of their breast cancer. However the actual benefit to overall and disease free survival has yet to be demonstrated, as well as the possible interactions with conventional therapy. Consequently more research is needed in this ever-growing field.

Complementary and alternative medicine use is associated with an increased perception of breast cancer risk and death.

PURPOSE: Complementary and alternative medicines (CAMS) are frequently used by patients with breast cancer and their use may be related to the presence of psychosocial distress. The objective of this study is to assess the presence of anxiety and depression in breast cancer patients who use CAM and assess how they perceive their risks of recurrence and dying from breast cancer compared to non-users. METHODS: Breast cancer patients attending ambulatory clinics at a single cancer center were approached by their oncologist. Participants completed a self-administered survey regarding CAM usage, beliefs associated with CAM, views of their risks of developing recurrent cancer, and of dying of breast cancer. The presence of anxiety and depression was scored using the Hospital Anxiety and Depression Scale (HADS). Responses were scored and compared between CAM users and non-users. RESULTS: A total of 251 patients completed the survey. CAM usage was reported by 43% of patients. Individuals who used CAM were younger [53.1 versus 63.0 year (p < 0.001)], had higher education (p < 0.001), were more likely to have full time employment [25.7 versus 16.3% (p < 0.001)] and have private insurance for medications (76 versus 60%, p = 0.007) compared to non-users. CAM users perceived their risk of recurrence (p = 0.011) and death from breast cancer (p = 0.0001) as being significantly greater than non-users. There were no significant differences in anxiety or depression scores between CAM and non-users. CONCLUSION: CAM use is associated with an increased perception of breast cancer recurrence and of breast cancer-related death. There was no association between the presence of anxiety or depression and CAM use. Improved patient understanding of actual risks of recurrence and death are required such that women will be able to make more informed decisions about using CAMs.

Should oral bisphosphonates be standard of care in women with early breast cancer?

There is increasing evidence that oral clodronate has important clinical benefits in early breast cancer. Longer-term follow-up data from two out of three randomized studies have shown that adjuvant clodronate improves survival. This article outlines the results of these studies and discusses the potential role for other bisphosphonates, such as ibandronate and zoledronic acid, in the adjuvant treatment of breast cancer.

Comorbidities in chronic neuropathic pain.

Neuropathic pain arises from a lesion or dysfunction within the nervous system; the specific mechanisms that elicit neuropathic pain symptoms are the subject of ongoing research. It is generally acknowledged that neuropathic pain is extremely difficult to treat, and a major factor impacting outcomes is the presence of comorbidities such as poor sleep, depressed mood, and anxiety. Patients who suffer from chronic pain experience difficulties in initiating and maintaining sleep. Sleep deprivation has been associated with a decreased pain threshold, muscle aches, and stiffness in normal volunteers. The interrelationship of these factors is complex: Many chronic pain patients are depressed and anxious; sleep deprivation can lead to anxiety; and depression can be both the cause and the result of sleep disturbances. Thus, physicians must evaluate all aspects of pain, sleep, and mood in chronic pain patients. Several instruments have been developed to aid physicians in gathering qualitative and quantitative information from chronic pain patients. This triad of chronic pain, sleep disturbances, and depression/anxiety must be fully addressed if the patient is to be restored to optimal functionality. A multidisciplinary team approach allows for treatment of the whole patient. Nonpharmacologic interventions include relaxation therapy, sleep restriction therapy, and cognitive therapy. Strategies for pharmacologic interventions should attempt to maximize outcomes by employing, where possible, agents that address both the pain and the comorbidities. In this way, functionality may be restored and the patient's quality of life improved.