Mindfulness meditation to improve care quality and quality of life in long-term care settings.

Quality of long-term care has been the focus of 2 recent Institute of Medicine reports: "Improving the Quality of Long-Term Care"(1) and "Improving the Quality of Care in Nursing Homes."(2) Although there has been some improvement in care quality since regulatory reforms were enacted in 1987,(3) poor care persists.(4) Certified nursing assistants (CNAs) are challenged in the provision of optimal care by chronic stress in the workplace, leading to absenteeism, reduced job satisfaction, and increased turnover.(5-7) Mindfulness training, which cultivates a practice of being present in the moment, recognizing stressful situations when they arise, and responding to stress in an adaptive manner,(8) holds promise as a simple, inexpensive approach to reduce CNA stress and improve quality of care and quality of life for residents in long-term care settings. Formal and informal mindfulness practices can readily be incorporated into CNA educational programs.

Mindfulness Training to Improve Nurse Clinical Performance: A Pilot Study.

Health care errors are a national concern. Although considerable attention has been placed on reducing errors since a 2000 Institute of Medicine report, adverse events persist. The purpose of this pilot study was to evaluate the effect of mindfulness training, employing the standardized approach of an eight-week mindfulness-based, stress reduction program on reduction of nurse errors in simulated clinical scenarios. An experimental, pre- and post-test control group design was employed with 20 staff nurses and senior nursing students. Although not statistically significant, there were numerical differences in clinical performance scores from baseline when comparing mindfulness and control groups immediately following mindfulness training and after three months. A number of benefits of mindfulness training, such as improved listening skills, were identified. This pilot study supports the benefits of mindfulness training in improving nurse clinical performance and illustrates a novel approach to employ in future research.

A pilot study to determine the safety and feasibility of oropharyngeal administration of own mother's colostrum to extremely low-birth-weight infants.

UNLABELLED: Own mother's colostrum is rich in cytokines and other immune agents that may stimulate oropharyngeal-associated lymphoid tissue if administered oropharyngeally to extremely low-birth-weight (ELBW) infants during the first days of life when enteral feeding is contraindicated. However, the safety and feasibility of the oropharyngeal route for the administration of colostrum have not been determined. PURPOSE: To determine the safety of oropharyngeal administration of own mother's colostrum to ELBW infants in first days of life. A secondary purpose was to investigate the feasibility of (1) delivering this intervention to ELBW infants in the first days of life and (2) measuring concentrations of secretory immunoglobulin A and lactoferrin in tracheal aspirate secretions and urine of these infants. SUBJECTS: Five ELBW infants (mean birth weight and gestational age = 657 g and 25.5 weeks, respectively). DESIGN: Quasi-experimental, 1 group, pretest-posttest design. METHODS: Subjects received 0.2 mL of own mother's colostrum administered oropharyngeally every 2 hours for 48 consecutive hours, beginning at 48 hours of life. Concentrations of secretory immunoglobulin A and lactoferrin were measured in tracheal aspirates and urine of each subject at baseline, at the completion of the intervention and again 2 weeks later. RESULTS: All infants completed the entire treatment protocol, each receiving 24 treatments. A total of 15 urine specimens were collected and 14 were sufficient in volume for analysis. A total of 15 tracheal aspirates were collected, but only 7 specimens (47%) were sufficient in volume for analysis. There was wide variation in concentrations of secretory immunoglobulin A and lactoferrin in urine and tracheal aspirates among the 5 infants; however, several results were outside the limits of assay detection. All infants began to suck on the endotracheal tube during the administration of colostrum drops. Oxygen saturation measures remained stable or increased slightly during each of the treatment sessions. There were no episodes of apnea, bradycardia, hypotension, or other adverse effects associated with the administration of colostrum. CONCLUSIONS: Oropharyngeal administration of own mother's colostrum is easy, inexpensive, and well-tolerated by even the smallest and sickest ELBW infants. Future research should continue to examine the optimal procedure for measuring the direct immune effects of this therapy, as well as the clinical outcomes such as infections, particularly ventilator-associated pneumonia.

Evaluating CAM education in health professions programs.

As medical, nursing, and allied health programs integrate complementary and alternative medicine (CAM) content into existing curricula, they face many of the same challenges to assessment and evaluation as do more traditional aspects of health professions education, namely, (1) specifying measurable objectives, (2) identifying valid indicators, and (3) evaluating the attainment of desired outcomes. Based on the experiences of 14 National Center for Complementary and Alternative Medicine (NCCAM) education grant recipients funded between 2000 and 2003, the authors cite selected examples to illustrate strengths and deficits to "mainstreaming" CAM content into established health professions curricula, including subjecting it to rigorous, systematic evaluation. In addition to offering recommendations for more strenuously evaluating key CAM-related educational outcomes, the authors discuss related attitudes, knowledge, and skills and how these, like other aspects of health professions training, may result in enhanced patient care through modifications in clinical (provider) behaviors.

Lack of association between dyslipidemia and insulin resistance in HIV-infected persons treated with highly active antiretroviral therapy.

OBJECTIVE: Highly active antiretroviral therapy has been implicated in the development of metabolic toxicities, including insulin resistance. Because it is "clinically silent," insulin resistance is often undetected, thus precluding the initiation of treatments that may prevent progression to frank diabetes. Previous studies have documented associations between dyslipidemic profiles and insulin resistance in patients who do not have the human immunodeficiency virus (HIV). Therefore, we explored whether serum lipids, parameters that are routinely measured in patients who have HIV or the acquired immunodeficiency syndrome, could be used to facilitate the identification of insulin resistance in patients infected with HIV. METHODS: Thirty-three adult patients who had clinically stable HIV infection and treated with highly active antiretroviral therapy fasted overnight and underwent phlebotomy to measure the following parameters: insulin levels, blood glucose, triacylglycerols, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and total cholesterol. RESULTS: Of the 33 participants, 15 had dyslipidemia, defined according to Adult Treatment Panel (ATP) III criteria, and 18 did not have dyslipidemia. The two groups did not differ significantly with respect to mean fasting insulin levels (P = 0.68). Only two participants had insulin levels that were higher than the laboratory reference range. No significant correlations were found between fasting insulin levels and any lipid parameters. CONCLUSIONS: Serum lipids are not predictive of fasting insulin levels in adult patients who are treated with highly active antiretroviral therapy. The findings are limited by the low prevalence of insulin resistance in the study sample and the small sample size.

A pilot study of the safety and efficacy of supplemental arginine to enhance immune function in persons with HIV/AIDS.

OBJECTIVE: We collected preliminary data on the safety and efficacy of supplemental arginine to improve natural killer cell cytotoxicity in a sample of persons with human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS). METHODS: In a randomized, double-blind, placebo-controlled pilot study in an academic medical center-based infectious disease clinic, 11 clinically stable, HIV-infected adults had been treated with highly active, antiretroviral therapy and had HIV plasma RNA levels of less than 10 000 copies/mL. Participants were randomly assigned to receive 19.6 g of arginine/d (n = 6) or placebo (n = 5) for 14 d. Plasma HIV RNA levels, neuropsychologic functioning, and self-reported adverse events were analyzed for safety of treatment. Efficacy was measured by natural killer cell cytotoxicity. RESULTS: None of the participants experienced any adverse clinical, virologic, or neuropsychologic events that necessitated withdrawal from the study. The arginine-supplemented group showed a mean natural killer cell cytotoxicity increase of 18.9 lytic units, whereas the placebo group showed an increase of 0.3 lytic units. This difference was not statistically significant (P = 0.79). CONCLUSIONS: Short-term arginine supplementation is safe for persons with HIV/AIDS. Additional studies with larger samples and longer periods are warranted to determine the effects of arginine supplementation on other indices of immune function and on clinical outcomes such as intercurrent illnesses.

A pilot study of the safety and efficacy of cholestin in treating HIV-related dyslipidemia.

OBJECTIVE: We collected preliminary safety and efficacy data on the effects of Cholestin, a statin-containing dietary supplement, in individuals with dsylipidemia related to human immunodeficiency virus. METHODS: Fourteen adults with dsylipidemia related to human immunodeficiency virus characterized by hypercholesterolemia, hypertriacylglycerolemia, or both participated in a randomized, double-blind, placebo-controlled pilot study in an infectious disease clinic based in an academic medical center. Participants were randomly assigned to receive 1.2 g of Cholestin twice daily (n = 7) or placebo (n = 7) for 8 wk. The main outcome measures were safety (hepatic function tests, plasma human immunodeficiency virus-1 RNA levels, CD4(+) cell counts, adverse effects) and efficacy (fasting serum cholesterol: total, high- and low-density lipoproteins, and fasting serum triacylglycerols). Safety and efficacy outcomes were evaluated at 2- and 8-wk intervals. RESULTS: Twelve participants (n = 6 per group) completed the 8-wk treatment protocol. After 8 wk of treatment with Cholestin, there were significant declines from baseline in mean (+/- standard error of the mean) fasting total cholesterol (-30.8 +/- 8.8 versus 7.7 +/- 5.6; P = 0.01) and low-density lipoprotein cholesterol (-32.2 +/- 7.2 versus 26.3 +/- 14.2; P = 0.01) versus placebo. Moreover, the decline in fasting total cholesterol was significant (-40.2 +/- 4.8 versus 2.8 +/- 11.9; P = 0.006) after 2 wk of therapy, at which time the low-density lipoprotein cholesterol approached significance (-30.2 +/- 7.4 versus 4.4 +/- 15.2; P = 0.068). High-density lipoprotein cholesterol and triacylglycerol levels did not change at either time point. No adverse effects were seen with Cholestin. CONCLUSIONS: Cholestin may safely lower total and low-density lipoprotein cholesterol in patients with dsylipidemia related to human immunodeficiency virus. Larger and longer-term trials of this approach are warranted.

Comparison of standard and immune-enhancing oral formulas in asymptomatic HIV-infected persons: a multicenter randomized controlled clinical trial.

BACKGROUND: Both standard and immune-enhancing oral formulas are widely used to forestall HIV wasting and to promote immune function. However, there is little scientific evidence to support the differential effects of these formulas in asymptomatic HIV disease. The aim of this study was to compare the effects of an immune-enhancing oral formula and a standard oral formula on nutrition and immune measures in asymptomatic HIV-infected persons. A secondary aim was to evaluate the feasibility of maintaining a diverse sample of outpatients on a long-term oral formula protocol. METHODS: In this multicenter controlled nonblinded study, 90 asymptomatic HIV-infected persons with CD4 cell counts between 275 and 550 cells/mm3 were randomized to a control group; a standard oral formula group (Ensure Plus); or an immune-enhancing oral formula group (Advera). All groups received basic nutrition counseling. Participants were evaluated on nutrition, immune, and feasibility measures at 3-month intervals during the 12-month study period. Differences in nutrition and immune measures among the 3 groups were analyzed using the Kruskal-Wallis and Wilcoxon tests. Wilcoxon tests and correlation coefficients were used to analyze feasibility data. RESULTS: Sixty-six outpatients completed the 12-month study protocol. Among the 3 groups, there were no significant differences with respect to body weight, bioelectrical impedance analysis (BIA)-derived body cell and fat mass, daily caloric intake, and serum albumin at any of the study visits. Moreover, absolute CD4+ T lymphocytes and percentages did not significantly differ at any time point among the 3 groups. Acceptability and tolerance of the formulas were high for both the standard and immune-enhancing oral formula groups. CONCLUSIONS: Within the context and limitations of this study, standard and immune-enhancing oral formulas consumed daily for 1 year had no differential effects on nutrition or immune parameters in asymptomatic HIV-infected persons.

The effect of mirthful laughter on stress and natural killer cell activity.

CONTEXT: A recent survey of rural Midwestern cancer patients revealed that humor was one of the most frequently used complementary therapies. Psychoneuroimmunology research suggests that, in addition to its established psychological benefits, humor may have physiological effects on immune functioning. OBJECTIVE: To determine the effect of laughter on self-reported stress and natural killer cell activity. DESIGN: Randomized, pre-post test with comparison group. SETTING: Indiana State University Sycamore Nursing Center, which is a nurse-managed community health clinic in a mid-sized, Midwestern city. PARTICIPANTS: 33 healthy adult women. INTERVENTION: Experimental subjects viewed a humorous video while subjects in the distraction control group viewed a tourism video. MAIN OUTCOME MEASURES: Self-reported stress and arousal (Stress Arousal Check List), mirthful laughter (Humor Response Scale), and immune function (chromium release natural killer [NK] cell cytotoxicity assay). RESULTS: Stress decreased for subjects in the humor group, compared with those in the distraction group (U32 = 215.5; P = .004). Amount of mirthful laughter correlated with postintervention stress measures for persons in the humor group (r16 = -.655; P = .004). Subjects who scored greater than 25 on the humor response scale had increased immune function postintervention (t16 = 2.52 P = .037) and compared with the remaining participants (t32 = 32.1; P = .04). Humor response scale scores correlated with changes in NK cell activity (r16 = .744; P = 001). CONCLUSION: Laughter may reduce stress and improve NK cell activity. As low NK cell activity is linked to decreased disease resistance and increased morbidity in persons with cancer and HIV disease, laughter may be a useful cognitive-behavioral intervention.

Mindfulness interventions to reduce stress among nursing personnel: an occupational health perspective.

Workplace stress within health care settings is rampant and predicted to increase in coming years. The profound effects of workplace stress on the health and safety of nursing personnel and the financial impact on organizations are well documented. Although organizational modification can reduce some sources of stress, several unique stress-producing factors inherent in the work of nursing personnel are immutable to such approaches. Mindfulness training, an evidence-based approach to increase situational awareness and positive responses to stressful situations, is an inexpensive strategy to reduce stress and improve the quality of nurses' work lives. Several approaches to training, such as mindfulness-based stress reduction, can be tailored to health care settings. Considerations for occupational health nurses in incorporating mindfulness training as an aspect of a comprehensive work site health promotion program for nursing and other hospital personnel are discussed.

Safety and efficacy of glucomannan for weight loss in overweight and moderately obese adults.

BACKGROUND: Few safe and effective dietary supplements are available to promote weight loss. We evaluated the safety and efficacy of glucomannan, a water-soluble fiber supplement, for achieving weight loss in overweight and moderately obese individuals consuming self-selected diets. METHODS: Participants were randomly assigned to take 1.33 grams of glucomannan or identically looking placebo capsules with 236.6 mL (8 ounces) of water one hour before breakfast, lunch, and dinner for 8 weeks. The primary efficacy outcome was change in body weight after 8 weeks. Other efficacy outcomes were changes in body composition, hunger/fullness, and lipid and glucose concentrations. Safety outcomes included gastrointestinal symptoms/tolerance and serum liver enzymes and creatinine levels. RESULTS: A total of 53 participants (18-65 years of age; BMI 25-35 kg/m²) were enrolled and randomized. The two groups did not differ with respect to baseline characteristics and compliance with the study supplement. At 8 weeks, there was no significant difference between the glucomannan and placebo groups in amount of weight loss (-.40 ± .06 and -.43 ± .07, resp.) or other efficacy outcomes or in any of the safety outcomes. CONCLUSIONS: Glucomannan supplements administered over 8 weeks were well tolerated but did not promote weight loss or significantly alter body composition, hunger/fullness, or lipid and glucose parameters. This trial is registered with NCT00613600.

Case-based online modules to teach graduate-level nursing students about complementary and alternative medical therapies.

We integrated complementary and alternative medicine (CAM)-related content into selected core courses in our master's-level curriculum. To facilitate students' application of the content, we developed evidence-based online case studies and evaluated their effectiveness by comparing students' pretest and posttest scores on multiple-choice quizzes. Findings suggest that evidence-based online case studies are an effective strategy for teaching graduate nursing students about the clinical issues surrounding patients' use of CAM therapies.

Spiritual well-being in individuals with fibromyalgia syndrome: relationships with symptom pattern variability, uncertainty, and psychosocial adaptation.

This study examined relationships among symptom pattern variability, uncertainty, spiritual well-being, and psychosocial adaptation in individuals with fibromyalgia syndrome (FMS). A survey design was used with 58 individuals with FMS. The Fibromyalgia Symptom Pattern Questionnaire, Mishel Uncertainty in Illness Scale--Community Form, Spiritual Well-Being Scale, and Psychosocial Adjustment to Illness Scale-Self Report were used to collect data. Positive relationships were found between symptom pattern variability and uncertainty and between uncertainty and poor psychosocial adaptation; spiritual well-being moderated the relationship between uncertainty and psychosocial adaptation. A positive sense of well-being aided adaptation to symptoms and uncertainties of FMS. Spiritual well-being had a greater effect on the relationship between symptom pattern variability and uncertainty than expected.

HIV infection and obesity: a review of the evidence.

This article provides a review of recent evidence pertinent to the prevalence, morbidities, and predictive value of overweight and obesity in PLWH. Implications for clinical outcomes are discussed, and recommendations for patient management and future research are advanced.

Psychoneuroimmunological Outcomes in Dementia Caregiver Intervention Studies: An Idea Whose Time Has Come?

PURPOSE: Mounting evidence indicates that the chronic stress of family caregiving has physiological effects and that caregiver stress may be associated with changes in the caregiver's physical health. Existing caregiver behavioral intervention studies have focused on caregiver stress and psychological distress outcomes. To date, no known caregiver intervention studies have included psychoneuroimmunological (PNI) outcome measures. Two bodies of literature were reviewed to determine if the current state-of-the-science supports the development of caregiver intervention studies that examine PNI outcomes--first, dementia caregiver PNI studies; and second, cognitive behavioral PNI intervention studies conducted with other clinical populations. CONCLUSIONS: If this line of research is pursued, the following issues need to be addressed: a) sampling strategies and study designs; b) measurement issues; and c) the need for multidisciplinary collaborative research teams. IMPLICATIONS: Nurses' preparation in the biomedical and behavioral sciences establishes a knowledge base that enables nurses to apply a PNI model in clinical situations. Their preparation and access to family caregivers put them in a unique position to design and implement improved caregiver interventions that focus on caregiver psychological, physiological, and physical health outcomes.