Pilot Randomized Trial of a Three Times Weekly Heparin Flushing Intervention in Children, Adolescents, and Young Adults With Cancer With Tunneled Central Venous Catheters.

Background: Children and adolescents with cancer often undergo aggressive treatment and receive supportive care requiring a long-term tunneled central venous catheter (TCVC). Regular flushing promotes TCVC patency when not in use (i.e., noninfusing). However, TCVC flushing guidelines and the current practice of daily flushing are not based on high-quality evidence. Few studies have compared the effect of less frequent flushing on TCVC patency. The purpose of this study was to evaluate the feasibility of a three times weekly heparin flushing intervention, as compared to daily heparin flushing, in children and adolescents and young adults (AYAs) with noninfusing TCVCs. Methods: Twenty children and AYAs were randomized to one of two groups, standard of care (SOC) (i.e., daily heparin flushing) or intervention (three times weekly heparin flushing) for 8 weeks. Feasibility data (recruitment, retention, acceptability, TCVC patency, and complications) were analyzed descriptively. Results: Twenty of 22 eligible patients were enrolled in the study (90% recruitment rate). Four participants discontinued the study early due to TCVC removal (20% attrition rate). One participant in each group had their TCVC removed due to a central line-associated bloodstream infection, one SOC group participant had their TCVC removed due to damage, and one intervention group participant had their TCVC removed due to discontinuation of treatment. No participants were withdrawn for safety concerns or because they did not find the protocol acceptable. Conclusions: It is feasible to conduct a large-scale randomized controlled trial to investigate a three times weekly heparin flushing intervention in children and AYAs with TCVCs.

Effects of Classical Music Virtual Reality on Pediatric Healthcare Worker Compassion Fatigue.

OBJECTIVE: The aim of this study was to explore the impact of classical music virtual reality (VR) on burnout, secondary traumatic stress, anxiety, and capacity for developing caring relationships with patients among healthcare workers (HCWs). BACKGROUND: COVID-19 accentuated the importance of promoting the well-being of frontline workers. Efforts to address the mental health needs of HCWs are likely to positively impact patient outcomes. METHODS: Healthcare workers completed 3 sessions of VR. A Wilcoxon rank-sum test was used to compare premeasure versus postmeasure on the Professional Quality of Life (ProQOL), State Trait Anxiety Inventory, and Caring Ability Inventory. Analysis of variance was performed to identify associations between the intervention and differences in scores for each ProQOL domain. Bonferroni correction adjusted for multiple comparisons. Fisher's t test was used for categorical analysis. RESULTS: Seventy-one HCWs completed the study. There was a significant reduction in burnout after the experience, compared with baseline. CONCLUSIONS: This study provides evidence that classical music VR may reduce burnout in HCWs.

Pilot randomized controlled trial of the Yoga for HEART intervention in community-dwelling older adults.

Physical activity reduces cardiovascular risk; however, many older adults do not engage in recommended levels. Theory-based interventions supporting motivation for physical activity are limited. This pilot study evaluated the feasibility of Yoga for Health Empowerment and Realizing Transformation (HEART), a theory-based intervention combining motivation and yoga-based physical activity. Feasibility was addressed as acceptability, demand, implementation fidelity, and limited efficacy in promoting physical activity, cardiovascular health, and mechanisms of action. Sedentary older adults (m = 65 years old, sd = 8.5) were randomized to Yoga for HEART (n=8) or Active Control (n=7) conditions. Yoga for HEART was: (a) acceptable, (b) retention 73%, (c) implemented as planned. A significant main effect for body mass index (BMI) was found in Yoga for HEART participants (p = .02). No significant effects were found for physical activity, other cardiovascular outcomes, or mechanisms of action. Yoga for HEART is feasible and recommended for further testing.

Effects of Acupuncture and Acupressure on Burnout in Health Care Workers: A Randomized Trial.

BACKGROUND: Health care workers face occupational stressors that may lead to burnout and secondary traumatic stress. Strategies to mitigate the negative psychological impact on frontline workers are urgently needed. OBJECTIVE: The purpose of this study was to evaluate the effect of auricular acupuncture or acupressure, as compared with ear massage, on anxiety, burnout, and caring capacity in health care workers. Results were stratified on the basis of subject's level of belief in traditional Chinese medicine. METHODS: This prospective randomized trial with an open, parallel-group design was conducted at a 334-bed Level II pediatric trauma center. Participants were randomized to one of three groups: (1) auricular acupuncture, (2) auricular seed acupressure, or (3) auricular massage. Interventions were delivered over 3 weeks. Self-reported State-Trait Anxiety Inventory (STAI), Professional Quality of Life (ProQOL), and Caring Ability Inventory (CAI) scores were analyzed using a pre-/posttest design. Univariate analysis, Fisher's exact test, and analysis of variance (ANOVA) were performed to assess group differences. RESULTS: A total of 117 (36%) of 325 eligible participants consented to participate in the study. Seed acupressure treatment (n = 14, 35.9%, one male, 13 females) was associated with a reduction in burnout (ANOVA, p = .04) and secondary traumatic stress (p = .03). This effect remained significant after adjusting for individual pretest scores (ANOVA, p = .05). The studied interventions did not have a significant effect on STAI, ProQOL, or CAI scores. CONCLUSIONS: Auricular acupressure is a safe, effective, and practical strategy to reduce burnout and secondary traumatic stress and may support health care workers' ability to develop caring relationships with patients and families.

Novel use of a midline catheter for therapeutic and donor apheresis in children and adults.

BACKGROUND: Apheresis procedures require adequate vascular access to achieve optimal inlet flow rates. While central lines provide such access, their placement and use are associated with risks; some of these risks are minimized if peripheral intravenous access can be established. However, peripheral intravenous access is associated with challenges in the pediatric setting. Research indicates that midline catheters reduce the use of CVADs and their associated risks. The use of midline catheters for apheresis has been reported recently in adults, but no studies have been published on their use in children. Thus, the purpose of this study was to evaluate the use of midline catheters for apheresis in the pediatric setting. METHODS: A retrospective observational study was conducted to evaluate the safety and efficacy of midline catheters in subjects who underwent apheresis at a pediatric hospital from April 2018 to August 2020. Demographic data, clinical data (diagnosis, procedure, catheter size, body mass), and outcome data (inlet flow rate, total blood volume [TBV] processed, procedure time, and cell counts) were collected. RESULTS: Eighteen subjects received a total of 100 midline catheters for 73 apheresis procedures. Inlet flow rates ranged from 45 to 80 mL/min, TBV ranged from 2872 to 20 000 mL, and procedure time ranged from 1.25 to 7 hours. Inlet flow rates met or exceeded the recommended inlet flow rates for apheresis in children and adults (P < .0001). No adverse events occurred. CONCLUSION: Midline catheters provide safe and effective vascular access for apheresis. Future research should include younger patients with lower body mass.

Systematic Review of Yoga Interventions to Promote Cardiovascular Health in Older Adults.

The benefits of physical activity are well established, yet few older adults engage in adequate physical activity to optimize health. While yoga may reduce the risk of cardiovascular disease, few studies have focused on the efficacy of yoga-based physical activity to promote cardiovascular health in older adults. The objective of this review is to provide an evaluation of yoga interventions to reduce cardiovascular risk in older adults. Four databases were searched for randomized controlled trials of yoga interventions in older adults. Studies with cardiovascular outcomes were included. Literature searches identified nine articles eligible for review. Significant health benefits were reported, including favorable changes in blood pressure, body composition, glucose, and lipids. Yoga practices, participant characteristics, and outcome measures were variable. There was limited use of theory. Yoga is safe and feasible in older adults; additional research is warranted to examine the specific components of yoga interventions essential to reducing cardiovascular risk.