Acupuncture for analgesia in veterinary medicine.

Acupuncture for analgesia is growing rapidly in popularity with veterinarians and pet owners. This article summarizes the mechanisms of analgesia derived from acupuncture and reviews current literature on the topic. Areas covered include the local effects at area of needle insertion, systemic effects secondary to circulating neurotransmitters and changes in cell signaling, central nervous system effects including the brain and spinal cord, and myofascial trigger point and pathology treatment. Clinical applications are discussed and suggested in each section. When used by appropriately trained professionals, acupuncture offers a compelling and safe method for pain management in our veterinary patients and should be strongly considered as a part of multimodal pain management plans.

Desired elements and timing of cancer survivorship care: one approach may not fit all.

INTRODUCTION: Although survivorship care recommendations exist, there is limited evidence about current practices and patient preferences. METHODS: A cross-sectional survey was completed by survivors of lymphoma, head and neck, and gastrointestinal cancers at an academic cancer center. The survey was designed to capture patients' reports of receipt of survivorship care planning and their attitudes, preferences, and perceived needs regarding content and timing of cancer survivorship care information. Elements of survivorship care were based on the Institute of Medicine recommendations, literature review, and clinical experience. RESULTS: Eighty-five survivors completed the survey (response rate, 81%). More than 75% reported receiving a follow-up plan or appointment schedule, a monitoring plan for scans and blood tests, information about short- and long-term adverse effects, and a detailed treatment summary. These elements were reported as desired by more than 90% of responders. Approximately 40% of these elements were only verbally provided. Although more than 70% described not receiving information about employment, smoking cessation, sexual health, genetic counseling, fertility, or financial resources, these elements were not reported as desired. However, "strategies to cope with the fear of recurrence" was most often omitted, yet desired by most respondents. Survivors' preferences regarding optimal timing for information varied depending on the element. CONCLUSIONS: Our study suggests that cancer survivorship care planning is heterogeneous and may not need to be comprehensive, but rather tailored to individual survivors' needs. Providers must assess patient needs early and continue to revisit them during the cancer care continuum.

African American, Chinese, and Latino family caregivers' impressions of the onset and diagnosis of dementia: cross-cultural similarities and differences.

PURPOSE: We explored cross-cultural similarities and differences in minority family caregivers' perceptions of the onset and diagnosis of Alzheimer's disease in their relatives, with specific attention to clinical encounters. DESIGN AND METHODS: We performed a meta-synthesis of three qualitative studies conducted in Massachusetts with 22 African American, Latino, and Chinese caregivers. RESULTS: All participants conveyed striking similarities of thought about normalization of cognitive symptoms until one critical event, usually relocation, precipitated family awareness that an elder's behavior was not the result of "normal aging." A lack of knowledge about Alzheimer's disease, rather than culturally influenced beliefs, was the major deterrent to having an elder's memory assessed. Community physicians' failure to recognize Alzheimer's disease or refer to specialists was more problematic than language or ethnic differences. Physicians' disrespect for caregivers' concerns about memory loss was particularly noted by African Americans, stigmatization of persons with Alzheimer's disease was noted by Chinese, and fears that acculturation would end family home care was noted by Latinos. IMPLICATIONS: Amid ethnocultural differences, there are many similarities in needs that offer providers the possibility to unify quality improvements in Alzheimer's disease outreach, education, and physicians' services. Suggestions include providing the public with more confidential access to Alzheimer's disease information, increasing dementia awareness among community physicians, motivating clinicians to adopt culturally sensitive communication patterns, and providing community education to reduce normalization by families and stigmatization of persons with Alzheimer's disease.

Dementia caregiving: the experiences of Hispanic/Latino caregivers.

The purpose of this study was to explore the phenomenon of dementia caregiving in an ethnically diverse group of Latino caregivers, with the goal of identifying cultural influences on the caregiving experience. This qualitative, descriptive, cross-sectional study used Leininger's ethnonursing approach. There were more similarities than differences in this multiethnic sample of Latino caregivers in understanding of dementia symptoms, beliefs about the caregiving role, and in the factors affecting ongoing care. A lack of knowledge about dementia, rather than culturally influenced beliefs, was the major deterrent to recognition of initial symptoms. Participants viewed family-centered home care as a culturally embedded value but were willing to consider placement when home care became impractical. Providers need to understand the ways in which caregivers must negotiate the tension between cultural beliefs and the demands of their individual circumstances.