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Clinical Inquiries: Does exercise relieve vasomotor menopausal symptoms?

Sat, 2019-04-13 07:28
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Clinical Inquiries: Does exercise relieve vasomotor menopausal symptoms?

J Fam Pract. 2018 03;67(3):175-176

Authors: Lyon C, Mullen R, Deffenbacher B, Reed A, Nashelsky J

Abstract
No. Exercise doesn't decrease the frequency or severity of vasomotor menopausal symptoms in perimenopausal and postmenopausal women (strength of recommendation: A, systematic review of randomized controlled trials [RCTs] and consistent RCT).

PMID: 29509823 [PubMed - indexed for MEDLINE]

Categories: Mind Body Medicine

Use of Pain Neuroscience Education, Tactile Discrimination, and Graded Motor Imagery in an Individual With Frozen Shoulder.

Sat, 2019-04-13 07:28
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Use of Pain Neuroscience Education, Tactile Discrimination, and Graded Motor Imagery in an Individual With Frozen Shoulder.

J Orthop Sports Phys Ther. 2018 03;48(3):174-184

Authors: Sawyer EE, McDevitt AW, Louw A, Puentedura EJ, Mintken PE

Abstract
Study Design Case report. Background Aggressive physical therapy in the freezing stage of frozen shoulder may prolong the course of recovery. Central sensitization may play a role in the early stages of frozen shoulder. Pain neuroscience education, tactile discrimination, and graded motor imagery have been used in a number of conditions with central sensitization. The purpose of this case report was to describe the examination and treatment of a patient in the freezing stage of frozen shoulder using pain neuroscience education, tactile discrimination, and graded motor imagery. Case Description A 54-year-old woman with a diagnosis of frozen shoulder was referred by an orthopaedic surgeon following lack of progress after 4 weeks of intensive daily physical therapy. Pain at rest was 7/10, and her Shoulder Pain and Disability Index score was 64%. She had painful and limited active range of motion and elevated fear-avoidance beliefs. Tactile discrimination and limb laterality were impaired, with signs of central sensitization. A "top-down" approach using pain neuroscience education, tactile discrimination, and graded motor imagery was used for the first 6 weeks, followed by a "bottom-up" impairment-based approach. Outcomes The patient was seen for 20 sessions over 12 weeks. At discharge, her Shoulder Pain and Disability Index score was 22%, resting pain was 0/10, and fear-avoidance beliefs improved. Improvements in active range of motion, laterality, and tactile discrimination were also noted. Discussion Intensive physical therapy in the freezing stage of frozen shoulder may be detrimental to long-term outcomes. This case report suggests that a top-down approach may allow a quicker transition through the freezing stage of frozen shoulder. Level of Evidence Therapy, level 5. J Orthop Sports Phys Ther 2018;48(3):174-184. Epub 19 Dec 2017. doi:10.2519/jospt.2018.7716.

PMID: 29257926 [PubMed - indexed for MEDLINE]

Categories: Mind Body Medicine

Brain plasticity following MI-BCI training combined with tDCS in a randomized trial in chronic subcortical stroke subjects: a preliminary study.

Fri, 2019-04-12 07:25
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Brain plasticity following MI-BCI training combined with tDCS in a randomized trial in chronic subcortical stroke subjects: a preliminary study.

Sci Rep. 2017 08 23;7(1):9222

Authors: Hong X, Lu ZK, Teh I, Nasrallah FA, Teo WP, Ang KK, Phua KS, Guan C, Chew E, Chuang KH

Abstract
Brain-computer interface-assisted motor imagery (MI-BCI) or transcranial direct current stimulation (tDCS) has been used in stroke rehabilitation, though their combinatory effect is unknown. We investigated brain plasticity following a combined MI-BCI and tDCS intervention in chronic subcortical stroke patients with unilateral upper limb disability. Nineteen patients were randomized into tDCS and sham-tDCS groups. Diffusion and perfusion MRI, and transcranial magnetic stimulation were used to study structural connectivity, cerebral blood flow (CBF), and corticospinal excitability, respectively, before and 4 weeks after the 2-week intervention. After quality control, thirteen subjects were included in the CBF analysis. Eleven healthy controls underwent 2 sessions of MRI for reproducibility study. Whereas motor performance showed comparable improvement, long-lasting neuroplasticity can only be detected in the tDCS group, where white matter integrity in the ipsilesional corticospinal tract and bilateral corpus callosum was increased but sensorimotor CBF was decreased, particularly in the ipsilesional side. CBF change in the bilateral parietal cortices also correlated with motor function improvement, consistent with the increased white matter integrity in the corpus callosum connecting these regions, suggesting an involvement of interhemispheric interaction. The preliminary results indicate that tDCS may facilitate neuroplasticity and suggest the potential for refining rehabilitation strategies for stroke patients.

PMID: 28835651 [PubMed - indexed for MEDLINE]

Categories: Mind Body Medicine

Different training durations and styles of tai chi for glucose control in patients with type 2 diabetes: a systematic review and meta-analysis of controlled trials.

Thu, 2019-04-11 07:23
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Different training durations and styles of tai chi for glucose control in patients with type 2 diabetes: a systematic review and meta-analysis of controlled trials.

BMC Complement Altern Med. 2019 Mar 14;19(1):63

Authors: Xia TW, Yang Y, Li WH, Tang ZH, Li ZR, Qiao LJ

Abstract
BACKGROUND: Physical activity is an important part of the diabetes management plan. However, the effects caused by different training durations and styles of Tai Chi have not been evaluated. We conducted an updated systematic review of the effects of Tai Chi on patients with type 2 diabetes based on different training durations and styles.
METHODS: We performed a search for Chinese and English studies in 8 databases. Two reviewers independently selected the eligible trials and conducted a critical appraisal of the methodological quality.
RESULTS: Seventeen trials were included. Tai Chi was found to have reduced fasting blood glucose (FBG) [SMD = - 0.54, 95% CI (- 0.91, - 0.16), P = 0.005] and HbA1c [SMD = - 0.68, 95% CI (- 1.17, - 0.19), P = 0.006] overall, compared with a control group. Considering the subgroup analysis, the pooled results showed that 24 movements or Yang-style Tai Chi did not significantly reduce FBG after a duration of ≤3 months [SMD = - 0.46, 95% CI (- 1.42, 0.50), P = 0.35] or > 3 months [SMD = - 0.50, 95% CI (- 1.49, 0.49), P = 0.32], nor did it reduce HbA1c [SMD = - 1.22, 95% CI (- 2.90, 0.47), P = 0.16] after a duration > 3 months in all studies. However, other styles of Tai Chi significantly reduced FBG [SMD = - 0.90, 95% CI (- 1.28, - 0.52), P < 0.00001] and HbA1c [SMD = - 0.90, 95% CI (- 1.28, - 0.52), P < 0.00001] after a duration > 3 months, while no significant reduction in FBG [SMD = - 0.34, 95% CI (- 0.76, 0.08), P = 0.12] or HbA1c [SMD = - 0.34, 95% CI (- 0.76, 0.08), P = 0.12] was found after a duration ≤3 months.
CONCLUSIONS: Tai Chi seems to be effective in treating type 2 diabetes. Different training durations and styles result in variable effectiveness. The evidence was insufficient to support whether long-term Tai Chi training was more effective.

PMID: 30871517 [PubMed - indexed for MEDLINE]

Categories: Mind Body Medicine

Exercise for preventing falls in older people living in the community.

Thu, 2019-04-11 07:23
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Exercise for preventing falls in older people living in the community.

Cochrane Database Syst Rev. 2019 Jan 31;1:CD012424

Authors: Sherrington C, Fairhall NJ, Wallbank GK, Tiedemann A, Michaleff ZA, Howard K, Clemson L, Hopewell S, Lamb SE

Abstract
BACKGROUND: At least one-third of community-dwelling people over 65 years of age fall each year. Exercises that target balance, gait and muscle strength have been found to prevent falls in these people. An up-to-date synthesis of the evidence is important given the major long-term consequences associated with falls and fall-related injuries OBJECTIVES: To assess the effects (benefits and harms) of exercise interventions for preventing falls in older people living in the community.
SEARCH METHODS: We searched CENTRAL, MEDLINE, Embase, three other databases and two trial registers up to 2 May 2018, together with reference checking and contact with study authors to identify additional studies.
SELECTION CRITERIA: We included randomised controlled trials (RCTs) evaluating the effects of any form of exercise as a single intervention on falls in people aged 60+ years living in the community. We excluded trials focused on particular conditions, such as stroke.
DATA COLLECTION AND ANALYSIS: We used standard methodological procedures expected by Cochrane. Our primary outcome was rate of falls.
MAIN RESULTS: We included 108 RCTs with 23,407 participants living in the community in 25 countries. There were nine cluster-RCTs. On average, participants were 76 years old and 77% were women. Most trials had unclear or high risk of bias for one or more items. Results from four trials focusing on people who had been recently discharged from hospital and from comparisons of different exercises are not described here.Exercise (all types) versus control Eighty-one trials (19,684 participants) compared exercise (all types) with control intervention (one not thought to reduce falls). Exercise reduces the rate of falls by 23% (rate ratio (RaR) 0.77, 95% confidence interval (CI) 0.71 to 0.83; 12,981 participants, 59 studies; high-certainty evidence). Based on an illustrative risk of 850 falls in 1000 people followed over one year (data based on control group risk data from the 59 studies), this equates to 195 (95% CI 144 to 246) fewer falls in the exercise group. Exercise also reduces the number of people experiencing one or more falls by 15% (risk ratio (RR) 0.85, 95% CI 0.81 to 0.89; 13,518 participants, 63 studies; high-certainty evidence). Based on an illustrative risk of 480 fallers in 1000 people followed over one year (data based on control group risk data from the 63 studies), this equates to 72 (95% CI 52 to 91) fewer fallers in the exercise group. Subgroup analyses showed no evidence of a difference in effect on both falls outcomes according to whether trials selected participants at increased risk of falling or not.The findings for other outcomes are less certain, reflecting in part the relatively low number of studies and participants. Exercise may reduce the number of people experiencing one or more fall-related fractures (RR 0.73, 95% CI 0.56 to 0.95; 4047 participants, 10 studies; low-certainty evidence) and the number of people experiencing one or more falls requiring medical attention (RR 0.61, 95% CI 0.47 to 0.79; 1019 participants, 5 studies; low-certainty evidence). The effect of exercise on the number of people who experience one or more falls requiring hospital admission is unclear (RR 0.78, 95% CI 0.51 to 1.18; 1705 participants, 2 studies, very low-certainty evidence). Exercise may make little important difference to health-related quality of life: conversion of the pooled result (standardised mean difference (SMD) -0.03, 95% CI -0.10 to 0.04; 3172 participants, 15 studies; low-certainty evidence) to the EQ-5D and SF-36 scores showed the respective 95% CIs were much smaller than minimally important differences for both scales.Adverse events were reported to some degree in 27 trials (6019 participants) but were monitored closely in both exercise and control groups in only one trial. Fourteen trials reported no adverse events. Aside from two serious adverse events (one pelvic stress fracture and one inguinal hernia surgery) reported in one trial, the remainder were non-serious adverse events, primarily of a musculoskeletal nature. There was a median of three events (range 1 to 26) in the exercise groups.Different exercise types versus controlDifferent forms of exercise had different impacts on falls (test for subgroup differences, rate of falls: P = 0.004, I² = 71%). Compared with control, balance and functional exercises reduce the rate of falls by 24% (RaR 0.76, 95% CI 0.70 to 0.81; 7920 participants, 39 studies; high-certainty evidence) and the number of people experiencing one or more falls by 13% (RR 0.87, 95% CI 0.82 to 0.91; 8288 participants, 37 studies; high-certainty evidence). Multiple types of exercise (most commonly balance and functional exercises plus resistance exercises) probably reduce the rate of falls by 34% (RaR 0.66, 95% CI 0.50 to 0.88; 1374 participants, 11 studies; moderate-certainty evidence) and the number of people experiencing one or more falls by 22% (RR 0.78, 95% CI 0.64 to 0.96; 1623 participants, 17 studies; moderate-certainty evidence). Tai Chi may reduce the rate of falls by 19% (RaR 0.81, 95% CI 0.67 to 0.99; 2655 participants, 7 studies; low-certainty evidence) as well as reducing the number of people who experience falls by 20% (RR 0.80, 95% CI 0.70 to 0.91; 2677 participants, 8 studies; high-certainty evidence). We are uncertain of the effects of programmes that are primarily resistance training, or dance or walking programmes on the rate of falls and the number of people who experience falls. No trials compared flexibility or endurance exercise versus control.
AUTHORS' CONCLUSIONS: Exercise programmes reduce the rate of falls and the number of people experiencing falls in older people living in the community (high-certainty evidence). The effects of such exercise programmes are uncertain for other non-falls outcomes. Where reported, adverse events were predominantly non-serious.Exercise programmes that reduce falls primarily involve balance and functional exercises, while programmes that probably reduce falls include multiple exercise categories (typically balance and functional exercises plus resistance exercises). Tai Chi may also prevent falls but we are uncertain of the effect of resistance exercise (without balance and functional exercises), dance, or walking on the rate of falls.

PMID: 30703272 [PubMed - indexed for MEDLINE]

Categories: Mind Body Medicine

Aerobic physical exercise for adult patients with haematological malignancies.

Thu, 2019-04-11 07:23
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Aerobic physical exercise for adult patients with haematological malignancies.

Cochrane Database Syst Rev. 2019 01 31;1:CD009075

Authors: Knips L, Bergenthal N, Streckmann F, Monsef I, Elter T, Skoetz N

Abstract
BACKGROUND: Although people with haematological malignancies have to endure long phases of therapy and immobility, which is known to diminish their physical performance level, the advice to rest and avoid intensive exercises is still common practice. This recommendation is partly due to the severe anaemia and thrombocytopenia from which many patients suffer. The inability to perform activities of daily living restricts them, diminishes their quality of life and can influence medical therapy.
OBJECTIVES: In this update of the original review (published in 2014) our main objective was to re-evaluate the efficacy, safety and feasibility of aerobic physical exercise for adults suffering from haematological malignancies considering the current state of knowledge.
SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library, 2018, Issue 7) and MEDLINE (1950 to July 2018) trials registries (ISRCTN, EU clinical trials register and clinicaltrials.gov) and conference proceedings. We did not apply any language restrictions. Two review authors independently screened search results, disagreements were solved by discussion.
SELECTION CRITERIA: We included randomised controlled trials (RCTs) comparing an aerobic physical exercise intervention, intending to improve the oxygen system, in addition to standard care with standard care only for adults suffering from haematological malignancies. We also included studies that evaluated aerobic exercise in addition to strength training. We excluded studies that investigated the effect of training programmes that were composed of yoga, tai chi chuan, qigong or similar types of exercise. We also excluded studies exploring the influence of strength training without additive aerobic exercise as well as studies assessing outcomes without any clinical impact.
DATA COLLECTION AND ANALYSIS: Two review authors independently screened search results, extracted data and assessed the quality of trials. We used risk ratios (RRs) for adverse events, mortality and 100-day survival, standardised mean differences (SMD) for quality of life (QoL), fatigue, and physical performance, and mean differences (MD) for anthropometric measurements.
MAIN RESULTS: In this update, nine trials could be added to the nine trials of the first version of the review, thus we included eighteen RCTs involving 1892 participants. Two of these studies (65 participants) did not provide data for our key outcomes (they analysed laboratory values only) and one study (40 patients) could not be included in the meta-analyses, as results were presented as changes scores only and not as endpoint scores. One trial (17 patients) did not report standard errors and could also not be included in meta-analyses. The overall potential risk of bias in the included trials is unclear, due to poor reporting.The majority of participants suffered from acute lymphoblastic leukaemia (ALL), acute myeloid leukaemia (AML), malignant lymphoma and multiple myeloma, and eight trials randomised people receiving stem cell transplantation. Mostly, the exercise intervention consisted of various walking intervention programmes with different duration and intensity levels.Our primary endpoint overall survival (OS) was only reported in one of these studies. The study authors found no evidence for a difference between both arms (RR = 0.67; P = 0.112). Six trials (one trial with four arms, analysed as two sub-studies) reported numbers of deceased participants during the course of the study or during the first 100 to 180 days. For the outcome mortality, there is no evidence for a difference between participants exercising and those in the control group (RR 1.10; 95% CI 0.79 to 1.52; P = 0.59; 1172 participants, low-certainty evidence).For the following outcomes, higher numbers indicate better outcomes, with 1 being the best result for the standardised mean differences. Eight studies analysed the influence of exercise intervention on QoL. It remains unclear, whether physical exercise improves QoL (SMD 0.11; 95% CI -0.03 to 0.24; 1259 participants, low-certainty evidence). There is also no evidence for a difference for the subscales physical functioning (SMD 0.15; 95% CI -0.01 to 0.32; 8 trials, 1329 participants, low-certainty evidence) and anxiety (SMD 0.03; 95% CI -0.30 to 0.36; 6 trials, 445 participants, very low-certainty evidence). Depression might slightly be improved by exercising (SMD 0.19; 95% CI 0.0 to 0.38; 6 trials, 445 participants, low-certainty evidence). There is moderate-certainty evidence that exercise probably improves fatigue (SMD 0.31; 95% CI 0.13 to 0.48; 9 trials, 826 patients).Six trials (435 participants) investigated serious adverse events. We are very uncertain, whether additional exercise leads to more serious adverse events (RR 1.39; 95% CI 0.94 to 2.06), based on very low-certainty evidence.In addition, we are aware of four ongoing trials. However, none of these trials stated, how many patients they will recruit and when the studies will be completed, thus, potential influence of these trials for the current analyses remains unclear.
AUTHORS' CONCLUSIONS: Eighteen, mostly small RCTs did not identify evidence for a difference in terms of mortality. Physical exercise added to standard care might improve fatigue and depression. Currently, there is inconclusive evidence regarding QoL, physical functioning, anxiety and SAEs .We need further trials with more participants and longer follow-up periods to evaluate the effects of exercise intervention for people suffering from haematological malignancies. To enhance comparability of study data, development and implementation of core sets of measuring devices would be helpful.

PMID: 30702150 [PubMed - indexed for MEDLINE]

Categories: Mind Body Medicine

Future directions in meditation research: Recommendations for expanding the field of contemplative science.

Thu, 2019-04-11 07:23
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Future directions in meditation research: Recommendations for expanding the field of contemplative science.

PLoS One. 2018;13(11):e0205740

Authors: Vieten C, Wahbeh H, Cahn BR, MacLean K, Estrada M, Mills P, Murphy M, Shapiro S, Radin D, Josipovic Z, Presti DE, Sapiro M, Chozen Bays J, Russell P, Vago D, Travis F, Walsh R, Delorme A

Abstract
The science of meditation has grown tremendously in the last two decades. Most studies have focused on evaluating the clinical effectiveness of mindfulness-based interventions, neural and other physiological correlates of meditation, and individual cognitive and emotional aspects of meditation. Far less research has been conducted on more challenging domains to measure, such as group and relational, transpersonal and mystical, and difficult aspects of meditation; anomalous or extraordinary phenomena related to meditation; and post-conventional stages of development associated with meditation. However, these components of meditation may be crucial to people's psychological and spiritual development, could represent important mediators and/or mechanisms by which meditation confers benefits, and could themselves be important outcomes of meditation practices. In addition, since large numbers of novices are being introduced to meditation, it is helpful to investigate experiences they may encounter that are not well understood. Over the last four years, a task force of meditation researchers and teachers met regularly to develop recommendations for expanding the current meditation research field to include these important yet often neglected topics. These meetings led to a cross-sectional online survey to investigate the prevalence of a wide range of experiences in 1120 meditators. Results show that the majority of respondents report having had many of these anomalous and extraordinary experiences. While some of the topics are potentially controversial, they can be subjected to rigorous scientific investigation. These arenas represent largely uncharted scientific terrain and provide excellent opportunities for both new and experienced researchers. We provide suggestions for future directions, with accompanying online materials to encourage such research.

PMID: 30403693 [PubMed - indexed for MEDLINE]

Categories: Mind Body Medicine

Rigor, reproducibility, and novel methodological approaches to eating disorders research.

Thu, 2019-04-11 07:23
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Rigor, reproducibility, and novel methodological approaches to eating disorders research.

Int J Eat Disord. 2018 07;51(7):591-592

Authors: Hildebrandt T, Crosby RD

Abstract
The explosion of new methods in science has put additional pressure on authors, readers, and peer reviewers to evaluate the rigor and reproducibility of these new approaches. This issue brings together a collection of articles aimed to stimulate our thinking about how to evaluate the quality of these new methodologies, in the form of several expert reviews on domains ranging from large scale genetics to clinical interventions. These expert reviews are followed by a collection of papers intended to illustrate new or underrepresented methods in our field and include novel approaches to clinical trials to the quantification of text data collected from public repositories online. The issue concludes with a number of original data papers applying network analysis to study comorbidity and symptom status in eating disorder and related populations and a couple of novel neuroimaging papers demonstrating the use of new and promising methods for studying heterogeneity and the use of psychophysiology to answer questions about emotion in eating disorder populations.

PMID: 30189114 [PubMed - indexed for MEDLINE]

Categories: Mind Body Medicine

Vision rehabilitation with biofeedback training.

Thu, 2019-04-11 07:23
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Vision rehabilitation with biofeedback training.

Can J Ophthalmol. 2018 06;53(3):e83-e84

Authors: Nido MD, Markowitz SN

PMID: 29784180 [PubMed - indexed for MEDLINE]

Categories: Mind Body Medicine

The physical postures of yoga practices may protect against depressive symptoms, even as life stressors increase: a moderation analysis.

Thu, 2019-04-11 07:23
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The physical postures of yoga practices may protect against depressive symptoms, even as life stressors increase: a moderation analysis.

Psychol Health Med. 2018 Aug;23(7):870-879

Authors: Franklin RA, Butler MP, Bentley JA

Abstract
Yoga contains sub-components related to its physical postures (asana), breathing methods (pranayama), and meditation (dhyana). To test the hypothesis that specific yoga practices are associated with reduced psychological distress, 186 adults completed questionnaires assessing life stressors, symptom severity, and experience with each of these aspects of yoga. Each yoga sub-component was found to be negatively correlated with psychological distress indices. However, differing patterns of relationship to psychological distress symptoms were found for each yoga sub-component. Experience with asana was negatively correlated with global psychological distress (r = -.21, p < .01), and symptoms of anxiety (r = -.18, p = .01) and depression (r = -.17, p = .02). These relationships remained statistically significant after accounting for variance attributable to Social Readjustment Rating Scale scores (GSI: r = -.19, p = .01; BSI Anxiety: r = -.16, p = .04; BSI Depression: r = -.14, p = .05). By contrast, the correlations between other yoga sub-components and symptom subscales became non-significant after accounting for exposure to life stressors. Moreover, stressful life events moderated the predictive relationship between amount of asana experience and depressive symptoms. Asana was not related to depressive symptoms at low levels of life stressors, but became associated at mean (t[182] = -2.73, p < .01) and high levels (t[182] = -3.56, p < .001). Findings suggest asana may possess depressive symptom reduction benefits, particularly as life stressors increase. Additional research is needed to differentiate whether asana has an effect on psychological distress, and to better understand potential psychophysiological mechanisms of action.

PMID: 29308657 [PubMed - indexed for MEDLINE]

Categories: Mind Body Medicine

Self-Care Strategies for Professional Development: Transcendental Meditation Reduces Compassion Fatigue and Improves Resilience for Nurses.

Wed, 2019-04-10 07:22
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Self-Care Strategies for Professional Development: Transcendental Meditation Reduces Compassion Fatigue and Improves Resilience for Nurses.

J Nurses Prof Dev. 2019 Mar/Apr;35(2):93-97

Authors: Bonamer JR, Aquino-Russell C

Abstract
The Transcendental Meditation technique was provided to 27 nurses across levels and areas of the organization. Quantitative tools measured the effect on nurses' compassion fatigue and resilience. Paired-sample t test analyses revealed significant improvements in the phenomena studied. Further, resilience showed a large significant, inverse relationship with burnout. This study contributes new knowledge for an innovative self-care strategy to improve resilience and reduce compassion fatigue and burnout among nurses.

PMID: 30741919 [PubMed - indexed for MEDLINE]

Categories: Mind Body Medicine

A cluster randomised trial of a classroom communication resource program to change peer attitudes towards children who stutter among grade 7 students.

Wed, 2019-04-10 07:22
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A cluster randomised trial of a classroom communication resource program to change peer attitudes towards children who stutter among grade 7 students.

Trials. 2018 Nov 29;19(1):664

Authors: Mallick R, Kathard H, Borhan ASM, Pillay M, Thabane L

Abstract
BACKGROUND: Classroom-based stuttering intervention addressing negative peer attitudes, perceptions, teasing and bullying of children who stutter (CWS) is required as part of holistic stuttering management because of its occurrence in primary school. This study was conducted in 2017, in 10 primary schools in the Western Cape, South Africa within lower (second and third) and higher (fourth and fifth) quintiles.
OBJECTIVES: The primary objective of this study was to determine treatment effect at six months after intervention of grade 7 participants (Classroom Communication Resource [CCR] intervention versus no CCR) using global Stuttering Resource Outcomes Measure (SROM) scores in school clusters. The secondary objective was to determine grade 7 participant treatment effect on the SROM subscales including Positive Social Distance (PSD), Social Pressure (SP) and Verbal Interaction (VI). The subgroup objective was to determine any difference in the primary outcome between schools between and across quintile clusters (lower and higher).
METHODS: Once schools were stratified into lower and higher quintile (which are defined according to geographical location, fee per school and resources) subgroup clusters, schools were assigned randomly to control and intervention groups consisting of grade 7 participants who were typically aged ≥ 11 years. Teachers received 1 h of training before administering the single-dose CCR intervention over a 60-90-min session. The CCR intervention included a social story, role-play and discussion. All participants viewed a video of a CWS and stuttering was defined at baseline. The SROM measured peer attitudes at six months after intervention. Randomisation was stratified by quintile group using a 1:1 allocation ratio. Full blinding was not possible; however, the outcome assessor was partially blinded and the analyst was also blinded. Generalised estimating equations (GEE) was used assuming an exchangeable correlation structure to analyse the data adopting an intention-to-treat principle. Multiple imputation was used to handle missing data. Criterion for statistical significance was set at alpha = 0.05.
RESULTS: Ten schools were randomly allocated to control (k = 5) and intervention groups (k = 5), with n = 223 participants allocated to intervention and n = 231 to control groups. A total of 454 participants completed the SROMs in control (n = 231) and intervention (n = 223) groups and were analysed at baseline and six months after intervention. There was no statistically significant difference on the global SROM score (mean difference - 0.11; 95% confidence interval [CI] - 1.56-1.34; p = 0.88). There were also no significant differences on SROM subscales: PSD (mean difference 1.04; 95% CI - 1.02-311; p = 0.32), SP (mean difference - 0.45; 95% CI - 1.22-0.26; p = 0.21) and VI (mean difference 0.05; 95% CI - 1.01-1.11; p = 0.93). Additionally, there was no significant subgroup effect on the global SROM score (lower versus higher quintile subgroups) (interaction p value = 0.52). No harms were noted or reported.
CONCLUSION: No statistically significant differences were noted. It is possible that the time frame was too short to note changes in peer attitudes and that further study is required to confirm the findings of this study.
TRIAL REGISTRATION: Clinicaltrials.gov, NCT03111524 . Registered on 9 March 2017.

PMID: 30497490 [PubMed - indexed for MEDLINE]

Categories: Mind Body Medicine

The effect of complementary medicines and therapies on maternal anxiety and depression in pregnancy: A systematic review and meta-analysis.

Wed, 2019-04-10 07:22
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The effect of complementary medicines and therapies on maternal anxiety and depression in pregnancy: A systematic review and meta-analysis.

J Affect Disord. 2019 02 15;245:428-439

Authors: Smith CA, Shewamene Z, Galbally M, Schmied V, Dahlen H

Abstract
BACKGROUND: Depression and anxiety are common during the antenatal and postnatal period, and are known to have a significant impact on the woman and her unborn infant. Pregnant women state a preference for non-pharmacological treatment options, and use complementary medicines and therapies to manage these symptoms. We examined the effectiveness and safety of these modalities on depression and anxiety during pregnancy.
METHODS: CENTRAL, EMBASE and PubMed databases were searched for randomised controlled trials comparing complementary therapies and medicines to a control, for pregnant women with depression or anxiety. The primary outcome measure was antenatal depression or anxiety.
RESULTS: Twenty randomised controlled trials containing 1092 women were included in the review. We found some evidence of reduced antenatal depression from three modalities. Acupuncture reduced the number of women diagnosed with antenatal depression (RR 1.68, 95% CI 1.06-2.66, 1 trial). Massage reduced the severity of antenatal depression in one trial of 149 women (SMD -0.73, 95%CI -1.07--0.39). One small trial of bright light therapy found reduced antenatal depression (RR 4.80, 95% CI -8.39--1.21, 27 women). There was no evidence of a reduction in depression and anxiety from relaxation, yoga, mindfulness and fish oils. Overall the risk of bias was high or unclear for the majority of studies.
LIMITATIONS: There are few high quality randomised controlled trials of complementary medicines and therapies examining the effect on anxiety and depression.
CONCLUSION: Acupuncture, bright light therapy, and massage may reduce antenatal depression. There is a need for high quality and larger studies that include postnatal follow up and maternal and neonatal outcomes.

PMID: 30423471 [PubMed - indexed for MEDLINE]

Categories: Mind Body Medicine

The Relational Mind in Couple Therapy: A Bateson-Inspired View of Human Life as an Embodied Stream.

Wed, 2019-04-10 07:22
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The Relational Mind in Couple Therapy: A Bateson-Inspired View of Human Life as an Embodied Stream.

Fam Process. 2018 12;57(4):855-866

Authors: Seikkula J, Karvonen A, Kykyri VL, Penttonen M, Nyman-Salonen P

Abstract
Research on human intersubjectivity has found that humans participate in a dialogue throughout their life, and that this is manifested not only via language, but also nonverbally, with the entire body. Such an understanding of human life has brought into focus some basic systemic ideas concerning the human relational mind. For Gregory Bateson, the mind works as a system, formed from components that are in continuous interaction with each other. In our Relational Mind research project, we followed twelve couple therapy processes involving two therapists per session, looking at the ways in which the four participants attuned to each other with their bodies, including their autonomic nervous system activity. Using observations from the project, we here describe the ways through which the relational and embodied mind can be realized in a couple therapy setting.

PMID: 30033642 [PubMed - indexed for MEDLINE]

Categories: Mind Body Medicine

Aromatherapy for the relief of symptoms in burn patients: A systematic review of randomized controlled trials.

Wed, 2019-04-10 07:22
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Aromatherapy for the relief of symptoms in burn patients: A systematic review of randomized controlled trials.

Burns. 2018 09;44(6):1395-1402

Authors: Choi J, Lee JA, Alimoradi Z, Lee MS

Abstract
BACKGROUND: Aromatherapy is often used to manage several conditions, including pain, psychological distress, and burn-related symptoms. The objective of this review was to assess the current evidence regarding the efficacy of aromatherapy as a treatment for burn wounds.
METHODS: The following fifteen databases and trial registries were searched for studies published between their dates of inception and January 2017: AMED, CINAHL, EMBASE, MEDLINE, and the Cochrane Central Register of Controlled Trials (CENTRAL), as well as six Korean medical databases and four Iranian databases. All the trials included in the review were randomized controlled trials (RCTs) assessing the efficacy any type of aromatherapy as a treatment for burn-related symptoms. Study selection and data extraction were performed by two independent reviewers, and the risk of bias (ROB) in the trials included in the review was assessed using the Cochrane ROB assessment tool.
RESULTS: Four RCTs met our inclusion criteria, including two RCTs comparing the efficacy of aroma inhalation as a treatment for pain and anxiety with that of placebo controls. Both studies showed that aroma inhalation was superior to placebo with respect to relieving pain and anxiety. The third study compared the effects of aroma inhalation on sleep quality with those of music therapy and showed that two the treatments exert equivalent effects on the above parameter, and the fourth trial compared the ability of aroma inhalation to reduce pain and anxiety with that of no treatment. The results showed that aroma inhalation can reduce pain but not anxiety.
CONCLUSIONS: The evidence from the above trials is not sufficient to conclude that aromatherapy effectively relieves symptoms in patients with burns. However, the findings of the trials do not seem very plausible, and the trials themselves were of low quality and included only small numbers of patients. Studies that are adequately powered and feature better designs are needed to investigate the potential mechanisms underlying the effects of aroma therapy on pain and anxiety.

PMID: 29169701 [PubMed - indexed for MEDLINE]

Categories: Mind Body Medicine

The Olin EILOBI Breathing Techniques: Description and Initial Case Series of Novel Respiratory Retraining Strategies for Athletes with Exercise-Induced Laryngeal Obstruction.

Wed, 2019-04-10 07:22
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The Olin EILOBI Breathing Techniques: Description and Initial Case Series of Novel Respiratory Retraining Strategies for Athletes with Exercise-Induced Laryngeal Obstruction.

J Voice. 2018 Nov;32(6):698-704

Authors: Johnston KL, Bradford H, Hodges H, Moore CM, Nauman E, Olin JT

Abstract
INTRODUCTION: Exercise-induced laryngeal obstruction (EILO), the condition previously known as paradoxical vocal fold motion and vocal cord dysfunction, is characterized by inappropriate glottic or supraglottic obstruction during high-intensity exercise, causing exertional dyspnea, frequently with stridor. EILO is definitively diagnosed through upper-airway visualization during a characteristic episode. Although respiratory retraining is a primary therapy for EILO, many patients report symptom persistence despite adequate performance of traditional techniques. This report describes three novel breathing techniques for EILO, the Olin EILOBI (EILO biphasic inspiratory) breathing techniques. We include a teaching process and case series with patient-reported assessments.
MATERIALS AND METHODS: Following descriptions of the techniques and teaching process, we present data from a questionnaire offered to all patients who learned at least one of the techniques between September 2015 and March 2017. Subjects evaluated (1) expectation setting, (2) teaching processes, (3) their ability to implement the techniques during high-intensity exercise, and (4) perceived clinical effectiveness.
RESULTS: Ninety-five percent of eligible patients participated, a primarily young, female, and Caucasian sample. Over 50% of subjects competed at the high school varsity level. Sixty-two percent of subjects perceived reasonable expectations, and 82% positively evaluated the teaching process. Seventy-nine percent were able to employ their technique in the high-intensity activity of choice, and 66% perceived clinical effectiveness with the techniques.
CONCLUSIONS: The Olin EILOBI breathing techniques are novel respiratory retraining techniques for use in high-intensity exercise. Case series subjects reported reasonable expectations, a helpful teaching process, the ability to use these techniques during high-intensity exercise, and perceived clinical effectiveness.

PMID: 29050661 [PubMed - indexed for MEDLINE]

Categories: Mind Body Medicine

The Fortuitous Discovery of the Olin EILOBI Breathing Techniques: A Case Study.

Wed, 2019-04-10 07:22
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The Fortuitous Discovery of the Olin EILOBI Breathing Techniques: A Case Study.

J Voice. 2018 Nov;32(6):695-697

Authors: Graham S, Deardorff E, Johnston K, Olin JT

Abstract
Exercise-induced laryngeal obstruction (EILO) is the term for the condition previously named vocal cord dysfunction and paradoxical vocal fold motion. It is defined by glottic or supraglottic obstruction during periods of intense exercise. Not all patients respond to conventional therapy with speech-language pathology, behavioral health interventions, and treatment of contributing conditions. In this edition of Journal of Voice, the authors describe a novel series of respiratory retraining techniques, now called Olin EILOBI (EILO biphasic inspiratory) breathing techniques, specifically designed for athletes with EILO. This case presentation describes the discovery of one of these techniques during a session of therapeutic laryngoscopy during exercise. The patient was an adolescent with EILO who demonstrated a positive response to therapy with a variant of these techniques over a few days, having previously struggled with symptoms despite multiple sessions of conventional respiratory retraining over the course of months.

PMID: 29050660 [PubMed - indexed for MEDLINE]

Categories: Mind Body Medicine

Amelioration of mild and moderate depression through Pranic Healing as adjuvant therapy: randomised double-blind controlled trial.

Wed, 2019-04-10 07:22
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Amelioration of mild and moderate depression through Pranic Healing as adjuvant therapy: randomised double-blind controlled trial.

Australas Psychiatry. 2018 02;26(1):82-87

Authors: Rajagopal R, Jois SN, Mallikarjuna Majgi S, Anil Kumar MN, Shashidhar HB

Abstract
OBJECTIVES: Depression is a mental disorder, affecting the quality of life. Our study explores the efficacy of Pranic Healing (PH), as an adjuvant therapy in treating depression Methods: In this randomised double-blind controlled trial, 52 participants with a mean age of 34.4 years, with mild to moderate depression were assessed using the Hamilton Depression Rating (HAM-D) scale during the 5-week study. Both Medication + PH (MedPH) and Medication + Mock PH (MedMockPH) groups comprising 26 members received Pranic and mock healing lasting 20 minutes per session respectively once a week for 4 weeks, along with the antidepressant drug.
RESULTS: The average decrease in HAM-D score in MedPH was median 11 (Interquartile Range (IQR) 7-12) and was significantly higher compared with the MedMockPH group median 6.5 (IQR 3-9). At pre-assessment, both groups had 8 cases of mild and 18 cases of moderate depression. At post-assessment, HAM-D showed that the improvement in depression category was seen in 69.2% of participants in the MedMockPH group and 100% in MedPH group.
CONCLUSIONS: These results give first the evidence that PH can aid as an adjuvant therapy for depressed people.

PMID: 28836826 [PubMed - indexed for MEDLINE]

Categories: Mind Body Medicine

Religiousness, Spirituality, and Salivary Cortisol in Breast Cancer Survivorship: A Pilot Study.

Wed, 2019-04-10 07:22
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Religiousness, Spirituality, and Salivary Cortisol in Breast Cancer Survivorship: A Pilot Study.

Cancer Nurs. 2018 Mar/Apr;41(2):166-175

Authors: Hulett JM, Armer JM, Leary E, Stewart BR, McDaniel R, Smith K, Millspaugh R, Millspaugh J

Abstract
BACKGROUND: Psychoneuroimmunological theory suggests a physiological relationship exists between stress, psychosocial-behavioral factors, and neuroendocrine-immune outcomes; however, evidence has been limited.
OBJECTIVE: The primary aim of this pilot study was to determine feasibility and acceptability of a salivary cortisol self-collection protocol with a mail-back option for breast cancer survivors. A secondary aim was to examine relationships between religiousness/spirituality (R/S), perceptions of health, and diurnal salivary cortisol (DSC) as a proxy measure for neuroendocrine activity.
METHODS: This was an observational, cross-sectional study. Participants completed measures of R/S, perceptions of health, demographics, and DSC.
RESULTS: The sample was composed of female breast cancer survivors (n = 41). Self-collection of DSC using a mail-back option was feasible; validity of mailed salivary cortisol biospecimens was established. Positive spiritual beliefs were the only R/S variable associated with the peak cortisol awakening response (rs = 0.34, P = .03). Poorer physical health was inversely associated with positive spiritual experiences and private religious practices. Poorer mental health was inversely associated with spiritual coping and negative spiritual experiences.
CONCLUSIONS: Feasibility, validity, and acceptability of self-collected SDC biospecimens with an optional mail-back protocol (at moderate temperatures) were demonstrated. Positive spiritual beliefs were associated with neuroendocrine-mediated peak cortisol awakening response activity; however, additional research is recommended.
IMPLICATIONS FOR PRACTICE: Objective measures of DSC sampling that include enough collection time points to assess DSC parameters would increase the rigor of future DSC measurement. Breast cancer survivors may benefit from nursing care that includes spiritual assessment and therapeutic conversations that support positive spiritual beliefs.

PMID: 28151830 [PubMed - indexed for MEDLINE]

Categories: Mind Body Medicine

Engines of alternative objectivity: Re-articulating the nature and value of participatory mental health organisations with the Hearing Voices Movement and Stepping Out Theatre Company.

Wed, 2019-04-10 07:22
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Engines of alternative objectivity: Re-articulating the nature and value of participatory mental health organisations with the Hearing Voices Movement and Stepping Out Theatre Company.

Health (London). 2018 05;22(3):205-222

Authors: Blencowe C, Brigstocke J, Noorani T

Abstract
Through two case studies, the Hearing Voices Movement and Stepping Out Theatre Company, we demonstrate how successful participatory organisations can be seen as 'engines of alternative objectivity' rather than as the subjective other to objective, biomedical science. With the term 'alternative objectivity', we point to collectivisations of experience that are different to biomedical science but are nonetheless forms of objectivity. Taking inspiration from feminist theory, science studies and sociology of culture, we argue that participatory mental health organisations generate their own forms of objectivity through novel modes of collectivising experience. The Hearing Voices Movement cultivates an 'activist science' that generates an alternative objective knowledge through a commitment to experimentation, controlling, testing, recording and sharing experience. Stepping Out distinguishes itself from drama therapy by cultivating an alternative objective culture through its embrace of high production values, material culture, aesthetic standards. A crucial aspect of participatory practice is overcoming alienation, enabling people to get outside of themselves, encounter material worlds and join forces with others.

PMID: 26112801 [PubMed - indexed for MEDLINE]

Categories: Mind Body Medicine

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