#Non-pharmacological Interventions

[livingwellnessblog]

Yoga's Potential for Neuropsychiatric Disorders: A Scientific Exploration

Yoga's Ancient Wisdom in Modern Psychiatry: A Fusion of Ancient Wisdom and Modern Challenges

Yoga’s Potential for Neuropsychiatric Disorders: A Scientific Exploration Understanding the Global Mental Health Challenge To understand mental health challenges, we must first acknowledge the shortcomings of conventional approaches. Mental illnesses, despite advancements in treatment accessibility, continue to cast a shadow on global health. The World Health Organization (WHO) has highlighted…

[artisticdivasworld]

Delirium: A Nurse's Perspective on Identification, Treatment, and Outcomes

Delirium, often mistaken for other conditions or sometimes overlooked entirely, is a complex and challenging syndrome. As a nurse, I’ve witnessed firsthand the profound impact delirium can have on patients and their families. This post aims to shed light on what delirium is, its presentation, the challenges in its identification, current treatments, and the outcomes associated with those…

[covid-safer-hotties]

Long COVID patients have similar brain activity to those with dementia, UK researchers find - Published Sept 10, 2024

By: Kendall Staton

Some patients with COVID see similar brain changes to people with such neurodegenerative disorders as Alzheimer’s, according to University of Kentucky researchers.

As the COVID pandemic raged across the world in 2020, researchers came together to start better understanding the new disease. At UK, Yang Jiang, a professor in the Department of Behavioral Science, led a study digging into the long-term effects of the virus.

“We’re together trying to understand how the COVID virus goes from getting into the nose and the lung, to somehow affecting the heart and the brain,” she said.

“We think there may be a long COVID, which we still don’t totally understand. It’s likely a risk factor for other neurodegenerative diseases.”

Looking at the effects of long COVID, Jiang sought help from the UK Sanders Brown Center on Aging to better understand the lingering mental effects of the virus.

“They understand some of the neuroinflammatory processes and how oxygen and blood will go through the blood brain barrier and interact with the virus, and how that alters brain functions,” she said. “So we began to sort of put two sides of evidence together.”

Chris Norris, a professor in the Department of Pharmacology and Nutritional Sciences and researcher at the Sanders Brown Center, said they were able to find brain cells, called astrocytes, in people diagnosed with COVID reacting similarly to brain cells of people with neurodecline.

“(Astrocytes) regulate blood flow to the brain, they regulate the shuttling of metabolites from the blood to the neurons, they support synaptic connections in the brain. When astrocytes become reactive and inflamed, like they do in COVID, all of those things – the metabolism, the blood flow, the synaptic communication – are adversely affected,” he said.

Those same cells also affect blood flow. Alzheimer’s patients and long COVID patients could both experience decreased blood flow in the brain, said Bob Simpol, an assistant professor in the Department of Pharmacology and Nutritional Sciences and researcher at the Sanders Brown institute.

He called COVID a “risk factor” that could contribute to long-term cognitive impairment or neurodegeneration.

People experiencing inflammation of astrocytes will see symptoms like brain fog, lapses in memory or forgetting the name of common items. Norris said these symptoms go beyond misplacing your keys, to something more serious – like forgetting you had your keys to begin with.

The research also showed that the brains of people with long COVID had similar electroencephalography (EEG) patterns to people with dementia.

Jiang said EEG’s measure “brain age” by looking at the activity of brain waves.

“Our brain is active all the time, even when you’re resting and when you sleep. EEG can capture the synchronized neural activity at the scalp. So what we observed, in COVID-19 patients, is the same pattern we see in dementia patients, which is the brain literally slows down,” Jiang said.

A COVID diagnosis does not mean you have dementia. Instead, people who have been diagnosed with COVID should have their brain function checked regularly, to catch signs of deterioration early and promote intervention.

With early intervention, 40-60% of neurodegeneration symptoms are reversible, Jiang said. With this research, the team is pushing for patients who have had a COVID diagnosis to get regular neurological check-ups.

“You can now look at brain function pretty easily and non invasively with EEG, just as easily as taking your blood pressure or listening to your lungs,” Norris said.

“After your symptomatic, it may be a good idea to have your brain activity assessed.”

[nightbunnysong]

Healing power of waves

Listening to the sea can provide numerous scientifically-backed benefits, particularly through its influence on the brain and body:

1. Stress Reduction and Cortisol Levels:

Research has shown that natural sounds, including the sound of the sea, can reduce levels of cortisol, the body's primary stress hormone. Lower cortisol levels are associated with reduced stress and anxiety .

2. Parasympathetic Nervous System Activation:

The sound of waves can stimulate the parasympathetic nervous system, which is responsible for 'rest and digest' activities. This can lead to a state of relaxation and calmness by reducing the heart rate and promoting a sense of well-being .

3. Alpha Wave Production:

Studies have found that natural sounds, such as the sea, can increase the production of alpha brain waves. These waves are linked to a relaxed, yet alert mental state, often associated with meditative and restful experiences.

4. Improved Sleep Quality:

The consistent and rhythmic sounds of the ocean can mask other noises that might disturb sleep. White noise from ocean sounds can enhance sleep quality by creating a stable auditory environment that aids in falling asleep and staying asleep .

5. Pain Management:

Listening to nature sounds, including the sea, has been found to aid in pain management. The calming effect can reduce the perception of pain and the need for pain medication, making it a useful non-pharmacological intervention in medical settings .

6. Cognitive and Emotional Benefits:

Natural sounds can improve mood and cognitive performance. They have been associated with increased positive affect and better task performance, possibly due to their ability to restore mental fatigue and enhance concentration .

7. Physiological Relaxation:

Ocean sounds can lower blood pressure and heart rate, contributing to a state of physical relaxation. This effect is partly due to the soothing nature of the sounds, which can counteract the body's stress response .

✨🍋✨🍋✨🍋✨🍋✨🍋✨🍋✨🍋✨🍋✨🍋

Nightbunny here!

It's summer here in Italy, and the heat waves are challenging our mood and inner peace while there are still many things to do.

To find relief and rejuvenation, many Italians love to go and enjoy the sea.

As spending time by the sea can improve your mood and overall well-being, trust me, a trip to the beach can be even to you a simple yet powerful way to boost your mental and physical health during this sweltering season.

Let's all meet at the seaside these hot days!🍋✨🌇

References:

1. Stress Research, Journal of Health Psychology

3. Parasympathetic Nervous System, Frontiers in Psychology

4. Alpha Waves and Relaxation, Clinical Neurophysiology

5. Brain Waves and Relaxation, International Journal of Psychophysiology

[liminalweirdo]

“Because clade 1 mpox is more infectious and more virulent than the earlier clade, we need to take non-pharmacologic interventions (NPIs) to reduce the spread.”

. . .

Dr. Angelique Corthals said the mask bans are “robbing us of the main tool to prevent not just this pathogen, but also novel pathogens that are coming our way thanks to climate change.” 

. . .

She asks advocates of #MaskTogetherAmerica to share her deep concerns about the lack of awareness and promotion of NPIs (Non pharmaceutical Interventions). Dr. Corthals urges us: “Public settings, such as schools, universities, hospitals, public transports should have precautions in place, so we don’t see outbreaks spilling from kids to adults (schools), commuters to the rest of the family, etc. A campaign about the protection that masks and handwashing/hand sanitizer provide is critical. Especially on the eve of the DNC convention. But because masks have been so politicized, it is unlikely to happen. Still, advocating to the DNC leadership might be the way to go. And again, rattling the chain of the CDC.”

[lazyyogi]

My Upcoming Research Study: The Effects of Yogic Breathing on Chronic Sinus Symptoms

This week I have been putting together a presentation that I will be giving about my new research project. It's a study of a yogic breathing technique called Bhramari Pranayama as an adjunctive treatment for people with chronic nose and sinus issues.

Essentially the premise is this:

Our sinuses produce nitric oxide, which then in turn effects our nasal airway and our lungs. The nitric oxide can improve nasal airflow, up-regulate mucociliary clearance, and enhance anti-viral immune activity. Additionally, humming actually temporarily increases the amount of nasal nitric oxide released by about 15 fold. Therefore my study is intended to examine the effects of this pranayama technique that utilizes humming on patients with chronic nose and sinus symptoms.

Typically for patients with these symptoms, we start them out on a steroid nasal spray (flonase) as well as sinus irrigations (something like a neti pot).

I always hear from people outside the medical field about how no one studies these things--non-pharmacologic interventions, the beneficial effects of non-proprietary supplements, or other alternative medical options. People often think that if big pharma (or someone expecting to profit) isn't paying for a study, it cannot happen.

This really isn't true likely 90-99% of the time. The problem isn't funding. I'm conducting a prospective randomized control study with human subjects in order to evaluate the benefits of yogic breathing for patients--something that if found to be helpful will bring in no additional monetary profit for anyone. How much will my study cost? $0.

But do you know what it did require?

Two things: interest and opportunity.

Firstly I, a resident physician, had an idea. I learned about nasal nitric oxide and thought it was cool. I read about how humming has a bolusing effect by transiently increasing nitric oxide output by 15x. And then I recalled that there are pranayama techniques that utilize humming.

With my interest piqued, I spoke with one of my bosses, an attending physician at an academic medical center. He's the head of our Rhinology and Skull Base Neurosurgery division and he is cool as hell. He's all about healthy lifestyle and benefiting patients as much as possible. He loved the idea immediately.

And lastly we roped in a medical student. Med students are very helpful with doing the grunt work of collecting the data into spreadsheets, running the statistical analyses and such. Sometimes they bring some excellent ideas of their own as well. In return for their work, med students are often given a significant portion credit upon publication of the study and this allows them the opportunity to add some scholarly publications to their CV. I don't really need more publications under my name, but they do.

My point with sharing all of this is that people often claim there are health benefits to doing or imbibing certain things but that they'll never be studied because there's no money to be made. And it may be true that private companies such as those in the pharmaceutical industry may not have such interest; their existence in a capitalistic economy relies on profitability. But this is part of why academic institutions are so important--because learning and discovery is part of the essential mission there. Profit doesn't dictate their avenues of research.

When it comes to the study and validation of alternative/complimentary medicine, the focus really needs to be on raising awareness and interest. Talk to your doctors, nurses, physician assistants, etc. The good ones listen. The younger they are, the more likely they are to be open-minded about it too (the older ones are hit or miss--some are so cool and some are very old school).

Just some errant thoughts this week as I work on my slide deck.

LY

[ourspecial]

One of the presenters at the conference I attended yesterday referred to *her own report* as "a great non-pharmacologic intervention for insomnia."

[macgyvermedical]

RN Scope of Practice

I recently learned something that was pretty interesting about the RN scope of practice.

In hospital settings, we tend to think of registered nurses as carrying out the orders of physicians and advanced practice providers. In a hospital just about everything needs an order, including things that in nursing school we were always told were under our scope of practice-like ambulating the patient, dietary plans, positioning, wound care, etc...

So I was wondering- what can a registered nurse do without an order? Do we have our own scope of practice if we were to, say, freelance?

It turns out, yes- I can only speak for the state of Ohio, but outside a facility that requires an order, an RN can actually do a lot in the way of independent practice. The reason everything requires an order in a hospital setting is facility policy, not law.

Here is what the Ohio Revised Code says the RN Scope of Practice is:

"Identifying patterns of human responses to actual or potential health problems amenable to a nursing regimen

Executing a nursing regimen through the selection, performance, management, and evaluation of nursing actions

Assessing health status for the purpose of providing nursing care

Providing health counseling and health teaching

Administering medications, treatments, and executing regimens authorized by an individual who is authorized to practice in this state and is acting within the course of the individual’s professional practice

Teaching, administering, supervising, delegating, and evaluating nursing practice."

"RNs have independent licensed authority to engage in all aspects of practice specified in Section 4723.01(B), ORC, except that, when providing nursing care pursuant to Section 4723.01(B)(5), ORC, the RN must have an order from an individual who is authorized to practice in this state and is acting within the course of the individual's professional practice for administration of medication or treatments or for the regimen that is to be executed."

Basically, if you read down that list, the only thing that actually requires an order is #5. But other than that, RNs are allowed to independently practice without medical direction, as long as we are doing something that is within our scope.

What does that mean? Well, if you look at number 1, we can identify patients who can use nursing care. If you look at number 2, we can independently select, use, and evaluate the effectiveness of nursing interventions such as positioning, diet, oral hydration, non-pharmacological pain, anxiety, and nausea control, run codes if we have ACLS, etc... If you look at number 3, we can do pretty much any physical assessment. If you look at number 4, we can provide health coaching and teach health education to the public. And if you look at number 6, we can teach nursing students, delegate to those lower on the nursing hierarchy, and study nursing practice academically.

So what does that look like? Well, an RN can independently select a patient who could benefit from nursing care, assess that patient, advise nursing interventions that may help them, perform those interventions or delegate them to an LPN, STNA, or CHW, evaluate the effectiveness of those interventions, provide health education to that patient, and pass along that knowledge to a next generation of nurses, STNAs, and CHWs.

So I just want you to know, RNs, future RNs, and writers that write RNs, an RN is an independent license. You do not need a medical provider to practice nursing, only to do things that fall under a medical scope of practice.

[transmutationisms]

hey thank you for your write up a long time about about SSRIs and the replies with personal anecdotes, that made me realize SSRIs are definitely not for me and helped me resist being prescribed them (i actually had a physical illness that was causing issues that presented like depression). do you know if the same applies to ADHD medication (or "adhd medication")? that is, do you know if they cause harmful effects from long term use. im wondering if seeking an ADHD diagnosis would harm me in the long run since its somewhat less stigmatized than other disorders and has a straightforward treatment plan that is mostly just pills (so im dramatically less likely to be institutionalized for it or forced into other "treatment") and i think the meds could help me out. i know i might be labeled "drug seeking" by some doctors but it might be worth it if the pills arent physically harmful. again sorry for relying on you and your followers, but the mainstream opinions are either that adhd meds are a magical make-me-NT drug OR something "impure" that makes u an "addict"

i mean truly i am just some guy online i really can't tell you what's the right medical call For You. it's true ADHD is not generally one of the more stigmatised psychiatric diagnoses, though this varies heavily, esp depending on factors like your race and class (this also goes for the risk of being labelled drug-seeking). you should also be aware that once you are in the room with a psychiatrist, you are not in control of what they write down and may very well be assigned other diagnoses you did not ask for and that are potentially more harmful to you. if you live somewhere without centralised health records these are easier to walk away from.

anyway as to the actual drugs, most pharmacological interventions for ADHD are stimulants, so. yeah they have side effects and potential long-term issues lmao. you'd have to look up details for each specific drug but in general you're looking at issues like cardiac strain, flushing, sweating, dizziness, &c. like. they're uppers. there are, afaik, two non-stimulant drugs for ADHD currently on the market (guanfacine and atomoxetine) tho these have their own side effects and many people find them ineffective. some psychs will also rx bupropion off-label for ADHD. again, has side effects. also, all of these can interact with other drugs so, keep that in mind. i personally like stimulants and will tolerate certain risks/side effects to use them but that's just a personal call. you might have different priorities or drug reactions to me.

[livingwellnessblog]

Yoga's Potential for Neuropsychiatric Disorders: A Scientific Exploration

Yoga's Ancient Wisdom in Modern Psychiatry: A Fusion of Ancient Wisdom and Modern Challenges

Yoga’s Potential for Neuropsychiatric Disorders: A Scientific Exploration Understanding the Global Mental Health Challenge To embark on a journey of understanding mental health challenges, we must first acknowledge the shortcomings of conventional approaches. Mental illnesses, despite advancements in treatment accessibility, continue to cast a shadow on global health. The World Health…

[twofacedtrickery]

Writing here: no obvious anything from new meds yet. Not expecting them yet. Part of me wants to jump to other, non-pharmacological interventions, but I need to try enough medicines before those are even available.

[myalgicencephalomyelitiscfstom]

I’m very grateful for the online chronic illness community and feel it can and does make a positive contribution

--- I was recently asked to submit some comments about my experiences of using the Internet as somebody with an energy-limiting chronic illness. As I was one of many people who were contacted for this article, “Spoonies: who we are and how to be an ally” https://chronicfeminist.uk/2022/09/17/spoonies-who-we-are-and-how-to-be-an-ally/ not all my comments were used so I thought I would share them in this mini blog. This of course is not a comprehensive exposition of the topic. --- I have been severely affected (housebound with dozens of debilitating symptoms) with Myalgic Encephalomyelitis (sometimes known as Chronic Fatigue Syndrome, or ME/CFS) since all the way back to 1994. In 1995, I joined my first online forum in 1995 (CFS-L/alt.med.cfs) and ever since I’ve been a regular contributor to online ME/CFS and chronic illness forums and more recently social media. My energy-limiting chronic illness/spoonie condition means I’ve never actually attended an in-person support group in all those years so it’s been great to have access to all the online discussions. One of the things I’m most proud of is highlighting how graded activity/exercise programmes may not just help but can sometimes cause harm in ME/CFS. I wish someone had warned me of this as it might have prevented much of my disability. I initially became ill in 1989 as a sports-mad 16-year-old after contracting a viral infection; I wasn’t diagnosed until age 22: I blame the late diagnosis and the advice to exercise as causing my illness to deteriorate drastically as for the first few years I was only mildly affected and in full-time education. Unlike pharmaceuticals, non-pharmacological interventions like exercise programs are not highly regulated. The harm many of us had suffered from exercise programs was not being picked up. I and others were able to use online media to warn others including in recent years those with similar symptoms following Covid (i.e. a subgroup of those with Long Covid). I would like to think this has prevented some people’s health deteriorating. I was so frustrated by the medical profession ignoring the fact that graded activity programs for ME/CFS very often didn’t work and sometimes caused harm that I eventually devoted a lot of my free time and energy writing to peer-reviewed journals (see: https://www.researchgate.net/profile/Tom-Kindlon/research ). I teamed up with others I met online on many occasions. In recent years, national guidance in the field from bodies like NICE and the CDC has changed with graded exercise programs no longer being recommended and I believe what I and others I worked with online helped bring about these changes. Both the internet and myself have changed over the years. Initially I was in some groups for young people who were ill but passing 50 last month, I can no longer be seen as young by any definition. Saying that, I’m still dependent on my parents who do all the chores for me in the family home, freeing me to use my limited energy in ways I find most meaningful. Apart from family life and some limited contact with old friends, most of my contact with the outside world is online. The internet has been a godsend in enabling me to connect with others with similar experiences and challenges in a way that doesn’t drain my energy stores too much. Also, now photos and videos can be shared enhancing the experience in comparison to the 1990s when everything was in text form. Throughout history, some have claimed the latest technologies would cause major harm in weird and wonderful ways we would now consider ridiculous and I think that’s how people should consider claims that it is somehow harmful for people with energy-limiting chronic illnesses to use the internet to discuss their challenges and reach out to others in similar circumstances.

[lostjared]

This is my breakdown of what Psychosis felt like to me.

The recent period has presented significant challenges, characterized by perceptual distortions where time seemed to elongate and contract, akin to traversing through a metaphysical tunnel that distorts time and space. This experience encompassed fluctuating emotional states, oscillating between positivity and negativity, and was accompanied by vivid, symbolic dreams. These dreams often depicted binary oppositions—good versus evil, happiness versus regret—with recurring motifs of entrapment, as illustrated by imagery of spider webs, suggesting feelings of being caught in an inescapable situation.

Further, these experiences included complex hallucinations or delusions involving interactions with non-human entities. One recurrent theme involved a disembodied presence denying the existence of my identity, suggesting a profound dissociation from self. This entity proposed that my experiences were designed as a form of existential lesson, aimed at fostering personal growth through the navigation of adversity. The notion of being stuck within a loop of recurring memories and the suggestion of an overarching lesson implies a struggle with existential and philosophical themes, often manifest in psychosis as a search for deeper meaning or understanding.

The persistence of these experiences indicates a sustained period of psychological distress, where reality and delusion blur, creating a sense of being observed and evaluated by unseen forces. The mention of Risperidone—a medication typically used to treat symptoms of schizophrenia and bipolar disorder—indicates a pharmacological intervention to manage these symptoms.

In a scientific context, this narrative can be interpreted as an account of acute psychosis, where the individual experiences significant alterations in perception, cognition, and emotion. These symptoms may manifest through delusions (fixed, false beliefs), hallucinations (perceptual experiences without an external stimulus), and disordered thinking, often necessitating medical treatment to restore a sense of reality and stabilize mood. The therapeutic goal in such cases is to alleviate these intense symptoms, facilitate a return to baseline functioning, and prevent recurrence.

[jcrmhscasereports]

 Use of acupressure to reduce nausea and vomiting in cancer patients receiving chemotherapy (literature study) by Maher Battat in Journal of Clinical Case Reports Medical Images and Health Sciences

ABSTRACT

Nausea and vomiting are distressing and serious problems for cancer patients receiving chemotherapy despite the fact that they are receiving antiemetics according to the standard guidelines which this problem is a huge challenge to nurses involved in cancer care.

Purpose: To explore and assess the effectiveness of using acupressure as a non-pharmacological intervention in addition to pharmacological interventions in reducing nausea and vomiting in cancer patients receiving chemotherapy.

Method: A literature review was conducted of 8 articles published between 2006 and 2014. These included one study of a randomized, double-blind, placebo controlled trial; one quasi-experimental model with a control group; four articles reporting on randomized control trials (RCTs); one systematic review study; and one review study. Key Findings: Seven of the articles we read supported the effect of an acupressure P6 Wristband in reducing chemotherapy induced nausea and vomiting in cancer patients and other databases also supported that finding. The one article with neutral results showed that there was no difference between a combination of acupuncture and acupressure treatment at P6 and at the sham point for the nausea score, but the level of nausea was very low in both groups.

Conclusion: We conclude that the acupressure P6 wrist band when applied to acupuncture point P6 is effective, safe, convenient, cost effective, and provides an easy, self-administrated, non-pharmacological intervention that can be used to reduce chemotherapy induced nausea and vomiting.

Keywords: Acupressure, Chemotherapy, Nausea and Vomiting, Cancer patients, Chemotherapy-induced nausea and vomiting.

INTRODUCTION

Nausea and vomiting are serious and troublesome side effects of cancer therapy. We chose this research topic in order to become familiar with the topic of the nausea and vomiting facing cancer patients during their chemotherapy treatment, which we have observed during our experience in the Oncology departments.

As nurses, we normally use updated and standard guidelines for managing clinical challenges. We reviewed the literature to explore whether there are alternative approaches to pharmacological management that might reduce or eliminate this problem. We found there are many interventions, such as music, acupuncture, acupressure, and yoga. We decided to assess the effectiveness of using acupressure to reduce the nausea and vomiting in cancer patients receiving chemotherapy. Acupressure is a type of complementary and alternative medicine which the National Cancer Institute (NCI Dictionary of Cancer Terms) defines as follows: “Acupressure is the application of pressure or localized massage to specific sites on the body to control symptoms such as pain or nausea".

THE RESEARCH QUESTION

Can acupressure reduce nausea and vomiting in cancer patients receiving chemotherapy?

We have chosen to use the definitions of the NCI Dictionary of Cancer Terms:

“Nausea is an unpleasant wavelike feeling in the back of the throat and/or stomach that may lead to vomiting", and “Vomiting is throwing up the contents of the stomach through the mouth”.

Nausea and vomiting affect the patient’s whole life. These side effects lead to metabolic imbalance, fatigue, distress, and lowered quality of life. We would like to fine a simple, effective and cost effective way to manage these problems so we can put it to use in our hospital.

METHOD

A literature study is, “A critical presentation of knowledge from various academic written sources, and a discussion of the sources in view of a particular research question" (Synnes 2014). There are many challenges when doing a literature study. There are many databases and much literature and our search process had to find the correct, scientific and relevant databases. It required a lot of time and effort to find the full text of all relevant articles. Fortunately, we received excellent help from the librarian at the Betanien University High school.

We started the search process by making a PICO outline to narrow down the search and to find the correct key words and mesh terms.

P: (Population or participants) Cancer patients experiencing chemotherapy-induced nausea and vomiting.

I:  (Intervention or indicator) Acupressure.

C: (Comparator or control) No comparison or placebo.

O: (Outcome) Reduce nausea and vomiting.

We used PUBMED, Google scholar, scholar.najah.edu and other search engines. When we used Acupressure as a search word we found more than 800 studies. When we added chemotherapy, cancer patients, and nausea and vomiting, we brought this down to 14 articles. We read these and decided to use 8 articles only, one of which was a systematic review. We also used an unpublished Master’s thesis from An Najah National University. This thesis was cited in one of the articles that we decided to review. The key words used were: Acupressure, Chemotherapy, Nausea and Vomiting, Cancer patients, Chemotherapy-induced nausea and vomiting, with Acupressure as a mesh term.

We then critically appraised all the articles according to our checklist. We included only those articles that followed the IMRAD style (i.e. those including an introduction, method, results and discussion section). We excluded all articles that were more than ten years old (i.e. published before 2004), except for two articles: one was about the mechanism of acupressure, which seemed to be directly relevant to our research topic, while the second article was used in the discussion section to discuss certain factors related to the topic. We also excluded one of the review articles because its method appeared to be weak. One of the Cochran reviews was also dropped because it had not been updated.

Despite applying these strict criteria, we were still concerned lest we had left out some important articles or included an inappropriate one. However, we were reassured by the fact that the librarian at Betanien had guided us in our search.

THEORETICAL PART

Nursing Need Theory and basic human needs

The Nursing Need Theory was developed by Virginia A. Henderson to define the unique focus of nursing practice. The theory focuses on the importance of increasing the patients’ independence to hasten their progress in the hospital. Henderson’s theory emphasizes the basic human needs and how nurses can assist in meeting those needs.

The 14 components of Need Theory present a holistic approach to nursing that covers the patient’s physiological, psychological, spiritual and social needs.

Physiological components

Breathe normally.

Eat and drink adequately.

Eliminate body wastes.

Move and maintain desirable postures.

Sleep and rest.

Select suitable clothes – dress and undress.

Maintain body temperature within normal range by adjusting clothing and modifying the environment.

Keep the body clean and well groomed and protect the integument.

Avoid dangers in the environment and avoid injuring others.

Psychological aspects of communicating and learning

Communicate with others in expressing emotions, needs, fears, or opinions. Spiritual and moral

Worship according to one’s faith. Sociologically oriented to occupation and recreation

Work in such a way that there is sense of accomplishment.

Play or participate in various forms of recreation.

Learn, discover, or satisfy the curiosity that leads to normal development and health, and use the available health facilities.

There is much similarity between Henderson’s 14 components and Abraham Maslow’s Hierarchy of Needs. Henderson’s Components 1 to 9 are comparable to Maslow’s physiological needs, with the 9th component also being a safety need. Henderson’s 10th and 11th components are similar to Maslow’s love and belonging needs, while her 12th, 13th and 14th components match Maslow’s self-esteem needs (Vera 2014).

The second of Henderson’s physiological needs is the need to “Eat and drink adequately”. Only the need to breathe is given a higher priority than the need for adequate nutrition. For cancer patients receiving chemotherapy and suffering from chemotherapy-induced nausea and vomiting, this need is the most critical.

Cancer prevalence and treatment

Cancer is a group of diseases characterized by uncontrolled growth and the spread of abnormal cells. It may be caused by internal factors, such as an inherited mutation, or a hormonal or immune condition, or it may result from a mutation from metabolism, or from external sources, such as tobacco use, radiation, chemicals and infectious organisms. Cancer is prevalent all over the world, in both developed and developing nations; it affects both sexes at all ages (Said 2009). The American Cancer Society (2010) estimated that 1,529,560 new cases of cancer were diagnosed in 2010 and that 80 % would be treated with chemotherapy; this means more than 1 million patients will be undergoing chemotherapy in any given year (Lee et al. 2010).

Cancer treatment may be based on chemotherapy, radiotherapy and surgical interventions. Chemotherapy is an important treatment in cancer care but it is associated with several side effects, such as bone marrow suppression, increased susceptibility to infection, diarrhea, hair loss, appetite changes, nausea and vomiting, among others (NCI Chemotherapy Side Effects Series, 2014).

Chemotherapy-induced nausea and vomiting (CINV) is the most prevalent and one of the hardest side effects to manage (Suh 2012).

Nausea and vomiting

Nausea and vomiting (N&V) can be acute or delayed. The incidence of acute and delayed N&V was investigated in highly and moderately emetogenic chemotherapy treatment regimens. Patients were recruited from 14 oncology practices in six countries. Overall, more than 35% of patients experienced acute nausea, and 13% experienced acute emesis. In patients receiving highly emetogenic chemotherapy, 60% experienced delayed nausea and 50% experienced delayed emesis. In patients receiving moderately emetogenic chemotherapy, 52% experienced delayed nausea and 28% experienced delayed emesis. CINV was a substantial problem for patients receiving moderately emetogenic chemotherapy in ten community oncology clinics. Thirty-six percent of patients developed acute CINV, and 59% developed delayed CINV (NCI, Nausea and Vomiting, 2015).

Chemotherapy is the most common treatment-related cause of N&V. The incidence and severity of acute emesis in persons receiving chemotherapy varies according to many factors, including the particular drug, dose, schedule of administration, route, and individual patient variables.

Risk factors for acute emesis include:

Poor control with prior chemotherapy

Female gender

Younger age

Emetic classification:

The American Society of Clinical Oncology has developed a rating system for chemotherapeutic agents with their respective risk for acute and delayed emesis.

High risk: Emesis has been documented to occur in more than 90% of patients on the following chemotherapeutic agents:

Cisplatin (Platinol).

Mechlorethamine (Mustargen).

Streptozotocin (Zanosar).

Cyclophosphamide (Cytoxan), 1,500 mg/m2 or more.

Carmustine (BiCNU).

Dacarbazine (DTIC-Dome).

Moderate risk: Emesis has been documented to occur in 30% to 90% of patients on the following chemotherapeutic agents:

Carboplatin (Paraplatin).

Cyclophosphamide (Cytoxan), less than 1,500 mg/m2.

Daunorubicin (DaunoXome).

Doxorubicin (Adriamycin).

Epirubicin (Pharmorubicin).

Idarubicin (Idamycin).

Oxaliplatin (Eloxatin).

Cytarabine (Cytosar), more than 1 g/m2.

Ifosfamide (Ifex).

Irinotecan (Camptosar).

Low risk: Emesis that has been documented to occur in 10% to 30% of patients on the following chemotherapeutic agents:

Mitoxantrone (Novantrone).

Paclitaxel (Taxol).

Docetaxel (Taxotere).

Mitomycin (Mutamycin).

Topotecan (Hycamtin).

Gemcitabine (Gemzar).

Etoposide (Vepesid).

Pemetrexed (Alimta).

Methotrexate (Rheumatrex).

Cytarabine (Cytosar), less than 1,000 mg/m2.

Fluorouracil (Efudex).

Bortezomib (Velcade).

Cetuximab (Erbitux).

Trastuzumab (Herceptin).

Minimal risk: Emesis that has been documented to occur in fewer than 10% of patients on the following chemotherapeutic agents:

Vinorelbine (Navelbine).

Bevacizumab (Avastin).

Rituximab (Rituxan).

Bleomycin (Blenoxane).

Vinblastine (Velban).

Vincristine (Oncovin).

Busulphan (Myleran).

Fludarabine (Fludara).

2-Chlorodeoxyadenosine (Leustatin).

In addition to the emetogenic potential of the agent, the dose and schedule used are also extremely important factors. For example, prescribing a drug with a low emetogenic potential to be given in high doses may cause a dramatic increase in its potential to induce N&V. For example, standard doses of cytarabine rarely produce N&V, but these often occur with high doses of this drug. Another factor to consider is the use of drug combinations. Because most patients receive combination chemotherapy, the emetogenic potential of all of the drugs combined needs to be considered, and not only that of individual drug doses.

Delayed (or late) N&V is that which occurs more than 24 hours after chemotherapy administration. Delayed N&V is associated with cisplatin and cyclophosphamide, and with other drugs (e.g., doxorubicin and ifosfamide) when given at high doses, or if given on 2 or more consecutive days.

Delayed emesis: Patients who experience acute emesis with chemotherapy are significantly more likely to have delayed emesis as well.

Risk factors: All the predicative characteristics for acute emesis are also considered risk factors for delayed emesis (NCI, Nausea and Vomiting, 2015).

The nausea and vomiting that are often associated with chemotherapy are a serious problem for cancer patients. Despite recent improvements in pharmaceutical technology, about 60% of cancer patients who receive antiemetic medications with their chemotherapy still suffer from nausea and vomiting, and as many as 20% of patients refuse to continue chemotherapy due to the severity of the nausea and vomiting (Shin et al. 2004). Early studies reported that patients cited nausea and vomiting as the most distressing symptoms when receiving chemotherapy. The distressing effect of severe nausea and vomiting can lead to nutritional deficiencies, dehydration, electrolyte imbalance, fatigue, depression and anxiety; they can also disrupt the activities of daily living and cause a lot of work time to be lost (Said 2009).

Uncontrolled nausea and vomiting can interfere with adherence to treatment regimens, and may cause the oncologists to reduce chemotherapy doses. Chemotherapy-induced nausea and vomiting is classified as being either “acute” if it happens within 24 hours post chemotherapy, or “delayed” if it occurs on days 2–5 of the chemotherapy cycle. The latter is particularly troublesome because there is no reliable pharmacological treatment for this problem. The American Society of Clinical Oncology’s (ASCO) recommendations include giving 5-HT3 (5-hydroxytryptamine, or serotonin) receptor antagonists plus corticosteroids before chemotherapy to patients who are at high risk for emesis. Nevertheless, many patients still experience nausea and vomiting related to chemotherapy, and approximately one-third of patients have nausea of at least moderate intensity, resulting in a significant reduced quality of life (QOL). Therefore, the experts emphasize the need for an evaluation of additional ways to reduce these symptoms (Said 2009).

Pharmacological interventions for the management of nausea and vomiting

Historically, antiemetic treatment has steadily improved since the introduction, in 1981, of high-dose metoclopramide which reduced the amount of emesis. This was followed by the development of serotonin (5-HT3) antagonist in the early 1990s, and the 5-HT3 antagonists proved to be more effective than the prior medications in preventing CINV. The concomitant use of corticosteroids was found to further improve the control of emesis. Despite these improvements, nausea and vomiting still remain a problem for many patients. Recently, a new drug, the neurokinin NK (1) receptor antagonist has been shown to be more effective at preventing both acute and delayed CINV for patients treated with highly emetogenic chemotherapy (Said 2009).

Non-pharmacological intervention for management of nausea and vomiting

Traditional Chinese medicine offers a possible intervention for the non-pharmacological treatment of nausea and vomiting in cancer patients. Traditional Chinese medicine (TCM) is a system of medical care that was developed in China over thousands of years. It looks at the interaction between mind, body and environment, and aims to both prevent and cure illness and disease.

TCM is based on Chinese views and beliefs about the universe and the natural world. It is a very complex system. In this essay we can only give a brief overview of what TCM involves. It is very different from Western medicine; Chinese medicine practitioners believe there is no separation between the mind and body and that illness of every kind can be treated through the body. They use a combination of various practices that may include:

Herbal remedies (traditional Chinese medicines).

Acupuncture or acupressure.

Moxibustion (burning moxa – a cone or stick of dried herb).

Massage therapy.

Feng shui.

Breathing and movement exercises called qi gong (pronounced chee goong).

Movement exercises called tai chi (pronounced tie chee).

TCM practitioners say that TCM can help to:

Prevent and heal illness.

Enhance the immune system.

Improve creativity.

Improve the ability to enjoy life and work in general.

Beliefs behind TCM

According to traditional Chinese belief, humans are interconnected with nature and affected by its forces. The human body is seen as an organic whole in which the organs, tissues, and other parts have distinct functions but are all interdependent. In this view, health and disease relate to the balance or imbalance between the various functions. TCM treatments aim to cure problems by restoring the balance of energies.

There are important components that underlie the basis of TCM:

Yin-yang theory is the concept of two opposing but complementary forces that shape the world and all life. A balance of yin and yang maintains harmony in the body, the mind and the universe.

Qi (pronounced chee) energy or vital life force flows through the body along pathways known as meridians, and it is affected by the balance of yin and yang. It regulates spiritual, emotional, mental, and physical health. If there is a blockage or an imbalance in the energy flow, the individual becomes ill. TCM aims to restore the balance of qi energy.

The five elements – fire, earth, metal, water, and wood – is a concept that explains how the body works, with the elements corresponding to particular organs and tissues in the body.

The TCM approach uses 8 principles to analyse symptoms and puts particular conditions into groups: cold and heat, inside and outside, too much and not enough, and yin and yang (Cancer Research, UK, 2015).

In summary, chemotherapy related nausea is not well controlled by pharmacological agents and identifying methods to prevent and alleviate treatment-related nausea remains a major clinical challenge. Non-pharmacological interventions such as music, progressive muscle relaxation (Said 2009), and ginger herbal therapy (Montazeri A et al. 2013) have all been shown to reduce CINV. Among the non-pharmacological interventions that reduce CINV are acupuncture and acupressure, based on the assumption that the individual’s welfare depends on a balance of energy in the body and their overall energy level (Said 2009). Yarbro et al. (2011, p. 645) also indicate in Cancer nursing: principles and practice book that acupuncture and acupuncture-related interventions (electroacupoint stimulation, acupressure, acustimulation wrist bands, and electroacupuncture) can be used to control nausea and vomiting in cancer patients.

Molassiotis et al. (2007) claim that the need for additional relief has led to the interest in non-pharmacological adjuncts to drugs, such as acupuncture or acupressure, since combining anti-emetics with other non-pharmacological treatments may prove to be more effective, safe and convenient in decreasing nausea than antiemetics alone.

From the National Cancer Institute website we found that acupressure is recognised as one of the non-pharmacologic strategies used to manage nausea and vomiting (Nausea and Vomiting, 3 September 2014). We used this website to get up to date, relevant information.

Acupressure

Acupressure involves putting pressure with the fingers, or with bands, on the body’s acupoints and is easy to perform, painless, inexpensive, and is effective. The P6 (Pericardium 6) point (Nei-Guan) refers to a point located on the anterior surface of the forearm, 3-finger widths up from the first wrist crease and between the tendons of flexor carpiradialis and Palmaris longus (figure1). P6 can be stimulated by various methods. The most well-known technique is manual stimulation by the insertion and manual rotation of a very fine needle (manual acupuncture). An electrical current can be passed through the inserted needle (electroacupuncture). Electrical stimulation can also be applied via electrodes on the skin surface or by a ReliefBand, a wristwatch-like device providing non-invasive electrostimulation. Pressure can be applied either by pressing the acupoint with the fingers or by wearing an elastic wristband with an embedded stud (acupressure).

Figure 1: Done by M.Battat & I.Amro 2015 The Acupressure P6 point determined in the picture And showing the SEA BAND acupressure

Acupressure is based on the ancient Eastern concept that Chi energy travels through pathways known as meridians. Along the meridians are acu-points, which are controlling points for the Chi energy flow. If the energy flow in meridians is slowed, blocked, or hyper-stimulated, it can be rebalanced or re-stimulated either by applying pressure (acupressure) or by inserting a needle (acupuncture) into one or more of these acupoints. Two points are known for relieving nausea and vomiting: the Nei-Guan point (P6) and the Joksamly point (ST36, located at 4-finger breadths below the knee depression lateral to the tibia).

Patients tend to prefer the P6 point over the ST36 point, Because of its ease of access and the freedom from restriction. When these points are correctly located and pressure applied, either through acupressure or acupuncture, the Chi energy flow is rebalanced, resulting in relief from nausea and vomiting.

The practice of acupressure requires some training and experience, but the technique is widely accessible to any healthcare professionals, particularly to clinical nurses. This acupressure technique is an approach that should be tried not only by healthcare professionals but also by family members or the patients themselves (Shin et al. 2004).

According to the teaching of traditional Chinese medicine, illness results from an imbalance in the flow of energy through the body. This energy or Qi (chee) is restored through the use of acupuncture and acupressure at certain points on the body that have been identified through critical observation and testing over 4000 years. In scientific terms, the neurochemicals that are released after needling or pressure at a specific point may be responsible for this effect. The most commonly used point for nausea and vomiting is Pericardium 6 (Neiguan or P6), located above the wrist (Molassiotis et al. 2007).

The literature review on acupressure

Acupressure for chemotherapy-induced nausea and vomiting in breast cancer patients: a multicentre, randomised, double-blind, placebo-controlled clinical trial. (Said 2009)

For a master degree in public health from An-najah National University, Said (2009) described a randomized, double-blind, placebo controlled trial that was done in Palestine with 126 women on chemotherapy for breast cancer. In this study the researcher divided the patients into 3 groups: the first group (n=42) received acupressure with bilateral stimulation of P6, the second group (n=42) received bilateral placebo stimulation, and the third group (n=42), which served as a control group, received no acupressure wrist band, but all groups received pharmacological management of their nausea and vomiting. Acupressure was applied using a Sea-Band (Sea-Band UK Ltd, Leicestershire, England) that patients had to wear for five days following the administration of chemotherapy. Assessment of acute and delayed nausea and emesis, quality of life, patients’ satisfaction, recommendation of treatment and requests for a rescue antiemetic were obtained. Said (2009) concluded that the acupressure showed benefits for delayed nausea and the mean number of delayed emetic episodes. Acupressure may therefore offer an inexpensive, convenient, and self-administered intervention for patients on chemotherapy to reduce nausea and vomiting at home during days 2-5 after chemotherapy. In addition, the percentage of patients who were satisfied with the treatment (≥ 3 on a 0-6 scale) was 81% (35/42) in the P6-acupressure group, and 64% (27/42) in the placebo group (p= 0.0471). The percentage of patients who would recommend acupressure treatment was 79% (34/42) in the P6-acupressure group, and 62% (26/42) in the placebo group (p= 0.0533). We used this study because it had a lot of essential information, it used the IMRAD system and was also mentioned in the literature (Genç and Tan 2014). This study demonstrated that the mean scores for the acupressure group were lower for both acute and delayed nausea.

Review of Acupressure Studies for Chemotherapy-Induced Nausea and Vomiting Control. (Lee et al. 2008)

In the Journal of Pain and Symptom Management Jiyeon Lee et al. (2008) reviewed ten controlled studies on acupressure in order to evaluate the effects of a non-invasive intervention, acupressure, when combined with antiemetics for the control of CINV. The review evaluated one quasi-experimental and nine randomized clinical trials, which included two specific acupressure modalities, namely, an acupressure band and finger acupressure. The effects of the acupressure modalities were compared study by study. Four of the seven acupressure band trials supported the positive effects of acupressure, whereas three acupressure band trials did not support the effects of acupressure. However, all the studies with negative results had methodological issues. In contrast, the one quasi-experimental and two of the randomized finger acupressure trials all supported the positive effects of acupressure on CINV control. The reported effects of the two acupressure modalities produced variable results at each stage of CINV. Acupressure bands were most effective in controlling acute nausea, whereas finger acupressure controlled delayed nausea and vomiting. The overall effect of acupressure was strongly indicative but not conclusive. We used this article because it is relevant, a review study, and is from a known journal.

The effects of P6 acupressure in the prophylaxis of chemotherapy-related nausea and vomiting in breast cancer patients. (Molassiotis et al. 2007)

As reported in the journal Complementary Therapies in Medicine, acupressure was applied using wristbands (Sea-Band™) in a randomized controlled trial conducted in two centres in the UK. Patients in the experimental group had to wear these bands for the five days following their chemotherapy administration. Assessments of nausea, retching and vomiting were obtained from all patients, daily, for five days. Molassiotis et al. (2007) evaluated the effectiveness of using acupressure on the Pericardium 6 (Neiguan) acupoint in managing CINV. Thirty-six patients took part in the study, with 19 patients allocated to the control group and 17 to the experimental group. The results showed that nausea with retching, nausea, and vomiting with retching, and the accompanying distress were all significantly lower in the experimental group as compared to the control group (p < 0.05). The only exception was the vomiting, where the difference was close to significance (p = 0.06). We used this article because it had a strong study design and also used an IMRAD system.

Acupuncture and acupressure for the prevention of chemotherapy-induced nausea- a randomized cross-over pilot study. (Melchart et al. 2006)

In a randomized, cross-over trial, Melchart et al. (2006) studied 28 patients receiving moderately or highly emetogenic chemotherapy and a conventional standard antiemetic for one chemotherapy cycle, followed by a combination of acupuncture and acupressure at point P6 for one cycle, and for another cycle a combination of acupuncture and acupressure at a close sham point. The results showed that there was no difference in the nausea score between the combined acupuncture treatment at P6 and at the sham point, but the level of nausea was very low in both cases. We used this study because the article had neutral results and because we trusted the source of article, coming as it did from a cancer support care journal.

The efficacy of acupoint stimulation for the management of therapy adverse events in patients with breast cancer: a systematic review. (Chao et al. 2009)

This is a systematic review of 26 articles published between 1999 to 2008 examining the efficacy of acupressure, acupuncture or acupoint stimulation (APS) for the management of adverse events due to the treatment of breast cancer. Published online on 17 September 2009 in the Breast Cancer Research and Treatment journal, 23 trials reported revealed that APS on P6 was beneficial in treating CINV. Chao et al. (2009) also presented the findings from three high quality studies comparing APS groups with control groups, which indicated that APS is beneficial in the management of CINV and especially in the acute phase, even with the non-invasive intervention. Health care professionals should consider using APS, and in particular acupressure on the P6 acupoint, as an option for the management of CINV. Furthermore, as a cost effective intervention, it warrants further investigation. We used this article because it used the IMRAD structure.

'Until the trial is complete you can’t really say whether it helped you or not, can you?’: exploring cancer patients’ perceptions of taking part in a trial of acupressure wristbands. (Hughes et al. 2013)

In Complementary and Alternative Medicine, Hughes et al. report on qualitative research undertaken with patients receiving chemotherapy in the UK. A convenience sample of 26 patients volunteered to participate in the clinical trial and to explore their experiences of using acupressure wristbands. Participants were recruited from three geographical sites: nine were recruited from Manchester, nine from Liverpool, and eight from Plymouth and the surrounding regions. Ten of the participating patients received true acupressure during the trial, 9 received sham acupressure, and 7 received no acupressure. Hughes et al. (2013) concluded that the research provided insights into cancer patients’ motivations and experience of taking part in a clinical trial for a complementary alternative medicine intervention, in which the participants perceived acupressure wristbands to reduce the level of nausea and vomiting experienced during their chemotherapy treatment. This article is important because it includes the benefits experienced by the patients taking part in the trial. This is also the first qualitative study to explore patients’ experiences of using acupressure wristbands and their perceptions of the effects. In the study, the patients perceived the wristbands as reducing their level of nausea and vomiting experienced due to their chemotherapy treatment. The study was an RCT.

The effect of acupressure application on chemotherapy-induced nausea, vomiting, and anxiety in patients with breast cancer. (Genç and Tan 2014)

Genç and Tan (2014) reported on a quasi-experimental study in Turkey with 64 patients with stages 1–3 breast cancer who received two or more cycles of advanced chemotherapy. Thirty two patients were in the experimental group, and thirty two in the control group. To determine the effect of acupressure P6 on CINV and anxiety in these patients, the P6 acupressure wristband was applied to the experimental group. Genç and Tan (2014) concluded that the total mean scores for patients in the experimental group, for nausea, vomiting and retching, were lower than those of the patients in the control group over the five days of application. We used this article because it is a recent and quasi-experimental study and used the IMRAD system.

The effects of P6 acupressure and nurse-provided counselling on chemotherapy-induced nausea and vomiting in patients with breast cancer. (Suh 2012)

Suh (2012) reported in the Oncology Nursing Forum on a RCT in South Korea with 120 women who were receiving chemotherapy for breast cancer. These patients had all had more than mild levels of nausea and vomiting during their first cycle of chemotherapy. The participants were assigned randomly to one of four groups: a control group (a placebo on a specific location on the hand); a counselling only group; a P6 acupressure only group; and a P6 acupressure plus nurse-provided counselling group. The purpose of the study was to evaluate the effects of pericardium 6 (P6) acupressure and nurse-provided counselling on CINV in patients with breast cancer. Suh (2012) concluded that nurse-provided counselling and P6 acupressure were together the most effective in reducing CINV in patients with breast cancer. We used this article because it is the first RCT evaluating the isolated and combined effects of P6 acupressure and counselling in reducing CINV among non-Western patients. The findings of the study support the use of P6 acupressure together with counselling that is focused on cognitive awareness, affective readiness, symptom acceptance, and the use of available resources as an adjunct to antiemetic medicine for the control of CINV. The article used the IMRAD system.

DISCUSSION

Can acupressure reduce nausea and vomiting in cancer patients receiving chemotherapy?

In our experience, we have usually used metoclopramide (pramin) plus serotonin (5-HT3) antagonist (as Ondansetron and Granisetron), plus Dexamethasone plus neurokinin NK (1) (as Emend - aprepitant) for moderate to high ematogenic chemotherapy, yet some of the patients have still suffered from nausea and vomiting. After reviewing the literature we would like to use the acupressure P6 wrist band to solve this problem as the findings of our literature review confirm that the acupressure P6 wrist band reduces CINV in cancer patients receiving chemotherapy. This result is corroborated by 7 of the articles reviewed.

The National Cancer Institute website supports the finding that acupressure is one of the non-pharmacologic strategies that may be used to manage nausea and vomiting (NCI Dictionary of Cancer Terms). Said (2009) adds that acupressure may offer an inexpensive, convenient, and self-administered intervention for patients on chemotherapy, helping to reduce nausea and vomiting at home on days 2-5 of chemotherapy. Genç and Tan (2014) conclude that the total mean scores for CINV in patients in the experimental group to whom they applied the P6 acupressure wristband were lower compared to patients in the control group over the five days of application. Lee et al. (2008) found that the two acupressure modalities produced variable results in each phase of CINV: acupressure bands were effective in controlling acute nausea, whereas acupressure controlled delayed nausea and vomiting. Molassiotis et al. (2007) showed that the experience of nausea and vomiting was significantly lower in the experimental group than in the control group. Chao et al. (2009) found that P6 acupoint stimulation was an option for the management of CINV. In the study reported by Hughes et al. (2013) the participants perceived that acupressure wristbands reduced the levels of nausea and vomiting experienced during chemotherapy treatment. Suh (2012) concluded that the synergistic effects of P6 acupressure together with nurse-provided counselling appeared to be effective in reducing CINV in patients with breast cancer.

Five of the seven articles investigating breast cancer patients, namely Said (2009), Chao et al.( 2009), Molassiotis et al. (2007), Suh (2012) and Genç and Tan (2014), involved breast cancer patients receiving highly ematogenic chemotherapy (e.g. Cisplatin and cyclophosphamide), and moderate risk ematogenic chemotherapy (like doxorubicin).

It is necessary to mention other therapeutic regimens that can also be used in cancer treatment that contain other types of chemotherapy that cause nausea and vomiting, for example, doxorubicin-containing regimens like ABVD (Adriamycin, Bleomycin, Vinblastine, Dacarbazine), CHOP (Cyclophosphamide, Adriamycin, Vincristine, Prednisone) and FAC (5-Fluorouracil, Adriamycin, Cyclophosphamide), and ACT (Adriamycin, Cyclophosphamide, Taxol) (Said 2009) and from our experience cisplatin-containing regimens which that classified as highly ematogenic chemotherapy we noticed the patients still experienced nausea and vomiting after they received the antiemitecs. We think it is necessary to use additional intervention like acupressure to be included in the nausea and vomiting management.

Based on the reviewed findings we plan to use acupressure for cancer patients receiving chemotherapy, because the acupressure in the studies conducted in breast cancer patients reported was used with highly ematogenic chemotherapy in addition to the standard antiemetic treatment, so it is reasonable to conclude that it will work equally well with other less ematogenic types of chemotherapy.

We prefer the use of the acupressure wrist band at P6 acupoint because it is an inexpensive, convenient, and self-administered intervention involving pressure instead of needles at the same point as that used in acupuncture. Furthermore it is safer than acupuncture and patients can easily learn to put pressure on their own wrists, whereas the acupuncture involves using needles that are about the diameter of a hair and can cause temporary discomfort during insertion (Said 2009; Molassiotis et al. 2007). Acupressure seems to be a good way to complement antiemetic pharmacotherapy as it is safe and convenient, with minimal (with bands) or no (finger acupressure) costs involved. It is thus an easy to use, cost-effective, non-invasive intervention (Lee et al. 2008; Melchart et al. 2006).

There was no study result that showed any negative effect from the acupressure wrist band at P6 point, except the review by Lee et al. (2008), which mentioned that three of the ten reported acupressure band trials did not support the possible positive effects of acupressure, but these studies all had methodological issues, such as a small sample size, no true control group, and a concern about the sham acupressure band having a possible antiemetic effect. Melchart et al. (2006) said that no difference was detected in the nausea score between the acupuncture treatment at P6 acupoint, and that at the sham point. Said (2009) mentioned that the acupressure showed no benefit in relation to the incidence of delayed vomiting, early vomiting, or acute nausea, but Melchart and Said’s studies were done with breast cancer patients and it could be that the acupressure benefits were not evident due to the breast cancer patients having had axillary lymph node resection that may have affected the meridian pathway or caused damage to the median nerve as mentioned by Roscoe et al. (2003). Consequently, we think that the evidence suggesting that there is no benefit from the acupressure method for reducing CINV is weak.

Regarding the placebo effect in the articles reviewed here, Melchart et al. (2006) indicated that there was no difference in the nausea score for the combined acupuncture treatment at p6 or that at the sham point, although the level of nausea was very low in both cases. Molassiotis et al. (2007), Said (2009) and Roscoe et al. (2003) all suggested that the placebo effect may be the result of psychological factors.

Application of acupressure in clinical practice

It is important to put this theory into practice, and health care professionals could consider using APS, in particular acupressure on the P6 acupoint, as an option in the management of CINV (Chao et al. 2009). Melchart et al. (2006) said acupressure bands can easily be used in busy oncological wards, while Suh (2012) supported the use of P6 acupressure with counselling focused on cognitive awareness, affective readiness, symptom acceptance, and the use of available resources as an adjunct to antiemetic medications for the control of CINV. Hughes et al. (2013) concluded that the research provides an insight into cancer patients’ motivations for and experiences of taking part in a clinical trial for a complementary alternative medical intervention in which the participants perceived the acupressure wristbands as reducing their level of CINV. Said (2009) suggests that oncology nurses should include acupressure in their list of options for the management of CINV, and especially delayed nausea and vomiting. Special recommendations by oncology nurses are not only useful but are also much appreciated by patients as shown in a study in which the patients were satisfied with the antiemetic treatment given by both P6-acupressure, and placebo-acupressure. The percentage of patients who were satisfied (≥ 3 on 0-6 scale) with their treatment was 81% (35/42) in the P6-acupressure group, which was in agreement with Roscoe et al. (2003), and 64% (27/42) in the placebo group (p= 0.0471). The percentage of the patients who would recommend acupressure treatment was 79% (34/42) in the P6-acupressure group, which again was in agreement with the results of Roscoe et al. (2003) and Hughes et al. (2013), compared to 62% (26/42) in the placebo group (p= 0.0533). This study presented the patients’ compliance with the use of acupressure. Acupressure is easily learnt and taught and patients should be informed about its potential role and taught how to apply it. Leaflets about acupressure for the management of nausea and vomiting could be available in chemotherapy units so that patients who are interested to use such a technique would be encouraged to come forward and learn more from nurses or other health professionals. This could add to the patients’ options for antiemetic approaches and empower them to be involved in the management of these distressing side effects. Acupressure offers a no-cost, convenient, self-administered intervention for chemotherapy patients to reduce acute nausea. Acupressure devices (i.e. Wrist Bands, travel bands, and acupressure bands) have been developed to provide passive acupressure on P6. Acupressure can be administered by healthcare providers, family members, or patients themselves, and does not involve puncture of the skin.

We therefore found that the acupressure wristband is a good way to reduce nausea and vomiting for cancer patients receiving chemotherapy by applying it in the correct position with the stud over the pericardium 6 acupoint located on the anterior surface of the forearm, 3-finger widths up from the first wrist crease, and between the tendons of flexor carpiradialis and Palmaris longus.

Lee et al. (2008) encourage the application of acupressure bilaterally, rather than unilaterally, in CINV control. They recommend three minutes of finger acupressure once daily, with additional acupressure as needed, as the optimal intervention, because both three and five minute trials have succeeded in achieving positive effects. On the other hand, Molassiotis et al. (2007) claimed that there is no correlation between the frequency of pressing the studs and the level of nausea and vomiting. Lee et al. (2008) and Molassiotis et al. (2007) therefore claim opposite results in the relationship between CINV and the frequency of pressing the stud of an acupressure P6 wrist band. But when applying the acupressure P6 wrist band bilaterally, Lee et al. (2008), Said (2009), Molassiotis et al. (2007), Suh (2012), and Genç and Tan (2014) all reported a positive effect with P6 stimulation in reducing CINV.

We would like to discuss some factors related to CINV in relation to nausea and vomiting: expectancy and gender: Roscoe et al. (2003) argued that patients who received the acustimulation bands and expected them to be effective did report having a higher quality of life and less nausea, and in relation to gender, that women are more likely to experience nausea when receiving chemotherapy. Lee et al. (2008) say this may be caused by classical conditioning and also that breast cancer patients may have had a damaged median nerve due to axillary lymph node removal, but Lee et al. (2008) also mention that P6 acupressure in younger women had a significantly greater positive effect on delayed nausea than those on a placebo or those in the no-intervention control group. On the other hand, Molassiotis et al. (2007) mentioned that younger age is associated with greater nausea. We think that men may have tolerated greater stimulation of the acupressure points, and therefore experienced greater symptom relief, so it may be that the acupressure is more effective for men than for women, but these questions of gender, age and the frequency of pressing the studs would need further investigation.

Based on the reported studies, we support the belief that acupressure on P6 is applicable in clinical practice for CINV for cancer patients provided the required education, training and counselling is given to maintain the acupressure benefits.

Acupressure side effects

The study by Molassiotis et al. (2007) found that there were no side effects from the use of the wristbands, but one patient reported that she had to take the bands off because they were too tight and left her with marks for a few days. Chao et al. (2009) also mentioned that very few minor adverse events were observed.

Melchart et al. (2006) did report adverse effects from the treatment in five cases. One suffered a hematoma when wearing the acupressure band at P6. In the sham group, one hematoma was reported after acupuncture, and another three adverse effects from the acupressure band were reported (one hematoma, one skin irritation, one eczema). Hughes et al. (2013) also reported that participants had not experienced any restrictions from wearing the wristbands in terms of everyday activities, other than when washing and bathing. As one female participant commented, for most participants the wristbands were found to be comfortable to wear. However, a few participants reported that they had experienced minor irritation, such as the wristbands feeling tight or painful, or their wrists becoming itchy. Reported adverse side effects were generally deemed minor and acceptable. In the study by Said (2009), no side effect or discomfort was noticed from wearing the acupressure wristband. Said told the patients that if the bands caused discomfort, they could be removed for 30 minutes every two hours. In this way, by taking it off for regular periods, we can prevent the side effects of acupressure, even its minor and rare effects.

Acupressure reduces CINV in cancer patients, in addition it reduces anxiety (Genç and Tan 2014) and that affects overall quality of life (Said 2009). Quality of life is defined by the NCI Dictionary of Cancer Terms as “The overall enjoyment of life and the individual’s sense of well-being and ability to carry out various activities”. Based on the physiological components of the Virginia Henderson’s theory of basic human needs and Abraham Maslow’s Hierarchy of Needs, the patient needs to eat and drink adequately, and sleep and rest (Vera, 2014). This means that when we are providing the required management for distressing symptoms, such as nausea and vomiting, by including the acupressure wrist band in addition to standard antiemetics, the patient’s appetite will improve, leading the patient to eat and drink adequately and improve their sleeping pattern. These may then also improve other aspects of the cancer patient’s life. According to the Henderson Nursing Need Theory, when we meet a patient’s needs, it results in an improved quality of life for the cancer patient receiving chemotherapy. Another way of expressing this is that it restores the balance of Yin and Yang energy that leads to reduced nausea and vomiting and improves the patient’s ability to enjoy life and work in general through a maintaining of the harmony of body and mind, as described in traditional Chinese medicine (Cancer Research UK, 2015).

We believe that it is essential for cancer patients undergoing chemotherapy treatment to have adequate nutrition to maintain their strength to fight the cancer. Different nursing actions are necessary to maintain adequate nutrition including the relieving of CINV. From this we extrapolate that using the acupressure P6 wrist band to reduce CINV improves the patient’s quality of life.

CONCLUSION

Chemotherapy-induced nausea and vomiting may be life threatening and is therefore a huge challenge to nurses involved in cancer care. Even with the best pharmacological management of CINV, patients continue to experience nausea and vomiting.

From a review of eight articles with strong methodology, seven supported the positive effect of an acupressure P6 wristband in reducing CINV for cancer patients. This was also supported by other databases. The one article with neutral results showed that there was no difference between a combined acupuncture and acupressure treatment at P6 and at a sham point in relation to the nausea score, but the level of nausea was very low in both groups. We conclude that the acupressure wrist band applied to acupuncture point P6 is effective, safe, convenient, cost effective, an easy and self-administrated non-pharmacological intervention from traditional Chinese medicine that reduces CINV. Solving the problem of CINV is a fundamental nursing task that can lead to improved quality of life and nutritional status, reduced anxiety and increases patient compliance. In the light of these results, and due to the effectiveness and inexpensiveness of acupressure, together with its ease of use, we suggest that it should be used in conjunction with pharmacological agents for CINV prophylaxis. To maintain the effectiveness of the acupressure, special education and training is needed to reassure the patient that the acupressure is at the correct point (P6) and counselling by the nurse is required.

We recommend the use of acupressure P6 in oncology departments and that future research should be conducted to include cancer patients receiving radiotherapy, and to investigate more about the relationship between the frequency of pressing the stud on the wrist band for acupressure P6 and CINV, and the relationship between gender and CINV, and whether it is better to apply it unilaterally or bilaterally.

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[lazyyogi]

What is your view on microdosing psychedelics for i/ medicinal effects like treating depression or just using it as a mood enhancer?

Psychedelics are a broad subcategory of hallucinogens that I think is difficult to comment on as a whole. However, one psychedelic I can comment on in particular is psilocybin.

I don't doubt that in the next ten years or so, psilocybin will be part of mainstream medicine.

Just recently I saw a presentation about psilocybin for terminally ill cancer patients at a conference in my medical field. This wasn't microdosing but rather a six hour guided "therapeutic experience," aka tripping, on full dose psilocybin. It dramatically reduced the anxiety and the fear of death for the patients as well as improving their quality of life.

What's more, the effect of a single session was found to endure for years.

I can count on one hand the number of times I've done shrooms and yet the first two times really were life-changing for me. So this enduring effect makes sense in my own experience as well.

It may be that microdosing is another form of effective treatment for things like depression. However, like any medication that may be advised by the medical community, it does need rigorous study in order to identify its appropriate dosing, scheduling, and adverse effects.

As far as mood enhancement goes, if we are talking about simply how to feel better in your daily life then I would recommend non-pharmacologic interventions first. Daily meditation would be the best way to go about that. Eating well and regular vigorous physical activity also really helps. It sounds probably stupidly simple but it's true.

One reliable way in which I always feel amazing is to do like 20 minutes of cardio, take a steaming hot shower, and then step out of the water stream and turn it cold, dunk each of my limbs and then go fully under the stream for like 30 seconds, and then end the shower. Afterward, you feel both invigorated and incredibly relaxed. Then I like to sit for a meditation session.

That's more like the stuff Wim Hof teaches, which is pretty good imo.

Just my two cents overall!

LY 😁

[mastergarryblogs]

Behavioral Health Market focuses on treating mental health disorders, substance abuse, and addictive behaviors through non-pharmacological interventions. Many individuals struggle with conditions such as depression, anxiety, personality disorders, and addiction, which can severely impact their daily lives. Behavioral health facilities play a vital role by offering support, medical care, and specialized treatment for those dealing with these challenges, whether identified or suspected.