#clinical study site management

[covid-safer-hotties]

Black Americans Are More Likely to Get Long COVID. These Clinical Trials Can Find a Cure - Published Sept 12, 2024

Millions of people worldwide, especially Black Americans, are experiencing long-term health effects after recovering from COVID-19, a condition known as Long COVID. While the initial stages of the pandemic saw significant progress in diagnosing and managing the virus itself, Long COVID remains a major public health challenge.

To address this growing concern, the National Institutes of Health (NIH) launched the Researching COVID to Enhance Recovery (RECOVER) Initiative. This initiative aims to understand, prevent, and ultimately treat Long COVID.

What is Long COVID? Long COVID, also known as post-acute sequelae of SARS-CoV-2 infection (PASC), is a condition that can develop in individuals who have recovered from COVID-19. It is characterized by a range of symptoms that persist for weeks or months after the initial infection. These symptoms can vary widely from person to person but commonly include fatigue, brain fog, shortness of breath, joint pain, chest pain, heart palpitations, and digestive problems.

The exact cause of Long COVID is still being investigated, but it is believed to be related to the body’s immune response to the virus. Some experts suggest the virus may damage organs or tissues, leading to long-term health problems. Others believe that the immune system may continue to attack the body even after the virus has been cleared, causing ongoing symptoms.

The severity and duration of Long COVID can vary greatly. Some people experience mild symptoms that resolve within a few weeks, while others suffer from severe symptoms that can significantly impact their daily lives.

Why are clinical trials for Long COVID important? There are currently no established treatments for Long COVID. Clinical trials are crucial for developing effective therapies. The RECOVER Initiative includes a program called RECOVER-CT, which is the largest national clinical trial network specifically designed to investigate treatments for Long COVID.

Why should Black Americans consider participating in Long COVID clinical trials? Studies suggest that Black Americans are disproportionately affected by Long COVID, experiencing a higher prevalence of symptoms compared to other races. Participating in clinical trials allows Black Americans to play a vital role in the development of treatments tailored to their specific needs.

What are RECOVER-CT trials studying? The RECOVER-CT program is exploring a wide range of interventions for Long COVID, including medications, rehabilitation strategies, and alternative therapies. These interventions target various Long COVID symptoms, such as fatigue, muscle aches, cognitive dysfunction, and sleep problems.

Early success and looking forward The RECOVER-CT program has already achieved significant milestones. It has initiated five clinical trial platforms, encompassing eight trials and testing thirteen interventions across more than 100 sites nationwide. The program’s success is further exemplified by the rapid enrollment of the first trial within nine months and low participant drop-out rates.

Trial's official website: www.rti.org/impact/long-covid-clinical-trials

[stevenbasic]

GITJ Post 309: Back to the Study Clinics, p1

That was one of the hardest things I’ve done in a while, just a few minutes ago, leave that beautiful, perfectly built woman alone, asleep in my apartment. There’s nothing I’d rather have done than snuck back under the sheets with Melissa and spend the rest of the morning - even after my pretty embarrassing loss of control against her as she slept. But, duty called and here I am - in the office. I had taken the chance to clean off what I could from Melissa’s remarkable behind, shower quick, and get dressed. Through the whole thing she basically slept, though she did give me a drowsy little kissy-face when I told her ‘bye, I’ve gotta go to work.’

“Yeah there are nights she barely sleeps at all,” Josie was explaining to me, as I readied myself in the hallway to go in to see our first study clinic patient for the morning, waiting in an exam room a few doors down. If you remember, our office had become an external study site for testing Evolution Pharmaceuticals new OTC dietary supplement for women as they looked for FDA approval. “And then there are times,” Josie finished, “where she’s, like, comatoast.”

“Comatose,” I corrected h-

“Yeah whatever,” she continued, pressing on. Josie, one of my new, poorly-trained medical assistants, had known Melissa a long time. Though younger than my new Office Manager by five years or so, I think, she understood her friend well and somehow in fact knew she was upstairs in my apartment sleeping off a night of vodka. That my staff knew my Office Manager had spent the night with me was a little embarrassing, a lot unprofessional, but just another small chip out of the armor of my professional dignity and male pride. “She can sometimes sleep for, like, two days straight,” Josie continued, readjusting her long, medium-brown hair in its ponytail, “especially if she gets really excited.” 

At that, I tried not to blush, or notice how - with her hands behind her head - Josie’s breasts seemed quite big today.

“Anything really exciting happen last night? This morning? Hm?” Josie then giggled, taking a second to adjust the strap of her bra through her thin blue scrubs. The ‘wink wink’ in her voice was plain to hear, and it brought flashes of memories, Melissa’s and my time together on the couch, and in bed. Josie seemed to know more than she should.

“Well, I think all you girls got a little excited at the bar last night, by the election results,” I began, loathe to start recounting the more lurid details of the evening to my young employee, “but, let’s get to work. Now, why are we doing this on a Wednesday, seeing study patients? Tell me again what that email said?”

“They said they’re fast-tracking everything, ‘cuz of the election results,” Josie explained, reaching out to readjust the two pens in the chest pocket of my new lab coat. The girls had ordered a few in smaller sizes for me. “Evolution needs us to see at least twenty a week now th-"

“Twenty? For real?” I remarked, the idea of it boggling my mind, which was already reeling after the election results, “that’s more than twice as many as we said would be doable when we started..!”

“Yeah I dunno…” Josie agreed, with a noncommittal shrug.

I huffed in my indignity, knowing I really had very little say in the matter at this point. Olivia, Sheryl, Gianna…they were the real decision makers with this thing; as much as I hated to admit it I was more a worker-bee at this point, a drone. The women who ran things at Evolution controlled the money, and - acutely aware of how my geriatric practice was suffering, how anemic it’d become under recent mismanagement - I knew we needed the cash.

“Anyway, who’s supposed to see this patient with me?” I began again, knowing that Josie was scheduled to assist my APRN Vida with Mr. Kowalski’s procedure down the hall, “And what’s this first patient’s name?”

“Her name’s Thalia, Thalia Bates. I don’t think you’ve seen her before. She started on treatment at Evolution. She’s the daughter of some politician guy, a senator from like Minnesota or Canada or something,”  Josie answered, handing me a chart, “and it’s Karen, the new nurse, who’ll be coming in with you. She’s worked with the patient before but I don’t think she’s here yet so-”

I opened the manila folder but just then both Josie and I turned our heads to see Angie, one of the girls from accounting, step out of one of the study exam rooms down the hall, the one where my patient awaited, and scoot quickly away in the opposite direction. She was shoving something into her purse. 

I saw Josie’s eyes narrow. She pulled out her phone, started a text.

“Anyway, I really have to get started so if you’ll excuse me…” I announced, snapping the patient’s chart closed and moving towards the room. I was a little confused why an accountant would be in a room with a patient but whatever. 

“Wait wait,” Josie stopped me, actually stepping towards me as I approached the room, “I didn’t think you were supposed to see these patients alone, by yourself? Karen’s not here yet?””

“It’s fine,” I replied, entering the room. With my first breath my vision began to swim. Spots, patterns appeared on the walls, straight lines and vines warped and everything in my world suddenly became focused on one thing…

“Hi doctor,” the hyper-developed teen seated in a chair across the small room from me chirped, “I’m Thalia…”

==========================================

More GITJ at my Patreon

[dozemax]

RX Slim Care Semaglutide Reviews Risky Complaints Revealed Alert! 2024 MY TruthFull Experience

RX Slim Care Semaglutide Reviews:

NEW YORK, United States [JULY 2024]: -In recent times, the conversation bordering weight management has progressed dramatically, with more individuals looking for effective and lasting options. Amongst the options available, RX Slim Treatment is an advanced online medical service offering innovative weight management services via clinically verified medications like Semaglutide and Tirzepatide Their method combines the convenience of telehealth with individualized care, making it possible for people to embark on their weight management journeys with expert advice and support. As somebody who has very closely adhered to the improvements in weight management therapies, I wanted to delve into the core offerings of RX Slim Treatment, discovering whatever from their special services to the scientific research behind their medications. This review intends to completely recognize RX Slim Treatment, highlighting its benefits, potential drawbacks, and real client experiences that might help you establish if this solution fits your weight management goals. With a focus on evidence-based methods and patient-centric care, RX Slim Care is poised to dramatically impact the lives of those looking to attain long-term weight loss results.

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What is RX Slim Care?

RX Slim Care is an advanced online clinical that helps people in managing their weight by providing prescription medications and virtual medical care consultations. By focusing on effective weight loss Care harnesses one of the most recent growths in clinical study to weight reduction methods like diet programs and working out without achieving the preferred results, and are seeking a much more successful approach.

RX Slim Care largely concentrates on using GLP-1 medications like Semaglutide and Tirzep which have been received in medical research to assist in weight loss. These medications are engineered to mimic the functions of hormones that normally regulate hunger and blood sugar levels, making them valuable properties for taking care of weight. Furthermore, RX Slim Treatment offers a practical online site for individuals to sign up, submit a health assessment, and initiate their weight management procedure without requiring in-person consultations.

RX Slim Care sticks out from various other weight management programs due to its concentration on customized treatment. Every patient is offered customized support that considers their particular health problems, everyday routines, and fat-burning objectives. In addition, the program uses constant communication with American medical professionals, guaranteeing that individuals can look for professional advice and help whenever necessary. The assimilation of effective medications, customized treatment, and the ease of telehealth make RX Slim Treatment an attractive option for people seeking to efficiently and permanently regulate their weight.

The Science Behind Semaglutide and Tirzepatide.

✅Semaglutide

Semaglutide is a cutting-edge medicine that has garnered substantial attention for its effectiveness in advertising weight loss. Initially authorized for dealing with kind 2 diabetic issues, It has also been revealed to promote weight reduction in people without diabetic issues. It resembles the effects of GLP-1, a hormonal agent in the intestinal tracts that is important in managing hunger and sugar metabolism.

Semaglutide helps individuals feel full quickly and preserves that feeling of volume for a longer period. This satiety results in lowered calorie intake, making it easier for users to adhere to their weight management objectives. Medical tests have demonstrated that individuals using Semaglutide can shed approximately 15% of their body weight over a continual period, with several individuals reporting significant reductions in waist size and improved general health pens.

Furthermore, Semaglutide is given through a shot, making it an eye-catching selection for people with chaotic schedules. The treatment has gained popularity due to its excellent efficiency and easy-to-use administration, with countless people achieving sustained weight reduction when paired with a balanced diet plan and normal exercise. The extremely favorable feedback from those who have taken Semaglutide has cemented the fat-burning market.

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✅Tirzepatide

Tirzepatide is another innovative GLP-1 medication that has emerged as a powerful tool for weight management. Like Semaglutide, Tirzepatide was at first developed for treating kind 2 diabetes but has shown impressive capacity in assisting weight loss. It works through a twin device of activity by simulating GLP-1 and triggering another hormonal agent called GIP (Gastric Repressive Polypeptide), which enhances insulin secretion and controls hunger.

Research in a clinical setting has shown that Tirzepatide might result in more considerable fat burning contrasted to Semaglutide, as some people have accomplished average weight reductions of more than 20%. This noteworthy efficiency is thought to be a result of its ability to greatly affect the body's metabolic features, causing increased calorie burning and boosted fat breakdown.

Tirzepatide, similar to Semaglutide, is offered through a convenient regular shot, making it easy to integrate into one's regular. to popularity originates from the amazing outcomes observed in scientific tests and the favorable experiences of countless users who have efficiently utilized it to manage their weight. The pairing of Semaglutide and Tirzepatide marks a major innovation in weight management to acquire their preferred weight-loss goals.

How RX Slim Care Works?

✅Online Consultation

The journey with RX Slim Treatment begins with a simple online examination procedure. Possible users need to finish a quick health consumption quiz examining their medical history, existing weight, and weight loss goals. This quiz is designed to collect necessary info that will help qualified medical professionals identify one of the most appropriate therapy options for every person.

The online consultation supplied by RX Slim Care is a game-changer for individuals who may feel distressed or uneasy in conventional healthcare settings. By leveraging a digital platform, users can get personalized guidance and support from the convenience of their very own homes, removing the need to browse standard in-person appointments. This method streamlines the process of seeking clinical recommendations, releasing users from the restrictions of traveling and scheduling, and empowering them to take control of their weight-loss objectives.

✅Telehealth Consultation

Following the online appointment, people may need to join a telehealth assessment with a certified healthcare provider. This stage makes it possible for extra customized evaluation of the person's health and weight management demands. In the telehealth session, the medical professional will check out the information offered in the health survey and may present further inquiries to gain an extensive understanding of the person's health concerns.

The telehealth examination is an important facet of RX Slim Care's technique, as it enables healthcare providers to supply tailored referrals based on the individual's special circumstances. Whether a person has certain weight-related health problems or has formerly attempted various other weight reduction approaches, the clinician can create a tailored plan that aligns with their goals.

✅Prescription

After completing the telehealth appointment and validating the individual's eligibility for medication, the clinician can prescribe either Semaglutide or Tirzepatide. RX Slim Care is understood for its reliable prescription procedure, ensuring that users get their medications swiftly and without any avoidable hold-ups.

The prescription is tailored to the person's health demands, and the clinician might learn how to use the medicine properly. This tailored strategy encourages users to organize their weight management trip with the support of physicians who comprehend their certain challenges.

✅Medication Delivery

RX Slim Treatment manages the process of providing medications when a prescription is offered. Users can expect to obtain their medications at their doorstep within 24 to 48 hours of the prescription finished. This fast and reliable delivery service is a considerable facet of RX Slim Treatment, getting rid of the demand for individuals to directly go to a drug store.

Users can promptly start their fat-burning program with the comfort of home shipment, staying clear of added problems. Each therapy plan supplies a month's worth of prescribed medicine, enabling users to proceed with their trip smoothly.

✅Ongoing Support

One of the standout features of RX Slim Care is its commitment to continuous support for users throughout their weight management journey. When registered in the program, people can access unlimited messaging with U.S.-based doctors, allowing them to ask inquiries and look for support whenever needed.

The continual support supplied by the RX Slim Care group is extremely important, creating a feeling of responsibility and inspiration for users. Whether people require help handling their medications, obtaining nutritional suggestions, or obtaining determined, the group is always there to offer support. This regular help can greatly enhance the chances of achieving long-lasting success, helping users to remain committed to their weight management objectives.

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The convenience of RX Slim Care is just one of its crucial benefits.

✅Convenience

The solution is straightforward with a structured procedure from the first assessment to obtaining the drug. By getting rid of the requirement for in-person appointments, RX Slim Treatment allows people to receive clinical aid and treatment comfortably from their very own homes.

This degree of benefit is specifically helpful for those with active routines or wheelchair issues, as it removes the usual obstacles to looking for medical support. Users can finish the health consumption quiz and join telehealth examinations at their very own pace, making prioritizing their health and wellness simpler.

✅Accessibility to Effective Medications

RX Slim Treatment provides users access to scientifically proven medications, Semaglutide and Tirzepatide, which have revealed substantial efficacy in advertising weight reduction. These medications are based on scientific research and have been endorsed by healthcare specialists for their capability to help people achieve lasting outcomes.

RX Slim Treatment furnishes people with the tools they need to gain back control of their well-being and attain substantial improvements in their weight management trip. By blending professional medical support with scientifically backed approaches, the program provides a powerful strategy for attaining enduring weight management success.

Individualized Attention

At the core of RX Slim Care's ideas lies the idea of personalized attention. Every individual is provided with customized pointers that are crafted according to their certain health characteristics, ensuring that the suggested therapy is appropriate for their needs. This special technique enriches the performance of the weight management routine by considering components such as clinical background, day-to-day practices, and health issues connected to weight.

The telehealth examinations permit users to engage with healthcare professionals who can use insights and techniques particularly developed to support their weight-loss trip. This level of customized focus is commonly lacking in standard weight-loss programs, making RX Slim Care a standout option for those seeking an extra customized experience.

✅Discreet Service

RX Slim Care provides very discreet services for those who might find weight-related discussions to be a delicate issue. The company values users' privacy and has customized its solutions to be respectful and personal. Via online assessments and medication delivery to your home, users can work towards their weight management goals without really feeling vulnerable or

RX Slim Treatment offers a personal and non-judgmental area for individuals to address their weight, helping those who may feel embarrassed or distressed about looking for help to take control of their health with

Potential Drawbacks

Cost

While RX Slim Treatment supplies various benefits, it is vital to consider the prospective drawbacks, consisting of the cost related to the service. The program's beginning price is $299, which may be a substantial investment for some people. While numerous users locate ineffective medications and personalized care, others might be prevented by the ahead-of-time cost

Moreover, as RX Slim Treatment does not take insurance, individuals ought to anticipate paying for their entire treatment expenses themselves. This absence of insurance policy support might hinder access to certain potential clients, particularly those handling monetary troubles.

One possible constraint of RX Slim Treatment is its restricted schedule. Although the online system offers ease, there are some geographical restrictions. Specifically, homeowners of Louisiana, Mississippi, and New Mexico are not qualified for the program, which might prevent them from

Furthermore, online consultations need a steady internet connection and a compatible tool, which may present challenges for those who are much less acquainted with innovation and absence regular on the internet access.

Negative effects

Like any type of medication, Semaglutide and Tirzepatide include prospective negative effects. While lots of users tolerate these medications well, some might experience adverse responses, such as gastrointestinal issues, queasiness, or modifications in appetite. It is necessary for people taking into consideration RX Slim Care to recognize these potential negative effects and discuss them with their doctor during the examination process.

Understanding the feasible dangers related to these medications is essential for making notified choices about weight reduction treatment. RX Slim Treatment provides users with thorough information about the drugs and encourages open communication with healthcare specialists to address any type of problem.

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How to Get Started With RX Slim Care

Starting your trip with RX Slim Care is straightforward and practical. If you want to manage your weight or enhance your diabetes mellitus management using Semaglutide or Tirzepatide, RX Slim Care uses a very easy means to obtain these prescription drugs. Below is a comprehensive on how to start your experience with RX Slim Care:

·         The initial activity to take is to visit the RX Slim Treatment website discovered at www.rxslimcare.com. Right here, you can check out information on the solutions offered and the types of medications that come.

·         To start, you should develop an account as the 2nd step. Look for the "Subscribe" or "Get Begun" option, usually found on the main web page. You will certainly after that be asked to input personal details such as your name, e-mail, and password. By setting up an account, you obtain the capacity to monitor your progress, view appointment history, and connect with a physician.

·         As soon as your account is established, you need to complete an in-depth clinical questionnaire. This action is critical as it supplies the healthcare providers with crucial info about your health condition, medical history, present medications, and weight-loss goals. Be honest and comprehensive in your responses to make sure that the doctor can make an enlightened choice about your suitability for Semaglutide or Tirzepatide.

·         Next, set up a virtual consultation with a certified healthcare professional through our telehealth system. Throughout this remote video session, your carrier will certainly examine your case history, and discover your wellness objectives, issues, or queries you have regarding the suggested treatments.

·         Throughout the telehealth appointment, the medical professional will certainly evaluate whether you get Semaglutide or Tirzepatide. They will certainly discuss the advantages and feasible drawbacks of the medication and determine if it fits your health condition and goals. This is likewise a possibility for you to elevate any inquiries or share any type of fear.

·         If the healthcare provider figures out that Semaglutide or Tirzepatide fits you, they will certainly provide a prescription. This prescription is sent electronically to the pharmacy connected with RX Slim Care.

·         Upon completion of the prescription processing, the medicine will certainly be sent to your home address. RX Slim Care ensures inconspicuous product packaging and punctual delivery so you can start your therapy efficiently.

·         RX Slim Treatment gives constant support throughout your therapy journey. You will certainly have access to follow-up examinations with healthcare providers who can monitor your progression, adjust your therapy strategy if essential, and address any concerns. You can also contact the support group for support on drug usage and handling adverse effects.

Tips for an Effective Experience with RX Slim Treatment.

1.      Be Honest and Thorough: When finishing the medical survey and throughout the telehealth consultation, supply exact and comprehensive information about your health condition and objectives. This ensures the doctor can make the very best choice for your treatment.

2.      Ask Concerns: Don't think twice about asking concerns throughout your telehealth examination. Recognizing how Semaglutide or Tirzepatide works, prospective side effects, and what to expect during therapy can help you feel more confident and prepared.

3.      Screen Your Progression: Track your weight reduction and any modifications in your health while using the drug. Normal monitoring aids you and your doctor assess the effectiveness of the treatment and make any kind of needed adjustments.

4.      Remain in Touch: Utilize the follow-up appointments and support services offered by RX Slim Care. Continuous communication with healthcare providers ensures that you get the most effective possible treatment and can address any issues immediately.

5.      Stick to the Therapy Plan: Comply with the suggested dose and use guidelines for Semaglutide or Tirzepatide. Uniformity is key to achieving the preferred outcomes and reducing possible negative effects.

Starting with RX Slim Care is a basic and effective procedure developed to give you with accessibility to effective weight-loss and diabetic issues management medications.

By following the steps outlined over, you can begin your trip towards much better health with the support of experienced healthcare providers and the comfort of on-the-internet clinical services. Keep in mind to be detailed in your first consultation, remain involved with follow-up support, and abide by your therapy to prepare for the most effective and feasible results. RX Slim Treatment offers an appealing remedy for individuals seeking to handle their weight and boost their total health from the convenience of their homes.

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Customer Experiences

▶️Testimonial from Sarah M. of Austin, TX

On her experience with RX Slim Care's online fat-burning program: Originally reluctant, Sarah discovered the examination process to be simple and the medical professionals to be extremely motivating. With the help of Semaglutide, she efficiently dropped 30 extra pounds within a short period leading to enhanced power levels and enhanced confidence.

▶️Testimonial 2: James R. from Seattle, WA

"After fighting with my weight for years and trying countless diet plans, I ultimately discovered RX Slim Treatment. The telehealth consultations were convenient, and I valued the individualized technique. The medicine functioned marvels for me, and I'm down 25 extra pounds. I very much recommend this program to any person wanting to make a real change."

▶️Testimonial 3: Emily T. from New York City, NY

"RX Slim Care has been a game-changer for me. I liked the service's discreetness; the ongoing support made a significant distinction. The group was constantly available to address my questions. I used Tirzepatide and lost 35 extra pounds in six months! I finally seem like I get on the ideal track."

Final Verdict for RX Slim Care    

In summary, RX Slim Care supplies a convincing selection for those looking for reliable and easy ways to manage their weight. By supplying customized care and tested medications, this service makes it possible for users to start their fat-burning efforts with the assistance of a seasoned doctor. The added convenience of virtual examinations and home shipment of medications boosts the total procedure, making it possible for individuals to concentrate on their well-being without the problem of in-person medical professional checkouts.

While there are possible drawbacks, such as cost and availability, the countless benefits of RX Slim Treatment make it a worthwhile consideration for any person dealing with weight management. Real consumer experiences demonstrate the program's efficiency, with lots of individuals accomplishing considerable weight loss results and boosting overall health.

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FAQs about RX Slim Care

Q. What exactly is RX Slim Care?

RX Slim Treatment is an internet-based healthcare provider that provides weight control choices using recommended medications such as Semaglutide and tripeptide, as well as virtual clinical assessments.

Q. How do I get started with RX Slim Care?

Begin your RX Slim Treatment journey by taking the online health assessment on their website, which will certainly be adhered to by a virtual consultation with a certified healthcare professional.

Q. Start your fat-burning journey today by completing the test!

Using RX Slim Care doesn't require you to have insurance policy coverage. Instead, the firm supplies a self-pay alternative, where you can straight purchase and pay for your therapies without needing to include an insurance policy service provider.

Q. How does the medication delivery process work?

After getting your prescription, RX Slim Treatment will deliver the medication to your doorstep within 24 to 48 days.

Q. What kind of support can I anticipate after signing up?

Users can access endless messaging with U.S.-based medical professionals for ongoing support and support throughout their weight loss journey.

Q. Are there any kind of negative effects connected with Semaglutide and Tirzepatide?

Yes, feasible negative effects might consist of gastrointestinal problems, nausea, or modifications in appetite. It is very important to go over any concerns with your healthcare provider.

Q. How much weight can I expect to lose with RX Slim Care?

On have taken Semaglutide or Tirzepatide together with maintaining a balanced way of living have seen a substantial decrease in body weight, with losses ranging from 15

Q. Is RX Slim Care available in all states?

RX Slim Treatment is not currently available in Louisiana, Mississippi, and New Mexico. Can I help with anything else?

Q. What is the cost of the program?

The program's price begins at $299 and covers the preliminary examination along with medications.

Q. Can I cancel my subscription at any moment?

Users can cancel their memberships anytime, supplying flexibility and peace of mind.

[shadowfromthestarlight]

The task of a marginalia maven is at right angles to the task of reading a book: It is an attempt to read the reader rather than to read the writer. For several decades now, scholars have been swarming the margins of books in dead people’s libraries. Those margins are among the most promising sites of “textual activity,” to use the scholar’s clinical phrase—a place to explore, analyze, and, it is hoped, find new raw material for the writing of dissertations. Famous readers whose libraries have fallen under such scrutiny include Melville and Montaigne, Machiavelli and Mark Twain. A book invites various kinds of engagement, depending on the reader. Voltaire (whom Nixon admired, to judge by his extravagant underlining in the Durants’ The Age of Voltaire) scribbled commentary so incessantly that his marginalia have been published in volumes of their own. Voltaire liked to argue with a book. Nixon did not. He had a lively mind but not, when reading, a disputatious one; he restricted his marginalia almost exclusively to underlining sentences or making other subverbal marks on the page—boxes and brackets and circles. You get the idea that he knew what he wanted from a book and went searching for it, and when he found what he wanted, he pinned it to the page with his pen (seldom, from what I’ve seen, a pencil). In his method, Nixon resembled the English writer Paul Johnson. I once asked Johnson how, given his prolific journalistic career—several columns and reviews a week in British and American publications—he managed to read all the books he cited in his own very long and very readable histories, which embraced such expansive subjects as Christianity, ancient Egypt, and the British empire. His reaction bordered on revulsion at my naivete. “Read them?!” he spat out. “Read them?! I don’t read them! I fillet them! As it happens, Nixon was an avid reader of Johnson, whose books he often handed out to friends and staff at Christmastime. John Adams, another busy producer of marginalia, liked to quote a Latin epigram: Studium sine calamo somnium. Adams translated this as: “Study without a pen in your hand is but a dream.” Nixon acquired the pen-in-hand habit early, as his surviving college and high-school textbooks show, and he kept at it throughout his life. For Nixon, as for the rest of us, marking up books was also a way of slowing himself down and attending to what he read. He was not a notably fast reader, by his own account, but his powers of concentration and memorization were considerable. Going at a book physically was a way of absorbing it mentally.

Go ahead! Mark up your books! Historians will love you for it someday.

[quinloki]

What have you wrote

As of Today I have three completed Multi-fic chapters posted to Tumblr, so I'm going to do a What Have You Wrote and What Are you Writing Combo Post.

Somehow there' like 100 of you following me, and maybe this post will help. (I do have a pinned Master Post, but this is gonna go beyond that a little).

This is also a way for me to vent, and you'll see why in a minute.

Anyway - This is gonna get long, so

Posted to Tumblr Items: (these are ALL x Reader/reader insert fics)

A Light Touch - x Eustass - Modern AU (Part of the Grandline Metropolis Series) - a regular paper pusher, you're pushed out into an intersection by a drunk driver and involuntarily meet Eustass Kid. You lose your hand, and gain new friends, new headaches, and new skills. (Part 1 of a series).

Some Direction - x Roronoa - Modern AU - The population is declining, so the World Government decided to step in and arrange marriage for most of its citizens. Lucky you, plucky little librarian, you've been paired with Roronoa Zoro. Good thing for you he's the protective type, because old childhood tragedies are trying to rear their ugly heads again.

Family Ties - x Doflamingo - Modern AU - Mafia style - You're the unofficially adopted daughter of Edward Newgate, and besties with the local clinic doctor. One day you find an injured man in an alleyway and decide to help him out. Dodging people who are trying to kill him, you manage a successful rescue, now if only you could stay out of Trouble >.>

Not On Tumblr Yet, but Done!

Quicksand - x Crocodile - Modern AU (Part of the Grandline Metropolis Series) - Secretary to Buggy the Clown, District boss to the Rain Dinners Casino in the West Blue district, you got over your crush of the CEO ages ago. Recently you've been trying to date via a dating site, and soon you'll meet your match face to face!

Thrice Prophesized - x Roronoa - Modern AU (Part of the Grandline Metropolis Series) - Your first memory was of being chase by marines and practically blasted out of the sky. You wake up after being yanked from the water by a boy made of rubber, but your memories are shaky at best. All you know for sure is, you prophesized the fall of the ruling class, so maybe pirates are the best allies.

Not on tumblr Yet, and not done yet! (all links lead to Wattpad where all my Wips are)

Family Practice - x Law - Set in the same AU as Family Ties, this story dives into a What If? - What if the reader had become more than Besties with Law? Same Reader Same AU - just... an AU of the AU xD 10 chapters

Souled Out - x Eustass - Someone's stolen your soul, and you want it back. You haven't aged in 25 years, and for the last decade you've been studying how to summon demons. Now's the day to see if it's paid off, and if your summoned help can actually help you. 3 Chapters

Unseen - x Killer - set in canon universe with non-canon events. I wanted to write a book where Killer gets smooches, and that's what this is. It kind of got away with me, and I think I have a LOT of chapters ahead of me. 13 chapters

Isn't Enough - x Marco - set in canon universe with canon events. Reader is a doctor on the Moby, and a crew mate of Marco's. But that just Isn't Enough. 5 Chapters

Whew.

Booked, Honeysuckle Red, and Heart of Gold only have two chapters a piece so far. Royal Pains is a bit stalled out, but I haven't given up on it.

None of this is counting two books of one-shots, and the following pending titles I don't even have on active rotation:

A Light Touch 2 - Emperors Bara-teased Family Ties 2 - Gilded Lily Honeysuckle Gold Quicksand 2 - Warlords An Untitled Shanks Mafia AU Song Bird

Look, I guess, what I'm saying is, if you followed me for my writing, I have a lot planned. Unless life punches me in the face, I update 3-5 times a week. I have a day job, and I play some D&D, but otherwise I write.

I even started another title called Mafia Inked - JUST TODAY - and I didn't plan it. I have no idea where it's going to go or anything. But that's what the brain does. I got the idea, meant to write some notes, wrote a first chapter.

ANYWAY - you don't have to go to Wattpad or Ao3 if you don't want (I'm Quinloki on both), everything will get here eventually. Wattpad's just kind of my workspace. So things post there unedited.

Hey hey, if you do something like this, tag me! I want to see what my peeps are working on <;3

[cure4pain]

Does acupuncture work for back pain?

Back pain is a common condition that affects millions of people worldwide. It can be caused by a variety of factors, including muscle strain, ligament injury, disc herniation, and arthritis. While there are many conventional treatments for back pain, such as medication, physical therapy, and surgery, many people also seek alternative therapies like acupuncture.

Acupuncture is an ancient Chinese practice that involves the insertion of thin needles into specific points on the body. It is based on the belief that disruptions in the flow of energy, or qi, can lead to pain and illness. By inserting needles into specific acupoints, acupuncturists aim to restore the balance of qi and promote healing.

How does acupuncture work for back pain?

The exact mechanism of acupuncture is not fully understood, but it is thought to work by stimulating the release of endorphins and other neurotransmitters that have pain-relieving effects. It may also modulate the activity of the central nervous system, which can influence pain processing and transmission.

Is acupuncture effective for back pain?

Numerous clinical studies have investigated the efficacy of acupuncture for back pain, with mixed but promising results. A 2018 meta-analysis of 39 randomized controlled trials (RCTs) found that acupuncture provided statistically significant pain relief compared to sham acupuncture or no treatment. The analysis also indicated that acupuncture was more effective than usual care interventions, such as medication or physical therapy.

Another RCT, published in JAMA Internal Medicine in 2012, compared acupuncture, sham acupuncture, and conventional therapy (medication and exercise) for chronic low back pain. The results demonstrated that acupuncture provided superior pain relief and functional improvement compared to sham acupuncture and conventional therapy. Additionally, the benefits of acupuncture persisted even after the treatment was discontinued.

While these studies suggest that acupuncture may be effective for back pain, it is important to note that the placebo effect may play a role in its effectiveness. The use of sham acupuncture, which involves the insertion of needles into non-acupuncture points or using non-penetrating needles, helps to control for this effect. However, determining the true efficacy of acupuncture remains challenging due to the subjective nature of pain perception and the difficulties in conducting double-blind trials.

What are the potential benefits and considerations of acupuncture for back pain?

One of the advantages of acupuncture is its relatively low risk of adverse effects compared to pharmaceutical interventions or surgical procedures. Acupuncture is generally well-tolerated, with the most common side effects being minor bruising or bleeding at the needle insertion sites. It can be a suitable option for individuals who cannot tolerate or prefer to avoid medications.

Moreover, acupuncture treatments are often individualized, taking into account the unique characteristics and needs of each patient. Acupuncturists may assess factors such as the location, severity, and duration of the pain, as well as the patient’s overall health and constitution. This personalized approach can contribute to a more holistic and patient-centered treatment experience.

However, it is important to recognize that not all individuals may experience the same degree of pain relief from acupuncture. Factors such as the underlying cause of back pain, the chronicity of the condition, and individual variability can influence treatment outcomes. Additionally, the availability and quality of acupuncturists may vary, highlighting the importance of seeking trained and licensed practitioners.

If you are interested in learning more about how acupuncture can help you manage your back pain, please visit India's Trusted & Best Pain Management Clinic In Mumbai » Cure 4 Pain.

Conclusion

Acupuncture appears to be a promising treatment option for back pain, offering potential benefits with relatively low risks. Clinical evidence suggests that acupuncture can provide significant pain relief and functional improvement, although further research is needed to fully understand its mechanisms and optimize treatment protocols. As an alternative therapy, acupuncture should be considered as part of a comprehensive approach to managing back pain, in conjunction with conventional treatments, lifestyle modifications, and other interventions tailored to the individual’s needs.

Looking for the best acupuncture clinic? Book your appointment at Cure4Pain today! 

#acupuncture #backpain #painrelief #holistichealth #naturalhealing #alternativemedicine

[mariacallous]

Exposure to poverty is deeply intertwined with the deterioration of emotional health. This linkage is often exacerbated by a lack of coordinated social support for individuals and families. To appreciate this connection and how efforts in some communities suggest ways to address it, consider three public health issues and their impact on mental health: homelessness, food insecurity, and hygiene poverty (i.e., a lack of resources to maintain personal hygiene).

Homelessness

There is a close connection between homelessness and mental health. Since the start of the COVID-19 pandemic, homelessness and associated behavioral health issues have increased. While there are widely differing estimates of the prevalence of mental disorders among individuals experiencing homelessness, a review of the research by the Substance Abuse and Mental Health Services Administration (SAMHSA) suggests that between 20% and 50% have serious mental illness. Research suggests, moreover, that the experience of being homeless often intensifies the condition of individuals with poor mental health, with factors such as increased stress aggravating previous mental illness through heightened anxiety, fear, substance use, etc.

Some believe that the best course of action for those experiencing homelessness and mental illness is to provide treatment and services first so that homeless individuals are stabilized and “housing ready,” and only then can live successfully in permanent housing. Under this approach, placement in housing would follow initial treatment. However, many jurisdictions now use a Housing First model. In this approach, an individual is placed into permanent supported housing as the first step, followed swiftly with treatment and social service supports to start addressing the individual’s physical and mental health, education, employment, and substance use issues. Studies suggest this is an improvement on “treatment first” approaches.

How communities are addressing the challenge

Philadelphia, Pennsylvania – Pathways to Housing: Pathways to Housing works with individuals experiencing homelessness to provide housing without treatment preconditions and, once participants are housed, goes on immediately to address underlying issues involving mental health, substance use, medical care, and education. After arranging housing, Pathways manages an integrated care clinic to ensure that “participants have access to a low-barrier, person-centered approach that emphasizes recovery, wellness, trauma-informed care, and the integration of physical and behavioral health care.”

Denver, Colorado – Colorado Coalition for the Homeless: The Colorado Coalition for the Homeless (CCH) operates twenty permanent supportive housing and affordable housing properties and administers housing vouchers nearly 1,300 households in the Denver area. Like Pathways, the Coalition takes steps to ensure that, once housed, residents immediately receive the physical and behavioral health services they need to be able to achieve stability. CCH provides integrated medical and behavioral health care, substance use treatment, dental, vision, and pharmacy services through an on-site Federally Qualified Health Center.

New York City, New York – Breaking Ground: Breaking Ground provides permanent supportive housing for individuals who have experienced chronic homelessness in New York City. Housing is co-located with wraparound services such as on-site medical care, psychiatric care, substance use referrals, and skills-building/employment programs. In addition to a focus on housing, Breaking Ground provides New Yorkers who remain unhoused with Street to Home services, which include 24/7 engagement and outdoor counseling and connections with available medical and social supports. Programs like this are likely to be particularly important in the context of New York City’s new plan to involuntarily hospitalize unhoused individuals with mental health conditions despite a chronic psychiatric bed shortage in city hospitals.

What else could be done to help?

Expand Housing First models to encompass more communities, including those in rural areas. As illustrated in the examples above, Housing First programs show that providing stable housing can improve the efficacy of psychiatric and substance abuse treatment as well as aid in connecting individuals to social services. A 2018 study on the effects of housing stability service use among homeless adults with mental illness found that participants who achieved housing stability had decreased use of inpatient psychiatric hospitals and emergency departments. Currently the severe shortage of affordable housing makes it very difficult in many jurisdictions to provide immediate housing for homeless individuals. Moreover, although the federal Department of Housing and Urban Development distributes emergency Section 8 housing vouchers to jurisdictions for unhoused individuals and people attempting to flee domestic violence, it is common for people to wait years for voucher assistance. Achieving the goal of stable housing for people with mental health conditions will therefore require ramped-up investment in housing as well as health and social service supports for residents.

Utilize mobile crisis intervention teams to address social and behavioral health needs of individuals experiencing homelessness that are at risk for a mental health crisis. Breakthroughs in mental health services are often the result of multi-agency partnerships. One such breakthrough has been the development of local crisis intervention teams, which use a co-response model between law enforcement, emergency medical services, and mental health providers. In a previous publication, we highlighted several successful programs using this model. Since the full launch of the 988 suicide and crisis lifeline in June of 2022, many jurisdictions are working to deploy crisis intervention teams for behavioral health emergencies in a way that is most beneficial to those in need, including those experiencing homelessness. Moreover, states can now receive an enhanced federal medical assistance percentage (FMAP) for mental health crisis systems.

Improve the coordination and continuation of services for people experiencing homelessness. Departments at all levels of government often fail people with housing and mental health problems because of administrative obstacles and budget silos. Fortunately, there have been some steps to tackle these challenges. California, Arkansas and other states, for instance, have received federal Medicaid 1115 Waivers that allow them to better coordinate housing, health care, and other services for vulnerable populations. In February 2023, Congresswoman Madeleine Dean reintroduced legislation through The Homelessness and Behavioral Health Care Coordination Act to the House of Representatives, which would authorize a Housing and Urban Development (HUD) grant to enable state/local/tribal entities to coordinate care for individuals simultaneously experiencing homelessness, behavioral health, and substance use disorders.

Food Insecurity

The U.S. Department of Agriculture (USDA) estimates that in 2021 over 34 million people—including 9 million children—were living in households that did not have enough to eat. Many of these families do not qualify for federal nutrition programs such as Supplemental Nutrition Assistance (SNAP) or the National School Lunch Program (NSLP) and are dependent on food banks or community donations.  A national study found that food insecurity was associated with a 257% higher risk of anxiety and a 253% higher risk of depression among low-income families. Mothers and children appear to be at an especially high risk of mental health distress associated with food insecurity. For instance, food insecurity can exacerbate postpartum depression, and food insecurity has been found to be associated with increased behavioral and emotional dysregulation during infancy and adolescence. Food insecurity has also been associated with maternal depression and increased developmental risk in children such as decreased psychosocial function, elevated aggression, anxiety, depression, hyperactivity, and difficulties interacting with peers. In another study conducted to analyze the relationship between food insecurity and poor mental health, researchers discovered that food insecurity correlates to depression, anxiety, shame, and acute psychological stress.

What is being done in some communities?

Maryland – Frustrated by the lack of food access and overburdened charity models, the Black Church Food Security Network (BCFSN) created a self-sustaining food system at Pleasant Hope Baptist Church in Baltimore, MD. Using the community garden at the church, the organization created a pipeline for fresh food from the garden directly to community members experiencing food insecurity. The organization has grown into a partnership of Black churches across the country to provide health-related, environmental, and economic benefits to those most vulnerable.

Connecticut – Recognizing that the quality of a diet can serve as either a risk factor or protective factor to mental health, Mental Health Connecticut (MHC) partnered with the Healing Meals Community Project to deliver nutritious meals to food-insecure individuals experiencing mental illness. A 2020 small-scale pilot study conducted by the University of Hartford examined the partnership. It found the program to be effective and Healthy Meals to be “a highly workable intervention approach,” and recommended expanded community collaboration to promote nutrition education and improve food access.

California – Food Equity Round Table: Los Angeles County’s Food Equity Roundtable is comprised of a coalition of county officials and Los Angeles-area philanthropic organizations dedicated to addressing food insecurity. The goal of the Round Table is to promote cross-sector collaboration to improve access to and affordability of healthy foods, support supply chain/food system resilience, and enhance county-wide nutrition education.

What else could be done to help?

Strengthen government safety net programs to better respond to food insecurity. During the COVID-19 public health emergency, Congress extended flexibility and increased benefit levels of federal nutrition programs such as SNAP. To continue these programs and make them permanent, several bills have been introduced in Congress in the last few years, including the Closing the Meal Gap Act of 2021. Such measures would prevent millions of people from falling into food insecurity and the associated mental and physical health implications by permanently raising the baseline benefits for SNAP households, particularly for families with large medical or housing expenses. Another approach, included in the Improving Access to Nutrition Act of 2021, would eliminate time limits on SNAP eligibility. Currently, the time limit restricts many working-age adults to only three months of benefits in a three-year period unless they document sufficient hours of work. But, of course, for those with mental and behavioral health conditions, staying in the workforce can be difficult.

Improve cross-sector coordination to allow for increased support for food insecurity across the public and private sectors as well as nonprofits and philanthropic organizations. In September 2022, the Biden administration released a National Strategy on hunger, nutrition, and health. This included steps to permit Medicaid to include nutrition education and supports and other proposed actions to address hunger, reduce diet-related diseases (including mental illnesses), and nutritional disparities.

Hygiene Poverty

Inequitable access to personal care and hygiene products is an overlooked public health crisis. In the United States, data is limited on the mental health implications of what is widely described as “hygiene poverty.” Most research focuses on what is known as “period poverty,” with a 2021 study finding an association between women struggling to afford menstrual products and depression. In fact, the study found that two-thirds of the 16.9 million low-income women in the U.S. could not afford menstrual products. Meanwhile, in homeless and low-income households, chronic absenteeism in schools has been attributed in part to the mental health impacts of poor hygiene (often involving increased anxiety, bullying, and isolation). More research is certainly needed to fully establish the relationship between hygiene poverty and behavioral health in women, but for young women in low-income households, this added stress in their daily lives is a significant factor in their behavioral health.

As an example of state efforts to help support such students, the Oregon legislature allocated $700,000 to support youth-led projects designed to help tackle factors that affect mental health. One of the funded projects was for “caring closets,” within schools; these are locations with supplies of hygiene products, underwear, and other basic supplies for children from low-income families.

Unlike the public programs available to help families obtain healthcare, food, and housing, there are generally no public supports for families in need of hygiene products. The most commonly used public  benefit programs (Medicaid, SNAP, and the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC)) do not cover essential hygiene items such as laundry detergent, toilet paper, diapers, feminine hygiene products, toothpaste, shampoo, and deodorant.

What is being done in some communities?

Washington State – Essentials First seeks to fill in a critical gap that food banks, homeless shelters, schools, and refugee resettlement agencies across the state generally do not have the capacity to fill for critical hygiene items.  Recognizing that household and personal care items were among the top tier of items Washingtonians had difficulty paying for during the COVID-19 pandemic, the organization focuses on the procuring large quantities of hygiene supplies that are distributed through existing social service networks across the state.

Massachusetts – Hope & Comfort addresses youth hygiene insecurity by providing supplies to youth-serving community organizations such as schools, Boys & Girls clubs, YMCAs, and food pantries in the greater Boston area. In a published pilot study from year one of the organization’s operations, 46% of surveyed youth said they had less stress, and another 19% said they had more confidence when given consistent and easy access to hygiene products.

What else could be done to help?

While local organizations are working to address hygiene poverty in their communities, they have limited capacity. Thus, it is important for policymakers at the state and federal level to recognize that hygiene poverty remains largely overlooked in health and social service programs and to take steps to include those needs in appropriate federal and state programs. Steps that could be taken include:

Increase flexibility for EBT cards. In late 2021 and early 2022, some states, such as Illinois, passed new laws permitting public benefits to be used to purchase diapers and menstrual hygiene products. This step does not require new programs or a new program infrastructure but is limited in that it does not provide dedicated funds specifically for hygiene products. A more complete solution would be to provide new funds under the existing program to cover essential hygiene needs.

Enable certain federal grant recipients to purchase hygiene products. Federal grant recipients providing services and supports, such as schools and homeless shelters, receive funds for a variety of uses. However, these funds typically come with tight requirements that often do not allow for the coverage of essential hygiene items, even where such coverage might further the objectives of the program. That usually forces organizations to purchase and distribute products using resources from private contributions, state and local grants, or in-kind donations.

There have been efforts in Congress to address these limitations on federal grants. In 2021, for instance, the Menstrual Equity for All Act was introduced in the House. If enacted, this would allow states to have the option to use federal grant dollars to provide students with free menstrual products in schools (currently only 15 states and DC have enacted requirements making it possible for students to access free state-funded menstrual hygiene products in schools). The legislation would, among other things, also fund pilot programs in colleges/universities for free menstrual hygiene products, allow homeless assistance providers to use grant funds that cover shelter necessities (e.g., bedding and toilet paper) to also use that money to purchase menstrual products, and require Medicaid to cover the cost of menstrual products.

Our understanding of behavioral and mental health conditions is gradually improving. This has led to advances in the development of treatment and support for populations experiencing these conditions, as well as the identification of circumstances that cause or exacerbate them. For instance, we have seen progress in dealing with the impact of warfare on many servicemen and servicewomen. There is also a greater understanding that law enforcement officers are not usually the best responders to someone experiencing a mental health crisis. Similarly, there is now greater attention being given to the effects of neighborhood violence and other sources of stress on school-aged children.

With these advances in mind, it is important for the health of individuals and communities that we continue to examine relationships between social conditions, the policies that shape them, and the impacts on behavioral health. The connection—in many cases the two-way connection—between behavioral health and homelessness, food insecurity, hygiene poverty, and other conditions needs to be studied and policies realigned to fit our increasing understanding of these relationships.

[covid-safer-hotties]

Also preserved in our archive

By Samantha Fields

When Charlie McCone got COVID in March 2020 in San Francisco, he was 30, otherwise healthy and fit, not considered high-risk. His doctors told him he’d get better in a couple of weeks. He didn’t.

Eventually, weeks into being sick and with no real answers from his doctors, he turned to that place many of us turn to for medical information: the internet.

“I found a Facebook group with thousands of other people asking what’s going on, and I was like, ‘Oh my God,’” he said, “‘This is happening to so many other people.’”

It was already becoming clear then, in spring of 2020, that COVID could cause serious, lasting issues, including debilitating fatigue and brain fog, among many other symptoms. Because there was so much attention on COVID at the time, McCone said, “there was a lot of hope about the response to long COVID, I think, the first two years.”

Then in late 2020, Congress allocated over $1 billion to the National Institutes of Health for long COVID research. “There was this feeling that we’re going to have answers here in a few years,” he said.

But now it is a few years later, and that feeling has changed.

McCone is still sick. He’s not working anymore and can’t walk much more than a block. Roughly 20 million people in the U.S. are now estimated to have long COVID, maybe more. And that initial $1.15 billion NIH got for the RECOVER program — which stands for Researching COVID to Enhance Recovery — has yielded few answers and zero approved treatments so far.

“There’s been a lot of disappointment in terms of the program moving slowly and also focusing a lot on the kind of observational side of things,” said Betsy Ladyzhets, co-founder and managing editor of the Sick Times, a nonprofit news site focused on long COVID.

Most of the research money has gone into trying to learn more about what long COVID is — into clinical research, data collection and analysis and studies of electronic health records.

“Rather than what many people in the patient community and also the research community really want, which is focus on treatments, clinical trials,” Ladyzhets said.

There’s good reason for the focus on observational research, according to Dr. Serena Spudich, a neurologist and researcher at Yale who’s working with the RECOVER program.

“There has to be a very, very strong urgency for finding treatments,” she said. “And at the same time, we will only find treatments if we understand the condition properly.”

And understand what’s causing the many different kinds of symptoms people are having.

“Because long COVID is not one condition, it’s a very heterogeneous condition,” Spudich said. “And it’s very, very possible, I would even say likely, that different forms of long COVID — for example, the more neurologic forms versus something like severe shortness of breath or problems with the heart rate — those may actually be due to different types of biologic mechanisms that need different treatments.”

Outside researchers agree that these kinds of observational studies and data collection are critical, but some feel the NIH didn’t need to spend nearly $1 billion on them.

Dr. Ziyad Al-Aly, director of the Clinical Epidemiology Center and chief of the Research and Education Service at the VA St. Louis Health Care System, said his team and others did similar research earlier in the pandemic, “for peanuts, a few hundred thousand dollars that generated evidence much more robustly, faster, years ahead of RECOVER, for a small, small, small, small fraction of the funds.”

At this point, more than four years in, “NIH should be laser-focused, laser-focused on finding treatment for long COVID,” he said.

That will be a bigger focus going forward. NIH got another $515 million this year for RECOVER and plans to put much of it toward clinical trials.

This fall, it held a kickoff meeting for the next phase of the RECOVER program, called RECOVER-TLC, which stands for Treating Long COVID. Now, Joseph Breen at the National Institute of Allergy and Infectious Diseases at NIH said it’s in the process of soliciting ideas for drugs and other treatments to trial.

“We have every intention of getting started as soon as possible,” he said. “In reality, we’re probably into next year.”

David Putrino, director of rehabilitation innovation for the Mount Sinai Health System in New York, has been doing long COVID research since 2020. He said how the clinical trials are designed will be critical.

“What we need to be doing is rapidly testing as many drug targets as possible, rather than taking big swings,” he said. Meaning that instead of putting all the funding into a few big, expensive trials of a couple of drugs, RECOVER could do a bunch of smaller trials.

“For a couple million dollars apiece, they could be testing 100 drugs. And they could be logging the responses of those 100 drugs, and they could be moving into more sophisticated clinical trial strategies,” Putrino said. “That is where I think we should be applying the money.”

Many long COVID patients and advocates are cautiously optimistic about this next phase of research. Charlie McCone, who has become something of an expert in his own illness and now volunteers with the Patient-Led Research Collaborative, was at the kickoff meeting and left feeling a little more hopeful.

“The NIH can do this right, they have to do this right,” he said. “And they need to do it fast, which we know is possible.”

But no matter what comes of this current slate of funding, he said more is going to be needed. “No disease is solved with a one-time investment. And so, just because this first billion dollars didn’t produce much does not mean the next billion and the next billion won’t.”

Some legislators are already pushing for additional funding. Sen. Bernie Sanders, a Vermont Independent, along with several Democratic senators, introduced the Long COVID Research Moonshot Act in the Senate, and a companion bill has been introduced in the House. The Moonshot Act would provide $1 billion a year for 10 years for long COVID research. It has yet to be brought to the floor for a vote.

[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.

For more information: https://jmedcasereportsimages.org/about-us/

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[croservices]

What is CRO and its role in clinical trials?

CRO stands for Clinical Research Organization. It is an organization that provides services to the pharmaceutical, biotechnology, and medical device industries to assist in the clinical development of their products. CRO`s provide a range of services, including clinical trial design, protocol development, data management, statistical analysis, and regulatory affairs.

They also provide support for clinical trial sites, such as patient recruitment, training, and monitoring. CROs play an important role in the clinical trial process, as they help to ensure that the trial is conducted in a safe and ethical manner, and that the data collected is accurate and reliable.

What is the basic principle of Clinical Research Organization?

The basic principle of Clinical Research Organization (CRO) is to provide services to the pharmaceutical, biotechnology, and medical device industries to help them develop new drugs, treatments, and medical devices.

Clinical Research Organization provide a range of services, including clinical trial design, data management, regulatory affairs, and quality assurance. They also provide expertise in areas such as clinical trial management, data analysis, and statistical analysis.

What are the main components of Clinical Research Organization?

1. Regulatory Affairs: This includes the development and implementation of regulatory strategies, preparation of regulatory documents, and communication with regulatory authorities.

2. Clinical Operations: This includes the management of clinical trials, including protocol design, site selection, patient recruitment, data collection, and data management.

3. Quality Assurance: This includes the development and implementation of quality systems, monitoring of clinical trials, and auditing of clinical sites.

4. Data Management: This includes the collection, storage, and analysis of clinical trial data.

5. Medical Writing: This includes the preparation of clinical trial documents, such as protocols, investigator brochures, and clinical study reports.

6. Project Management: This includes the coordination of all aspects of a clinical trial, including budgeting, timelines, and resource allocation.

[do-foryou]

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[sudheervanguri]

Work from Home CRA Job vacancies at Syneos Health Syneos Health is hiring Clinical Research Associates for remote positions in Hyderabad/Bangalore. Minimum 03 year of CRA experience required. Apply now for a chance to work with a leading biopharmaceutical solutions organization. Job Title: Clinical Research Associate I (CRA I) Job ID: 24005945 Location: India-Asia Pacific - IND-Home-Based Description: Syneos Health® is a leading fully integrated biopharmaceutical solutions organization focused on accelerating customer success. We are currently seeking Clinical Research Associates for remote positions in Hyderabad/Bangalore. Job responsibilities Performs site qualification, site initiation, interim monitoring, site management activities and close-out visits (performed on-site or remotely) ensuring regulatory, ICH-GCP and/or Good Pharmacoepidemiology Practice (GPP) and protocol compliance.  Uses judgment and experience to evaluate overall performance of site and site staff and to provide recommendations regarding site-specific actions; immediately communicates/escalates serious issues to the project team and develops action plans.  Maintains a working knowledge of ICH/GCP Guidelines or other applicable guidance, relevant regulations, and company SOPs/processes. Verifies the process of obtaining informed consent has been adequately performed and documented for each subject/patient, as required/appropriate. Demonstrates diligence in protecting the confidentiality of each subject/patient. Assesses factors that might affect subject/patient’s safety and clinical data integrity at an investigator/physician site such as protocol deviation/violations and pharmacovigilance issues. Per the Clinical Monitoring/Site Management Plan (CMP/SMP): Assesses site processes Conducts Source Document Review of appropriate site source documents and medical records Verifies required clinical data entered in the case report form (CRF) is accurate and complete Applies query resolution techniques remotely and on site, and provides guidance to site staff as necessary, driving query resolution to closure within agreed timelines Utilizes available hardware and software to support the effective conduct of the clinical study data review and capture Verifies site compliance with electronic data capture requirements May perform investigational product (IP) inventory, reconciliation and reviews storage and security. Verifies the IP has been dispensed and administered to subjects/patients according to the protocol. Verifies issues or risks associated with blinded or randomized information related to IP. Applies knowledge of GCP/local regulations and organizational procedures to ensure IP is appropriately (re)labelled, imported and released/returned. Routinely reviews the Investigator Site File (ISF) for accuracy, timeliness and completeness. Reconciles contents of the ISF with the Trial Master File (TMF). Ensures the investigator/physician site is aware of the requirement of archiving essential documents in accordance with local guidelines and regulations. Documents activities via confirmation letters, follow-up letters, trip reports, communication logs, and other required project documents as per SOPs and Clinical Monitoring Plan/Site Management Plan.  Supports subject/patient recruitment, retention and awareness strategies.  Enters data into tracking systems as required to track all observations, ongoing status and assigned action items to resolution. For assigned activities, understands project scope, budgets, and timelines; manages site-level activities / communication to ensure project objectives, deliverables and timelines are met.  Must be able to quickly adapt to changing priorities to achieve goals / targets. May act as primary liaison with study site personnel, or in collaboration with Central Monitoring Associate.  Ensures all assigned sites and project-specific site team members are trained and compliant with applicable requirements.

Prepares for and attends Investigator Meetings and/or sponsor face to face meetings.  Participates in global clinical monitoring/project staff meetings (inclusive of Sponsor representation, as applicable) and attends clinical training sessions according to the project specific requirements. Provides guidance at the site and project level towards audit readiness standards and supports preparation for audit and required follow-up actions. Maintains a working knowledge of ICH/GCP Guidelines or other applicable guidance, relevant regulations, and company SOPs/processes; completes assigned training as required. For Real World Late Phase, the CRA II will use the business card title of Site Management Associate II.  Additional responsibilities include: Site support throughout the study lifecycle from site identification through close-out Knowledge of local requirements for real world late phase study designs Chart abstraction activities and data collection Collaboration with Sponsor affiliates, medical science liaisons and local country staff The SMA II may be requested to train junior staff Identify and communicate out of scope activities to Lead CRA/Project Manager  Proactively suggest potential sites based on local knowledge of treatment patterns, patient advocacy and Health Care Provider (HCP) associations Qualifications What we’re looking for Minimum 3yrs of experience in onsite monitoring and remote monitoring. Should have Neurology, immunology, rare diseases, CVD and Oncology therapeutic area experience preferred. Candidate from Mumbai, Delhi, Bengaluru, Hyderabad, Ahmedabad preferred. Bachelor’s degree or RN in a related field or equivalent combination of education, training and experience  Knowledge of Good Clinical Practice/ICH Guidelines and other applicable regulatory requirements Must demonstrate good computer skills and be able to embrace new technologies  Excellent communication, presentation and interpersonal skills Ability to manage required travel of up to 75% on a regular basis [caption id="attachment_66251" align="aligncenter" width="1200"] Work from Home Clinical Research Associate Opportunities at Syneos Health[/caption] Get to Know Syneos Health: Over the past 5 years, Syneos Health has worked with 94% of all Novel FDA Approved Drugs and 95% of EMA Authorized Products across 73,000 sites and 675,000+ trial patients. Join us in a highly competitive and ever-changing environment. Additional Information: Tasks, duties, and responsibilities as listed in this job description are not exhaustive. The company may assign other tasks as needed. Equivalent experience, skills, and education will also be considered. The company is committed to complying with applicable legislation and providing reasonable accommodations as needed. Apply now for a rewarding career opportunity with Syneos Health in the clinical research field! Apply online

[oneminutereviews]

Darwin’s Cipher by M.A. Rothman

Fairly quickly into Darwin’s Cipher it became, if not a hate-read, then an amusingly frustrated read. I suspect that I was not the target audience. I’m studying graduate-level genetics. Mr. Rothman’s novel uses very, very incorrect genetics.

The main bad-pop-sci-genetics element is also the novel’s premise. One of the main characters, a geneticist named Juan, creates an algorithm which can predict millions of years of evolution. To be clear, evolution does not move “forward” over time. Evolution does not go in the same “direction” across all species. And that’s not the only such egregious element. Even Juan’s climatic solution is mind-bogglingly impossible. I freely admit that the terrible genetics probably biased me towards the rest of the novel.

So, what about the actual plot? Passable at best. The book jumps in between too many points of view, which take too long to intersect. The threat fails to be tense due to a lack of concrete stakes. I expect my thrillers to tell me what concrete badness the protagonists have to stop, or at least point to an obviously nefarious antagonist. Instead, the novel spends a while hinting that nonspecific bad things are happening. The blurb makes the novel seem way better than it actually is, by pulling interesting elements across, no joke, 7 hours of the audiobook.

Furthermore, the description and exposition is excessive for my taste. It’s often done via dialogue, even when the people involved would not naturally say description. And despite all that exposition, many people act in ways I found illogical, including the antagonists (e.g. desiring secrecy but still allowing someone to take medication out of a clinical trial site). There was a geopolitics blunder so unbelievable that it took me out of the story. No, I don’t think that a bunch of Argentineans would accept being whisked into a secret US government camp without so much as a fight. In short, the characters stumbled through painfully described scenes while I stayed thoroughly confused.

I only managed it through Darwin’s Cipher because it was like a trainwreck. I couldn’t look away, too curious for what genetics would be butchered next. I don’t recommend it to anyone.

Review submitted by bobble.

[market-insider]

Exploring the Clinical Trial Management Services Market: Detailed Insights on Size, Share, and Growth Potential

The global clinical trial management services market size is anticipated to reach USD 53.85 billion by 2030, according to a new report by Grand View Research, Inc. The market is expected to expand at a CAGR of 8.25% from 2024 to 2030. The increasing trend of outsourcing clinical trial activities, the rise in research and development of advanced therapies, and the globalization of clinical trials are a few key factors driving the growth of the market.

The number of clinical trials has significantly increased in the past two decades. This is due to the rising need for novel pharmaceutical products with improved efficacy as well as the increasing penetration of cutting-edge medical technologies. According to Clinical trials.gov, the total number of clinical trials accounted for 325,773 in 2020, whereas, as of April 2022, the number of clinical trials this year totaled more than 410,903.

Clinical Trial Management Services Market Report Highlights

The clinical trial monitoring segment dominated the market with a revenue share of 27.64% in 2023. The rising number of clinical trials and technological advancements in trial monitoring are key factors driving the growth.

The oncology segment dominated the market with a revenue share of 37.05% in 2023 and is expected to grow at the fastest CAGR of 8.45% during the forecast period.

The pharmaceuticals segment dominated the market with a revenue share of 38.96% in 2023. This can be largely attributed to the rise in R&D investments and the development of new drugs over the past two decades.

North America clinical trial management services market dominated globally in 2023 with the largest revenue share of 34.96%. The demand for new therapies and drugs has led to a surge in clinical trials across the region.

Asia Pacific clinical trial management services market is expected to grow at the fastest CAGR over the forecast period.

For More Details or Sample Copy please visit link @: Clinical Trial Management Services Market Report

Clinical trial management services such as clinical monitoring, data management, site monitoring, and medical writing service are cost-effective and time-saving. These also harmonize clinical data across sites and failure rates. Furthermore, the integration of digital technologies, including cloud computing, Artificial Intelligence (AI), big data prescriptive, and predictive analytics, the Internet of Medical Things, and mobile technology remain major developments on the horizon. These technologies have shown great promise in improving productivity while accelerating the pace of clinical trials.

The COVID-19 pandemic significantly impacted the market. It created an unexpected urgency for alternative solutions to clinical trial execution, limiting on-site monitoring visits. It prompted researchers to use remote clinical trial monitoring services and platforms to reduce the spread of the COVID-19 infection as well as to simultaneously function in clinical research. For instance, according to the Florence survey in 2020, more than 60% of clinical study sites and clinical trial sponsors stated more than 50% acceptance of remote site monitoring solutions for clinical research.

List of major companies in the Clinical Trial Management Services Market

CTI Clinical Trial & Consulting

Charles River Laboratories

Medpace Holdings, Inc.

Wuxi Apptec

SGS Société Générale de Surveillance SA

Laboratory Corporation of America Holdings

IQVIA, Inc.

Syneous Health

For Customized reports or Special Pricing please visit @: Clinical Trial Management Services Market Analysis Report

We have segmented global clinical trial management services market report based on services, indication, end-use, and region.

[shrirampharmacycollege]

Shriram Pharmacy College: Leading Pharmacy Education Program In India

Pharmacy education plays a pivotal role in the healthcare system, shaping future pharmacists who understand the complexities of human health. Shriram Pharmacy College, located in Bankner, India, stands out for its comprehensive curriculum and innovative teaching methods. In this blog post, we will explore various aspects of the college’s pharmacy program, emphasizing its focus on human body systems, anatomy, physiology, and their applications in pharmaceutical sciences.

## Understand Human Body Systems Deeply

A fundamental aspect of pharmacy education is the comprehensive understanding of human body systems. At Shriram Pharmacy College, students delve into various biological systems, such as the circulatory, respiratory, and nervous systems. This knowledge is essential for aspiring pharmacists, as it lays the foundation for understanding how medications affect the body. Through lectures, practical sessions, and advanced simulations, students gain insights into the complexity of human physiology, which is crucial for effective patient care and medication management.

## Explore Anatomy For Pharmaceutical Knowledge

Anatomy serves as a cornerstone in pharmacy education. Shriram Pharmacy College emphasizes the importance of studying human anatomy to prepare students for real-world challenges in pharmaceutical practice. By understanding the structural organization of the body, students can better appreciate the target sites for drug action. The college employs modern teaching aids, such as 3D models and virtual dissections, to enhance learning. This hands-on approach fosters a deep connection between anatomical structures and their clinical significance in pharmacy.

## Study Physiology To Understand Functions

Physiology complements anatomy by exploring how body systems function. At Shriram Pharmacy College, students study various physiological processes, such as metabolism, homeostasis, and neurotransmission. This knowledge is crucial for understanding how drugs interact with biological systems. The curriculum integrates theoretical knowledge with practical applications, enabling students to analyze how medications can influence bodily functions. Such an understanding is vital for pharmacists in evaluating drug efficacy and safety.

## Learn Organ Functions And Interactions

Understanding the functions and interactions of different organs is essential for effective pharmaceutical education. Shriram Pharmacy College focuses on the interrelationships between organ systems, such as the liver, kidneys, and heart. By studying these interactions, students learn how drugs are metabolized and eliminated from the body. This comprehensive knowledge equips future pharmacists to make informed decisions regarding dosage and potential drug interactions, ultimately enhancing patient safety and therapeutic outcomes.

## Connect Anatomy To Drug Interactions

The connection between anatomy and drug interactions is a crucial aspect of pharmacy education. At Shriram Pharmacy College, students learn how different anatomical structures influence drug absorption, distribution, metabolism, and excretion. By linking anatomical knowledge with pharmacokinetics, students develop a robust understanding of how medications function within the body. This integration prepares them to assess individual patient needs and tailor medication regimens effectively.

## Apply Physiology In Pharmaceutical Contexts

Applying physiological principles in pharmaceutical contexts is essential for understanding drug mechanisms. Shriram Pharmacy College encourages students to translate their physiological knowledge into real-world applications. By examining case studies and engaging in clinical simulations, students learn how physiological variations among patients can affect drug responses. This practical approach not only reinforces theoretical concepts but also enhances critical thinking skills, preparing students for the dynamic field of pharmacy.

## Explore Pharmacokinetics With Anatomical Insights

Pharmacokinetics, the study of how drugs move through the body, is a core component of pharmacy education. Shriram Pharmacy College incorporates anatomical insights to help students understand pharmacokinetic principles better. By examining how anatomical variations can impact drug distribution and metabolism, students gain a nuanced understanding of drug therapy. This knowledge is vital for optimizing medication regimens and ensuring therapeutic efficacy.

## Link Drug Effects To Physiology

Linking drug effects to physiological responses is a fundamental skill for pharmacists. At Shriram Pharmacy College, students learn to analyze how various medications influence physiological processes. This understanding enables them to predict potential side effects and interactions based on a patient’s physiological status. By fostering this analytical approach, the college prepares students to engage in informed discussions with healthcare providers and patients about medication therapy.

/media/68c2574b9c98e57c43cd41bdf7582e02

## FAQs

**1. What programs are offered at Shriram Pharmacy College?**

Shriram Pharmacy College offers undergraduate and postgraduate programs in pharmacy, including B.Pharm and M.Pharm degrees. The curriculum is designed to provide a thorough understanding of pharmaceutical sciences, human anatomy, and physiology, preparing students for various roles in the healthcare sector.

**2. How does the college incorporate practical learning?**

The college emphasizes practical learning through laboratory sessions, clinical simulations, and case studies. Students engage in hands-on activities that reinforce theoretical knowledge, allowing them to apply their understanding of anatomy and physiology in real-world pharmaceutical contexts.

**3. What are the career opportunities after graduating from Shriram Pharmacy College?**

Graduates can pursue various career paths, including roles in community pharmacies, hospitals, pharmaceutical companies, and research institutions. The college’s strong emphasis on practical skills and industry connections helps students secure employment in diverse healthcare settings.

**4. How does Shriram Pharmacy College stay updated with industry trends?**

The college maintains strong ties with the pharmaceutical industry, regularly updating its curriculum to reflect current trends and advancements. Guest lectures, workshops, and seminars featuring industry experts further enrich the learning experience and keep students informed about emerging practices.

**5. Is there a focus on research at Shriram Pharmacy College?**

Yes, Shriram Pharmacy College encourages research among students and faculty. The college promotes participation in research projects, conferences, and publications, fostering a culture of inquiry and innovation in pharmaceutical sciences. This focus helps students develop critical thinking and analytical skills essential for their careers.

## Conclusion

Shriram Pharmacy College in Bankner is committed to providing a leading pharmacy education program that integrates the study of human body systems, anatomy, and physiology. By emphasizing the practical applications of this knowledge, the college prepares students for successful careers in pharmacy. With a focus on real-world challenges and innovative teaching methods, Shriram Pharmacy College equips future pharmacists to contribute effectively to the healthcare system.

### Stay Connected with Shriram Pharmacy College!

For the latest updates, educational content, and insights into the dynamic field of pharmacy, don’t miss out on the Shriram Pharmacy College YouTube channel. By liking, sharing, and subscribing, you’ll gain access to expert lectures, student testimonials, campus events, and much more. Stay informed about advancements in pharmaceutical sciences and become a part of our vibrant community. Your support helps us grow and continue providing valuable resources to students and professionals alike. Join us today and never miss an update!

[insightfulblogz]

Bone Densitometer Market Growth, Analysis, and Industry Insights 2024 to 2032

Bone densitometers are specialized diagnostic devices used to measure bone mineral density (BMD), a key indicator of bone health. By assessing bone strength and mineral content, bone densitometers provide essential insights into conditions such as osteoporosis and osteopenia, allowing healthcare providers to diagnose and monitor these conditions effectively. Typically utilizing dual-energy X-ray absorptiometry (DEXA) technology, bone densitometers offer non-invasive, accurate readings that guide treatment decisions and preventive strategies to maintain bone health, particularly in at-risk populations such as postmenopausal women and the elderly.

The Bone Densitometer Market Size was valued at USD 314.1 million in 2023 and is expected to reach USD 453.5 million by 2031, and grow at a CAGR of 4.7% over the forecast period 2024-2031.

Future Scope

With the growing prevalence of osteoporosis and bone-related disorders, the demand for bone densitometers is expected to rise significantly. Future advancements are likely to focus on portable and miniaturized devices that allow for bone density testing outside of clinical settings, enhancing accessibility for remote or underserved communities. Furthermore, the integration of AI is anticipated to provide more accurate fracture risk assessments and personalized recommendations for bone health. These innovations will likely expand the utility of bone densitometers, making them an integral tool in proactive health management and osteoporosis prevention.

Trends

Notable trends in bone densitometry include the increasing adoption of portable devices, which facilitate on-site testing in clinics and mobile health units, and the incorporation of advanced analytics to assess fracture risk beyond BMD measurements. Another trend is the development of hybrid devices that combine bone density measurement with other health metrics, such as body composition analysis. This holistic approach to health assessment is gaining traction as it allows for comprehensive evaluation of an individual’s musculoskeletal health.

Applications

Bone densitometers are essential in diagnosing osteoporosis and assessing fracture risk, especially in older adults and postmenopausal women. In addition to clinical applications, they are used in sports medicine to monitor bone health in athletes and in research to study the impact of medications or lifestyle factors on bone density. Bone densitometry is also valuable in pediatric cases for identifying bone density issues related to genetic disorders or long-term medical treatments. Its versatility makes it a vital tool for preventive health, diagnosis, and long-term monitoring.

Key Points

Bone densitometers measure bone mineral density to assess osteoporosis and fracture risk.

Future advancements include portable devices and AI integration for enhanced analysis.

Growing trend toward hybrid devices that provide body composition alongside BMD.

Widely used in clinical settings, sports medicine, and pediatric health assessments.

Supports proactive health management and early intervention in bone health.

Conclusion

Bone densitometers are at the forefront of bone health assessment, offering a reliable means of identifying osteoporosis and related conditions. As technology advances, bone densitometers will become even more accessible and precise, aiding healthcare providers in proactive bone health management and prevention. By providing accurate, actionable data, these devices continue to play a crucial role in improving quality of life for those at risk of bone deterioration.