ArticleLiterature Review

Surgery and complementary therapies: A review

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Abstract

The incorporation of complementary therapies into the surgical setting has been slow compared to that of other areas of conventional medicine. This paper summarizes the available information on complementary therapies in surgery from a broad range of sources in the medical literature. The effects of psychological distress on the surgical patient and potential relief from that distress by such methods as relaxation techniques, hypnosis, suggestion, and imagery, as well as the role of coping style and locus of control on choice of therapy are reviewed. The role of acupuncture, music, massage therapy, therapeutic touch, and Reiki, as well as the use of herbs and supplements in modifying surgical outcome, is explored.

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... The mortality rate in eastern Mediterranean countries including Iran will be 30-35% [6,7]. Despite the emphasis on prevention and development of new *Address correspondence to this author at the Research Center for Nursing and Midwifery Care in Family Health, School of Nursing and Midwifery, Shahid Sadoughi University of Medical Sciences, Yazd, Iran; Tel: +98351-8258404; Fax: 0351-8249705; E-mail: javadi@ssu.ac.ir treatments, surgery is the only choice for many patients with cardiovascular disease [8]. ...
... Of the most important complications are anxiety and depression so that approximately 65% of cardiovascular patients experience them after surgical and medical interventions. In fact, anxiety and depression complicate the treatment process [7,8]. Some scientists believe that anxiety is one of the essential elements of human life. ...
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Abstract: Background and Objective: Anxiety and depression are among the psychological disorders in heart surgeries. Establishing a simple communication is essential to reduce anxiety and depression. Hence, the objective of the present studywas to examine the impact of Peplau therapeutic communication model on anxiety and depression in patients, who were candidate for coronary artery bypass in Al-Zahra Heart Hospital, Shiraz during 2012-2013. Methods: This is a clinical trial in which 74 patients were randomly divided into intervention and control groups, each consisted of 37 patients. Anxiety and depression levels were assessed before, and two and four months after intervention using the Hospital Anxiety and Depression Scale (HADS). Seven therapeutic communication sessions were held in four stages. Data were analyzed with the SPSS (version 16) using analysis of covariance. Results: The mean anxiety and depression levels decreased in the intervention group after the therapeutic communication (p<0.01). Anxiety scores in the intervention group before and after intervention were 10.23 and 9.38, respectively. While the corresponding scores in the control group were 10.26 and 11.62, respectively. Depression scores in the intervention group before and after intervention were 11 and 9.13, respectively. The corresponding scores in the control group were 11.30 and 12.08, respectively. Conclusion: The results demonstrated the positive role of therapeutic communication in reducing anxiety and depression of the patients. Therefore, the therapeutic communication is recommended as a simple, cost effective and efficient method in this area.
... The mortality rate in eastern Mediterranean countries including Iran will be 30-35% [6,7]. Despite the emphasis on prevention and development of new *Address correspondence to this author at the Research Center for Nursing and Midwifery Care in Family Health, School of Nursing and Midwifery, Shahid Sadoughi University of Medical Sciences, Yazd, Iran; Tel: +98351-8258404; Fax: 0351-8249705; E-mail: javadi@ssu.ac.ir treatments, surgery is the only choice for many patients with cardiovascular disease [8]. ...
... Of the most important complications are anxiety and depression so that approximately 65% of cardiovascular patients experience them after surgical and medical interventions. In fact, anxiety and depression complicate the treatment process [7,8]. Some scientists believe that anxiety is one of the essential elements of human life. ...
Article
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Background and Objective: Anxiety and depression are among the psychological disorders in heart surgeries. Establishing a simple communication is essential to reduce anxiety and depression. Hence, the objective of the present studywas to examine the impact of Peplau therapeutic communication model on anxiety and depression in patients, who were candidate for coronary artery bypass in Al-Zahra Heart Hospital, Shiraz during 2012-2013. Methods: This is a clinical trial in which 74 patients were randomly divided into intervention and control groups, each consisted of 37 patients. Anxiety and depression levels were assessed before, and two and four months after intervention using the Hospital Anxiety and Depression Scale (HADS). Seven therapeutic communication sessions were held in four stages. Data were analyzed with the SPSS (version 16) using analysis of covariance. Results: The mean anxiety and depression levels decreased in the intervention group after the therapeutic communication (p<0.01). Anxiety scores in the intervention group before and after intervention were 10.23 and 9.38, respectively. While the corresponding scores in the control group were 10.26 and 11.62, respectively. Depression scores in the intervention group before and after intervention were 11 and 9.13, respectively. The corresponding scores in the control group were 11.30 and 12.08, respectively. Conclusion: The results demonstrated the positive role of therapeutic communication in reducing anxiety and depression of the patients. Therefore, the therapeutic communication is recommended as a simple, cost effective and efficient method in this area.
... A treatment option for CAD, which has decreased its mortality rate, is coronary artery bypass graft (CABG) surgery (4). The quality of life (QOL) of most patients who undergo CABG is dramatically decreased due to fragile recovery, anxiety, depression, and decreased self-confidence in doing activities of daily life (5). ...
... Currently, post-CABG hospital stay has been shortened and hence, patients usually achieve recovery at their homes without receiving con-tinuous healthcare services. On the other hand, because of CABG-related stress, rehabilitation of patients who undergo the surgery is a matter of great importance (4). ...
Article
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Background: The chronic disease self-management program is among the most important methods for promoting self-care. Objectives: This study was done to evaluate the effects of this program on patients' health status after undergoing coronary artery bypass graft surgery.
... Hand massage as a non-pharmacological, simple, cheap, and non-invasive nursing intervention can significantly reduce preoperative pain, anxiety, and stress. In addition, it can improve positive feelings like relaxation, calmness, and satisfaction (133,(140)(141)(142). No side effects are reported about massage (143). ...
Article
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During the pre-operation period, surgical candidates experience situations that stimulate psychological anxiety leading to stress during and after surgery which is known as preoperative anxiety. This condition can cause psychological and physiological adverse effects on both children and adults. Due to the high prevalence and adverse effects of preoperative anxiety, different treatments have been evaluated including pharmacological and non-pharmacological approaches. As pharmacological treatments may cause adverse effects such as breathing problems, drowsiness, interfering with anesthetic drugs, and prolonged recovery, non-pharmacological interventions are becoming more popular. These methods include cognitive-behavioral therapy, music therapy, pre-op preparation video, aromatherapy, hypnosis, guided imagery relaxation therapy, and massage. In this study, the most popular non-pharmacological approaches to preoperative anxiety are reviewed focusing on more recent evidence provided by clinical studies. The reviewed clinical evidence on the mentioned methods shows the efficacy of non-pharmacological interventions for the treatment of preoperative anxiety, so they can be used in patients of different ages and types of disease and surgery.
... A holistic approach to illness also improves quality of life and treatment outcome. Simple measures such as relaxation techniques, hypnosis, meditation, mental visualization, and guided imagery can improve surgical outcomes, shorten hospital stays, and reduce surgical and anesthetic-related side effects [109], restore hope [77], improve immune function [47,57,77], improve quality of life [77,124], and reduce side effects associated with radiation therapy and chemotherapy [86,77,8]. Psychosocial and spiritual interventions can also improve the survival of cancer patients [39,8], including men with prostate cancer [123]. ...
Article
An accumulating body of scientific evidence supports the notion that a holistic outlook on health and life and complementary and alternative medicine health practices can promote wellness and prevent and treat prostate disease. This overview explores some of the fundamental philosophical, diagnostic, and therapeutic differences between conventional and holistic medicine, and discusses how to integrate evidence-based complementary and alternative medicine, holistic medicine, and conventional medicine for the prevention and treatment of prostate disease.
... Algunos estudios han demostrado la influencia positiva de técnicas de reducción de estrés sobre la disminución de la presión arterial y el aumento de la tolerancia al dolor 33,55 . Una revisión sobre intervenciones de relajación en pacientes prequirúrgicos, menciona que intervenciones sencillas, como la respiración profunda, puede tener efectos benéficos post-cirugía, como menor reporte de incomodidad, menor uso de analgésicos, menor tiempo de hospitalización, menor presión arterial postoperatoria, menor frecuencia respiratoria y cardiaca, e incluso con menor concentración de cortisol y adrenalina 56 . ...
Article
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Enterocutaneous fistula is the most common of all intestinal fistulas. Is a condition that requires prolonged hospital stay due to complications such as electrolyte imbalance, malnutrition, metabolic disorders and sepsis. Nutritional support is an essential part of the management; it favors intestinal and immune function, promotes wound healing and decreases catabolism. Despite the recognition of the importance of nutrition support, there is no strong evidence on its comprehensive management, which can be limiting when establishing specific strategies. The metabolic imbalance that a fistula causes is unknown. For low-output fistulas, enegy needs should be based on resting energy expenditure, and provide 1.0 to 1.5 g/kg/d of protein, while in high-output fistulas energy requirement may increase up to 1.5 times, and provide 1.5 to 2.5 g/kg of protein. It is suggested to provide twice the requirement of vitamins and trace elements, and between 5 and 10 times that of Vitamin C and Zinc, especially for high-output fistulas. A complete nutritional assessment, including type and location of the fistula, are factors to consider when selecting nutrition support, whether is enteral or parenteral nutrition. The enteral route should be preferred whenever possible, and combined with parenteral nutrition when the requirements cannot be met. Nutritional treatment strategies in fistulas may include the use of immunomodulators and even stress management.
... Another safety issue which gained interest at a similar time was the use of herbal and dietary supplements before surgery. Between 2000 and 2003, at least 10 reviews were published in anaesthesia, surgery, nursing, medical and complementary medicine journals regarding concerns about the perioperative safety of dietary supplements [11][12][13][14][15][16][17][18][19][20][21]. A key focus was on substances that could increase bleeding and herbs such as ginger (Zingiber officinales), ginkgo (Ginkgo biloba), garlic (Allium sativum) and feverfew (Tanacetum parthenium) were consistently implicated. ...
Article
We are living with risks all the time; it's just a fact of life. There are some risks we happily accept, others we fear so much that they over-ride our rational decision making and some very large risks that are so mundane that we often ignore them. Identifying, minimising and communicating risk is necessary for improving public safety and a frequent concern for many working in healthcare. However, there is relatively little discussion about risk perception, which ultimately influences how people respond and can explain why some make seemingly irrational decisions, regardless of the evidence. This has obvious implications for clinicians and patients, but also committees and policy makers who consist of individuals with varying levels of experience, knowledge and risk perception. Deciding to restrict or promote a particular behaviour, access to a medicine, practice of a profession or integration of a therapy will be influenced by these factors. This article reviews some of the social science and psychology literature which has identified the key factors which attenuate or amplify risk perception. In particular, Ropeik's perception gap is discussed together with Slovic's work identifying factors which affect risk perception and heuristics. Several examples are given which are relevant to integrative medicine as it relates to safety. Drug–herb interactions and the perceived danger of herbal and nutritional medicines in surgery are key examples. The ‘risk as feelings’ hypothesis is also discussed as a means of better understanding barriers to the adoption of evidence based integrative medicine, and how it may affect practitioner–patient interactions.
... In order to achieve their intervention goals, counselling health psychologists may choose from an array of intervention strategies and techniques: individual and group counselling, brief therapies, providing information and training, crisis intervention, stress management, motivational interview, guided imagery, behaviour analysis and modification, cognitive restructuring and many more. The majority of these techniques and strategies are based on the cognitive-behavioural model, which has been found really effective in treating many health conditions, including: cardiovascular disorders (e.g., Bellg, 2004;Gidron, Davidson, & Bata, 1999); neoplasms (e.g., Khazam, 1996;Spira & Reed, 2002); diabetes mellitus (e.g., Norris, Engelgau, & Narayan, 2001); HIV/ AIDS (e.g., Bor, du Plessis, & Russell, 2004;Bor & du Plessis, 1997;Chesney & Antoni, 2002); sexual health (e.g., Aarø et al., 2006); surgical procedures (e.g., Lang et al., 2000;Petry, 2000); renal disease (e.g., Griva & Newman, 2007); urological disorders (e.g., Nicolau, Toro, & Perez Prado, 1991); dermatology (e.g., Kent & Keohane, 2001;Papadopoulos, Walker, Aitken, & Bor, 2000); obstetrics (e.g., Klock, 2004); transplantation (e.g., Blumenthal et al., 2006) etc. Medical patients are rather interested in short-term and focused interventions that can facilitate their recovery, than long-term insight-oriented therapies . These requirements are typically met by behavioural (e.g., conditioning, operant conditioning, modeling), cognitive (e.g., selfmanagement, cognitive therapy), and cognitive-behavioural approaches (for more details, Bennett, 2000;Bennett, Conner, & Godin, 2004;Lorig, 1996 Rutter & Quine, 2002). ...
Article
In recent decades a biopsychosocial understanding of health predominated, and health problems stopped being just a physician‟s job. Consequently, the role of experienced psychologists in health care is gradually becoming more important. Counselling Psychology as a major field of psychological science with an enormous knowledge and experience in dealing with a diversity of problems has only to offer to the medical health care. Our purpose is to present the multiple roles of counselling psychologists (e.g., as evaluators, advisors, therapists) in health and health care. Issues regarding the training of 'health counselling psychologists' are also being discussed. Finally, I argue about the opportunities and difficulties that counselling health psychologists may meet in daily practice.
... A number of studies have demonstrated positive influence of mindfulness-based stress reduction techniques on physiological processes and psychological states, such as reducing blood pressure, increasing pain tolerance and improving coping ability [9,10] . A review of preoperative relaxation interventions in surgical patients supports the use of simple techniques such as deep breathing [11] and self-hypnosis [12] to enhance a range of postoperative outcomes. Mind-body approaches such as lifestyle modification and stress reduction have long been known to have beneficial effects on cardiovascular diseases [13] . ...
Article
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Preoperative anxiety and physical unfitness have been shown to have adverse effects on recovery from cardiac surgery. This study involving cardiac surgery patients was primarily aimed at assessing the feasibility of delivering physical conditioning and stress reduction programs within the public hospital setting. Secondary aims were to evaluate the effect of these programs on quality of life (QOL), rates of postoperative atrial fibrillation (AF) and length of stay (LOS) in hospital. Elective patients scheduled for coronary artery bypass graft and/or valve surgery at a public hospital in Melbourne, Australia were enrolled. Patients were randomized to receive either holistic therapy (HT) or usual care (UC). HT consisted of a series of light physical exercise sessions together with a mental stress reduction program administered in an outpatient setting for the first two weeks after placement on the waiting list for surgery. A self-administered SF-36 questionnaire was used to measure QOL and hospital records to collect data on LOS and rate of postoperative AF. The study population comprised 117 patients of whom 60 received HT and 57 received UC. Both programs were able to be delivered within the hospital setting but ongoing therapy beyond the two week duration of the program was not carried out due to long waiting periods and insufficient resources. HT, as delivered in this study, compared to UC did not result in significant changes in QOL, LOS or AF incidence. Preoperative holistic therapy can be delivered in the hospital setting, although two weeks is insufficient to provide benefits beyond usual care on QOL, LOS or postoperative AF. Further research is now required to determine whether a similar program of longer duration, or targeted to high risk patients can provide measurable benefits. This trial was conducted as part of a larger study and according to the principles contained in the CONSORT statement 2001.
... Surgery is a life event of dramatic significant to many people. It disrupts their personal, professional, and economical lives, as well as their physical bodies (1). A number of psychological variables may predict new coronary events and quality of life of heart patients. ...
Article
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Background: Coronary artery bypass grafting surgery (CABG) and precutaneous transluminal coronary intervention (PCI) are safe and effective in the treatment of coronary artery disease. The aim of this study was to determine and compare anxi-ety, self efficacy expectation and perceived social support between CABG patients and PCI patients referral to receiving cardiac rehabilitation programs. Methods: In this descriptive-analytical study 150 patients with CABG and PCI were selected. The Spilberger state trait anxiety inventory, general self efficacy scale and perceived social support scale three instruments for collecting data in the present study. Results: PCI patients as compared to CABG patients experience higher anxiety (P= 0.02) and lower perceived social sup-port (P= 0.02). Self efficacy score in the PCI patients was higher than CABG patients (P= 0.01). Conclusion: It is necessary to be more considerate to psychological problems in the PCI patients.
... Higher incidence of depression in these patients can be probably owing to their supposition, as they believe they need more intervention actions such as opening of the sternum, hospitalization in critical care units, removal of the saphenous vein for coronary artery bypass graft, and longer hospital stays due to higher severity of their disorder [5]. CABG surgery contributes to significant alterations in personal, social, professional, and occupational life status, and these patients undergo more postoperative disability [21]. Besides, uncertainty about the future has always been a part of cardiovascular disorders, and this has been particularly observed in patients awaiting coronary artery bypass graft surgery. ...
Article
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Abstract Aims: Anxiety and depression have a high prevalence rate in patients with coronary artery disease, leading to reduced treatment outcome in these patients. Therefore, the present study has been conduced to compare anxiety and depression among patients with coronary artery disease based on proposed treatment. Methods: Anxiety and depression were compared through a standardized hospital anxiety and depression questionnaire (HADS) in 300 patients, in need of drug therapy, percutaneous coronary angioplasty (PCI), or coronary artery bypass graft (CABG), admitted to male cardiac unit of internal medicine department of Jamaran hospital, Tehran, in 2010, for coronary angiography. Data were analyzed by SPSS17 statistical software using ANOVA, Kruskal-Wallis, and chi-square. Results: Incidence of depression was higher in patients candidate for CABG than the other two groups; likewise, level of anxiety was more in those with PCI as well as CABG compare to drug treatment group (p<0.05). In total, 38 and 45.7 percent of patients underwent some degrees of depression and anxiety respectively. Conclusion: Regarding high prevalence of anxiety and depression among patients with coronary heart disease and its negative impact on treatment outcome, appropriate screening and therapeutic approaches have to be applied for this group of patients. Keywords: Coronary artery disease; Hospital anxiety and depression
... Fear, anxiety, depression, and other mental health problems may be experienced by the postoperative patient. 1 Anxiety, fear, depression, and pain are common physical and psychological problems in patients undergoing cardiac surgery, and have been related to the recovery of patients from major cardiac surgical procedures. 2 Optimal management of physical and psychological problems during the immediate postoperative phase might improve satisfaction with the surgery experience, and decrease complications and duration of hospital stay. 3 Anxiety, depression, and negative thoughts are the psychological factors related to the pathophysiological changes. ...
Article
Purpose The objective of this review was to assess the effect of preoperative education on postoperative outcomes among patients undergoing cardiac surgery. Design Systematic review and meta-analysis. Methods A comprehensive literature search was made on PubMed, CINAHL, Ovid, ProQuest, ScienceDirect, Scopus, Web of Science, and the Cochrane database between 1995 and 2015. Fourteen randomized controlled trials were included. Data analysis was performed with RevMan software and created the summary of findings using the GRADE approach. Findings Meta-analysis showed that preoperative education reduced anxiety scores (standardized mean difference = −0.96, 95% confidence interval: −1.37, −0.54; P < .0001). However, there was no significant effect of preoperative education on pain, depression, and length of hospital stay. There is low-quality evidence, and reasons for downgrading are due to study design limitations, inconsistency, and imprecision of effect estimates. Conclusions The results show that preoperative education can effectively decrease anxiety in patients undergoing cardiac surgery.
... The results suggest that relaxation is often used as a common treatment for such issues as pains, hypertension, and fatigue. A review of relaxation interventions before the operation in patients indicates the efficacy of simple practices such as deep breathing 24 for improving postoperation outcomes. Mind-centered attitudes including adjusting lifestyle and reducing stress have been known as positive effects on cardiovascular diseases. ...
Article
The aim of this study to examine the effects of supportive-educational nurse-led intervention on the patients' anxiety and sleep before the coronary artery bypass grafting.The current clinical trial recruited 160 patients (N = 160) waiting for the coronary artery bypass grafting by random block sampling and divided them into two 80-people experimental and control groups. Spielberger's State Anxiety Inventory was completed on the first day. The Groningen's Sleep Quality Index was also completed by the patients on the day of surgery. Data were analyzed in SPSS software version 16, using descriptive and inferential statistics tests.The mean anxiety score in the experimental group decreased to 48.39, whereas in the control group, the mean anxiety score saw a rise after the intervention (61.09). The comparison of the mean quality of sleep the night before the surgery for both groups showed that sleep in the control group compared with sleep in the experimental group had a lower quality, and statistically, it was significant (P < .001).Results showed that nonpharmacological and supportive interventions can reduce patients' anxiety and sleep disturbance before the coronary artery bypass grafting. According to the results, nonpharmacological therapies should be placed at the top of nurses' tasks.
... Variety of collection of techniques are available in order to use as individual and group counselling, therapies, training, crisis intervention, stress management, motivational interview, guided imagery, behavior analysis and modification, cognitive restructuring and many more as per the obligatory conditions (Karademas, 2009). Cognitive behavioral models are the main base of these techniques which have been associated in the effectiveness of many health conditions including cardio-vascular disorders (e.g., Bellg, 2004;Gidron et al., 1999); diabetes mellitus (e.g., Norris et al., 2001), HIV/AIDS (e.g., Chesney and Antoni, 2002); sexual health (e.g., Aarø et al., 2006) and surgical procedures (e.g., Lang et al., 2000;Petry, 2000) and many more. ...
Article
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The significant role and contributions of counselling is now well recognized in remedial and preventive areas. Different models of healing and human functioning has appreciated the incredible efforts of counselling in the relevant fields. Medical setting has always been promoted by counselling, where counselling has proved its exertions through vital contributions in primary care to deal with various issues and problems towards patient perception, diagnosis, treatment and care. The health awareness, prevention and developmental issues are also covered by counselling in medical care. The contributions of counselling to medical care are enormous. This paper explores the integrity of counselling in medical setting along with the issues of patients perception.
... Massage is a simple, nonetime-consuming, and noninvasive intervention that serves as a complementary and alternative method for managing patients' surgical anxiety. 6 Recent trials have confirmed the effects of hand massage on preoperative anxiety of patients waiting for different types of surgeries. [7][8][9] However, there is limited evidence regarding the anxiolytic properties of foot massage in the preoperative setting, 10 and most studies merely focus on postoperative anxiety. ...
Article
Purpose: The present study aimed to compare the effects of foot and hand massage on preoperative anxiety. Design: Three-arm randomized, nonblinded, placebo-controlled, parallel group trial. Methods: This study was conducted on 90 female candidates waiting for phacoemulsification cataract surgery in Arak Amirkabir Hospital, Iran. Patients were consecutively selected and randomly divided into three groups of hand (n = 30), foot (n = 30), and placebo (n = 30), using a random number generator software program. In each group, massage was performed 5 minutes for each hand or foot in the surgical waiting room about 10 minutes before surgery. Anxiety was measured before and after the intervention by visual analog scale and also assessing physiological indicators (heart rate, respiratory rate, systolic and diastolic blood pressures). Findings: All the 90 patients completed the study and were included in the final analysis. Both hand and foot massage resulted in a significant decrease compared with placebo massage in anxiety and heart rate. However, no significant difference was found between hand and foot massage in any of the measured parameters. In the foot group and hand group, a significant reduction was observed in heart rate and anxiety after the intervention, whereas the anxiety increased significantly in the placebo group after the intervention. Moreover, systolic blood pressure in the foot group and the respiratory rate in the hand group significantly decreased after the intervention. Conclusions: Application of hand or foot massage seems to be effective in managing anxiety in patients waiting for phacoemulsification cataract surgery.
... This event can disrupt personal, occupational, and economical aspects of life as the patients physical function can be disrupted (12). In our study, the factor of "pain and discomfort" among intrapersonal stressors has been identified as the first stressor factor in patients (with the mean score of 2.86 ± 1.23) and also in nurses (with the mean score of 2.86 ± 0.86) indicating perception similarity between nurses and patients about this stressor ( Table 2). ...
Article
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Objective: Cardiac surgery due to its-associated stressors has the potential physiological, psychological, emotional, and spiritual consequences. Assessment of stressors needs to nurses and patients understanding these factors that are different from each other. The aim of this study was to determine nurse-patient perception of stressful factors in patients undergoing coronary artery bypass surgery (CABG). Materials and Methods: It was a descriptive comparative study on patients who underwent CABG and were hospitalized at cardiac surgery wards between the third and fifth days after operation and also on nursing caregivers of these patients working in these wards. The Revised Cardiac Surgery Stressor Scale (RCSSS) was used for assessing related stressors after determining its reliability and validity. The data analysis was performed by SPSS and with descriptive statistical methods (frequency, percent, mean ± standard deviation) and inferential statistical analysis was performed. Results: According to overall mean RCSSS score, the perception of stressors in nurses was significantly higher than patients (2.38 ± 0.56 versus 1.65 ± 0.44) and the nurse-patient understanding was different for interpersonal, intrapersonal, and extra-personal stressors. Conclusion: According to the results, nurses can generally assess their patients in terms of interpersonal, intrapersonal, and extra-personal stressors and train them according to the needs of patients. It can help them to personal assessment of the patients and facilitate their adaptation.
... Both behavioral and pharmacological modalities are currently used to treat this perioperative anxiety. Recently, music has gained popularity as a part of complementary medical therapies directed at patients undergoing medical and surgical procedures (3,4). In fact, the American Music Therapy Association indicates that perioperative music can result in a reduction of anxiety and a positive change in mood (5). ...
Article
Unlabelled: In this study, we examined whether interactive music therapy is an effective treatment for preinduction anxiety. Children undergoing outpatient surgery were randomized to 3 groups: interactive music therapy (n = 51), oral midazolam (n = 34), or control (n = 38). The primary outcome of the study was children's perioperative anxiety. We found that children who received midazolam were significantly less anxious during the induction of anesthesia than children in the music therapy and control groups (P = 0.015 and P = 0.005, respectively). We found no difference in anxiety during the induction of anesthesia between children in the music therapy group and children in the control group. An analysis controlling for therapist revealed a significant therapist effect; i.e., children treated by one of the therapists were significantly less anxious than children in the other therapist group and the control group on separation to the operating room (OR) (P < 0.05) and on entrance to the OR (P < 0.05), but not on the introduction of the anesthesia mask (P = not significant). Children in the midazolam group were the least anxious even after controlling for therapist effect (P < 0.05). We conclude that music therapy may be helpful on separation and entrance to the OR, depending on the therapist. However, music therapy does not appear to relieve anxiety during the induction of anesthesia. Implications: Depending on the music therapist, interactive music therapy may relieve anxiety on separation and entrance to the operating room but appears less effective during the induction of anesthesia.
Thesis
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International and national use of complementary and alternative medicine (CAM) is high in the general population and among patients. The level of knowledge about CAM among health care professions is low, but an interest in receiving education about this field has been observed. Concerning surgical care, previous studies indicate a wide range of CAM use among patients, but the level of knowledge among health care professions is poorly investigated, both internationally and in Sweden. Concerning CAM therapies in the management of signs and symptoms in surgical care, transcutaneous electric nerve stimulation (TENS) was used with a variety of effectiveness and osteopathic medicine was found to be poorly investigated in this context. The overall objective of this thesis was to investigate CAM in the surgical context with a focus on health care professions’ perceptions and understanding and the usefulness of therapy in symptom management in clinical settings. Both inductive (paper I; semi structured interviews, n=16) and deductive (paper II; questionnaire, n=737) methods were used to investigate perceptions and understanding of CAM among Swedish health care professions in surgical care. TENS as a pain relieving complement during the transition from epidural analgesia (EDA) to general analgesia after major abdominal surgery was investigated in a randomized controlled trial design (paper III; n=20). Osteopathic intervention in management of chronic signs and symptoms after thoracotomy was investigated with a single-subject research design (paper IV; n=8). The results reveal that surgical health care professions understand and perceive CAM as a wide range of therapies, remedies and systems. Their self valued level of knowledge was low, both concerning CAM and CAM research, but a desire was found to gain knowledge about CAM. A majority of the participants would consider learning a CAM therapy. Dialog about and referral to CAM occurred, but to a limited extent. Concerning therapy usability, TENS was not found to significantly relieve pain, promote recovery or reduce consumption of analgesics. In addition, comments from nurses and patients indicated that TENS treatment obstructed postoperative care. A significant improvement was observed in the osteopathic intervention in stiffness and benefits for pain, but not in breathing. The comprehensive conclusion of the thesis is that Swedish health care professions recognise the concept of CAM and some of its therapies, but their knowledge is in general low. Concerning therapy usability and the effectiveness of CAM in surgical care, the context is essential; TENS after major abdominal surgery in EDA elimination is questionable as concerns pain and its clinical application, while osteopathy may be beneficial in the management of chronic signs and symptoms after thoracotomy.
Article
This pilot study examined the use of Reiki prior to colonoscopy to reduce anxiety and minimize intraprocedure medications compared with usual care. A prospective, nonblinded, partially randomized patient preference design was employed using 21 subjects undergoing colonoscopy for the first time. Symptoms of anxiety and pain were assessed using a Likert-type scale. Between-group differences were assessed using chi-square analyses and analysis of variance. There were no differences between the control (n = 10) and experimental (n = 11) groups on age (mean = 58 years, SD = 8.5) and gender (53% women). The experimental group had higher anxiety (4.5 vs. 2.6, p = .03) and pain (0.8 vs. 0.2, p = .42) scores prior to colonoscopy. The Reiki intervention reduced mean heart rate (-9 beats/minute), systolic blood pressure (-10 mmHg), diastolic blood pressure (-4 mmHg), and respirations (-3 breaths/minute). There were no between-group differences on intraprocedure medication use or postprocedure physiologic measures. Although the experimental group patients had more symptoms, they did not require additional pain medication during the procedure, suggesting that (1) anxious people may benefit from an adjunctive therapy; (2) anxiety and pain are decreased by Reiki therapy for patients undergoing colonoscopy, and (3) additional intraprocedure pain medication may not be needed for colonoscopy patients receiving Reiki therapy. This pilot study provided important insights in preparation for a rigorous, randomized, controlled clinical trial.
Article
Previous studies offer contradictory evidence regarding the effects of cortisol changes on health outcomes for surgical heart patients. Increased cortisol and inflammation have been related to psychological stress while separate studies have found an inverse relation between cortisol and inflammation. Psychological preparations for surgery can reduce stress and improve outcomes and may interact with cortisol changes. Following from these relationships, we hypothesised that a preparation for surgery will interact with changes in cortisol to affect outcomes. Measures were the SF 36 General Health and Activities, medical visits and satisfaction. Eighty-five patients were randomly assigned to standard care plus a psychological preparation or standard care alone using a single-blind methodology. Data on psychological and biological functioning were collected at admission, 1 day prior and 5 days post-surgery, and 12-months after hospital discharge. General health and activities, and medical visits were related to the interaction of cortisol change and psychological preparation in support of the hypothesis. Patients were more satisfied in the preparation group than controls. Based on these findings, some outcomes from psychological preparations may be affected by changes in levels of cortisol. These results caution against a one-size-fits-all approach to psychological preparations.
Article
To identify patients' report of complementary and alternative medicine (CAM) use, along with their knowledge, their attitudes, and their use/willingness to use CAM. A total of 353 patients were recruited through a 'convenience' sampling method in four metropolitan hospitals in Adelaide. Data were collected by means of questionnaires with open- and close-ended questions. The prevalence of CAM use among patients was 90.4%; although a considerable proportion of patients using CAM did not disclose this information to nurses/doctors (39.9%) and 20.7% said they would report it as "only when needed/or if asked to". A high proportion of patients reported using non-herbal supplements (60.3%) and massage therapy (45%) while most forms of therapies were mainly used "only when needed". The CAM domain most frequently used was biologically based therapies (68.8%). Patients rated themselves as having "none" (24.4%) or "very little" (42.5%) knowledge about most CAM, although nearly half (46.4%) of them had a positive attitude towards CAM. Use, knowledge, and attitudes towards CAM were also associated with diverse socio-demographic variables. This study provides a comprehensive analysis of the use of CAM by patients.
Chapter
It is now generally acknowledged that the functioning of the cardiovascular system is determined in large part by attitudes, emotions, anxiety and distress [1]. Resulting clinical implications include the use of behavioral and psychological interventions during cardiac rehabilitation in order to achieve relaxation [2], which can be defined as a state of physiological distension aimed at re-balancing changes deriving from distressful conditions. Relaxation techniques and hypnosis have become particularly relevant in treatment programs aimed at stress management and homeostatic rebalancing, since a continuous state of arousal can, in the long run, result in damage or dysfunction cardiovascular system. Many authors, however, argue that techniques aimed at achieving a relaxation condition can be considered elective in the treatment of cardiovascular disease [3]–[6].
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This national multisite study examined complementary and alternative medicine (CAM) use by surgical patients during the two weeks preceding their surgery. A simple descriptive design consisting of anonymous self-report questionnaires was used to measure CAM use and determine participant demographics. A purposive sample of adult, English-speaking, elective outpatients from 16 hospitals representing seven US regions was used. Data were collected randomly at each site. Sixty-seven percent of participants disclosed use of all types of CAM; 27% consumed herbs, 39% used dietary supplements, 54% took vitamins, and 1% reported use of homeopathics. Thirty-four percent of participants reported using CAMs that potentially can interact with anesthetics and inhibit coagulation. The results of this study suggest that perioperative nurses should encourage patients to disclose CAM use and should educate patients about anesthetic interactions that may contribute to bleeding.
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Complementary therapies support and enhance the quality of life and people's wellbeing. Increasingly, people are seeking out complementary therapies in managing their healthcare. Practitioners in the perioperative setting, who are at the forefront of healthcare delivery, should be aware of the current complementary therapies available to patients, including the potential benefits and any contraindications of the therapies.
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Introduction Statement of the problem Cardiac surgery is an important event in an individual's life and can cause the collapse of the economic, personal, and professional life of the individual, and impair their physical functioning. Fear, anxiety, depression, and other mental health problems may be experienced by the operated patient (1). Patients consider coronary artery bypass surgery as an interference with their life and have trouble in adjusting with routine hospital care. They feel stressed and that they lack control over their lives (2). Concerns of patients undergoing coronary artery bypass include success chances of surgery, waiting period before the surgery, fear of death, previous negative experiences in the hospital, fear of the recovery process, fear of pain and discomfort of surgery, concerns about loss of appetite, fatigue, sleep disorders, resumption of normal life, activities after surgery, cardiac monitoring, drug addiction, length of hospitalization, and hospital costs. Patient training during nursing of surgical patients is essential. Patients who receive training have decreased stress levels and their length of hospitalization is reduced (3). Arthur et al. have suggested that long period of time of waiting for coronary bypass surgery resulted in the deterioration of the patient's emotional state and physical activity (4). Identifying the stress factors in patients undergoing coronary artery bypass graft (CABG), particularly stressful factors that are associated with anxiety, is important for nurses because it helps in the ranking and performing of effective actions. Therefore, it is essential to evaluate the patients knowledge of stressors related to coronary bypass surgery (5). It is of some Open Access Review Article
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È ormai riconosciuto come il funzionamento del sistema cardiovascolare sia ampiamente determinato da atteggiamenti personali, emozioni, ansia e disagio psicologico [1] Questo determina, nella pratica clinica, la necessità di interventi per la modificazione di comportamenti a rischio e per la gestione di problematiche di tipo psicologico. Tra i vari possibili approcci hanno trovato ampio spazio le tecniche che consentono il raggiungimento di uno stato di rilassamento, vale a dire una distensione fisiologica che riporta l’organismo in una condizione di equilibrio dopo il verificarsi di episodi disturbanti. Le tecniche di rilassamento e l’ipnosi sono divenute particolarmente rilevanti nei programmi di trattamento volti alla gestione dello stress ed alla ricostituzione dell’equilibrio omeostatico, dal momento che un continuo stato di arousal può determinare, a lungo andare, danni o malfunzionamenti a carico del sistema cardiovascolare. Molto spesso, nel campo della riabilitazione cardiaca, gli interventi di tipo psicologico sono stati basati sul modello cognitivo-comportamentale, centrato sulla #x201C;ristrutturazione” di credenze negative, relative a sé e all’ambiente, che emergono in presenza di eventi stressanti [2, 3]. A confronto con queste tecniche, le procedure di rilassamento e l’ipnosi hanno una caratteristica distintiva: invece di cercare di promuovere un’analisi critica delle reazioni allo stress e al disagio psicologico, l’obiettivo è quello di “aggirare” i processi mentali razionali.
Article
Introduction Psychological distress, suffering and negative emotions are commonly experienced by breast cancer patients during the course of their illness. The present study aims to measure the efficacy of an integrative intervention of music therapy and emotional expression on lowering negative emotions in breast cancer patients during chemotherapy administration. Methodology Sixty-two breast cancer patients were recruited in the outpatient Oncology Unit, and were randomly assigned to either the experimental or the control arms of the study. The experimental group (N = 31) received a single integrated intervention of music therapy and emotional expression in group format during the infusion of chemotherapy. The control group (N = 31) received standard psychosocial care. The “Emotion Thermometers tool” was administered before and after the intervention. This tool is a combination of visual scales which measure stress, anxiety, depression and anger. It also includes a “need for help” variable. Results The experimental group had significant reductions in stress, anxiety, depression and anger (p < 0.05, Cohen's d > 50 for all variables). Anxiety and stress were reduced also in the control group, but the effect size was small (p < 0.05, Cohen's d < 50). Patients in the experimental group were more satisfied in their “need for help” than the control group (p < 0.001, Cohen's d > 80). Discussion The integrative intervention has been rated helpful by women with cancer and can be considered useful in lowering negative emotions during the administration of chemotherapy, in particular anger and depression. The limitations of this study and future research directions are discussed.
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La fístula enterocutánea es la forma más común de las fístulas intestinales. Es una patología que obliga la estancia hospitalaria prolongada debido a complicaciones como desequilibrio hidroelectrolítico, desnutrición, desajustes metabólicos y sepsis. El apoyo nutricio es parte esencial en el manejo, ya que favorece la función intestinal, inmune, promueve la cicatrización y disminuye el catabolismo. Aunque se ha reconocido la importancia del apoyo nutricio no existen ensayos clínicos sobre su manejo integral, lo cual puede resultar limitante al establecer estrategias específicas. Se desconoce el desajuste metabólico que ocasiona una fístula. Para fístulas de bajo gasto, se recomienda cubrir el gasto energético en reposo, con un aporte de 1,0 a 1,5 g/kg/d de proteína; mientras que en fístulas de alto gasto puede aumentar hasta 1,5 veces su requerimiento, con un aporte de proteína de 1,5 y hasta 2,5 g/kg. Se recomienda el aporte del doble del requerimiento de vitaminas y elementos traza y entre 5 y 10 veces el de Vitamina C y Zinc, especialmente para fístulas de alto gasto. La decisión de elegir entre la vía enteral o parenteral dependerá de la evaluación de cada paciente, del tipo y localización de la fístula, estado nutricio previo, entre otros. Siempre que sea posible debe preferirse la vía enteral; y cuando no se pueda cubrir el requerimiento por esta vía, combinar con nutrición parenteral. Otras estrategias de tratamiento nutricio en fístulas podrían incluir el uso de inmunomoduladores e incluso el manejo de estrés.
Article
Purpose The purpose of this study was to identify the factors predictive of postoperative nausea and vomiting (PONV) after laparoscopic cholecystectomy. Design This is a descriptive, cross-sectional study. Methods In total, 172 patients completed the study. “The Questionnaire Form,” “Visual Analog Scale,” “Nausea Scale,” and “Anxiety Specific to Surgery Questionnaire” created by the researchers were used for data collection. Findings At the second postoperative hour, 55.8% of the patients had nausea, 20.3% had vomiting and 75% had severe pain. The severity of nausea, vomiting, and pain decreased with time. Age, gender, smoking, motion sickness, postoperative pain, opioid use, preoperative fasting time, time of first postoperative fluid intake and preoperative anxiety score were found to be among the factors predictive of PONV (P < .05). Conclusions High rates of postoperative nausea and vomiting were recorded. The factors predictive of PONV can be evaluated in the preoperative period, and PONV can be controlled with early interventions and treatment of patients in the risk group.
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Aromatherapy is one of the main complementary therapies to be practiced by nurses and other health care professionals in hospital, hospice, and community settings. Written by a nurse, this clinical text highlights how aromatherapy can enhance care and the role health care professionals play in its practice. It examines key facts and issues in aromatherapy practice, and applies these within a variety of contexts and conditions, taking a carefully holistic approach in dealing with the patient.
Chapter
The 3rd edition of Relaxation Techniques provides the health care professional with a practical introduction to a variety of approaches to relaxation, both somatic and cognitive, that may contribute to patient care. Each technique is easy to teach and use, and has been demonstrated effective in the clinical situation. The background theory to each method is also described and its rationale spelled out, thus helping the clinician to select the appropriate technique. All the methods included are suitable for use with both small groups and individuals. Focuses on the practical aspects of relaxation techniques. Aimed at clinicians for use with patients/clients. Gives the background theory to each technique. Includes cognitive approaches (e.g. self -awareness, imagery, autogenics, meditation, and positive self-talk). Includes somatic approaches (e.g. progressive relaxation, stretchings, and the Mitchell method). Discusses the advantages and pitfalls of each method. Evidence based and fully referenced. Two new chapters on cognitive behavioral approaches and other techniques including yoga, Eastern methods, body awareness therapy, massage, aromatherapy, and reflex therapy. 2-color design throughout. Most line drawings are redrawn in 2-color. Now includes guidelines for selecting the appropriate therapy for use with each individual. Psychological theory sections in Chapters 1 and 3 are completely rewritten and expanded. Includes references and short explanations of relevant recent research.
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Physical restraints are commonly used in health care facilities in the United States. Despite their extensive use, virtually no evidence exists to support the efficacy ofphysical restraints in maintaining the safety of patients. Current scientific evidence suggeststhat the use ofrestraints is not only outdated, it is so potentially harmful that any benefit rarely outweighs the risk. The use of restraints among the elderly and the negative sequelae has sparked legislation concerning patients' rights. While physicians are responsible for restraint decisions under all laws and regulations, other members of the health care team have an ethical and legal obligation to consider the implications of restraint use as well. The purpose of this article is to review the literature regarding efficacy of physical restraints and introduce the regulations relatedto the use ofphysical restraints. Further, ethical and legal principles related to restraint use will be discussed.
Chapter
The definition of aromatherapy is the controlled use of essential oils (2). Essential oils are steam distillates obtained from aromatic plants. Aromatherapy is a fairly new complementary therapy, although its roots are in herbal medicine, one of the oldest known forms of medicine. Aromatherapy is an accepted part of nursing care in the United Kingdom, Switzerland, Germany, Australia, and Canada, and many nurses in the United States are beginning to use aromatherapy. Aromatherapy is particularly useful in cardiology (see Table 1), because the use of familiar smells and gentle touch can be deeply reassuring. Essential oils have many other properties that can be useful in cardiology-hypotensor, sedative, antiinflammatory, antispasmodic, analgesic, antibiotic, antifungal, and antiviral. This chapter covers the use of aromatherapy for borderline hypertension and for fear and anxiety associated with myocardial infarction (MI) or cardiac surgery and outlines interesting case and small clinical studies addressing the effect of essential oils on methicillin-resistant Staphylococcus aureus (MRSA) Table 1 Essential Oils for Specific Diagnosis Diagnosis Essential oil Research Reference Borderline hypertension Ylang ylang Lavender Rose Neroli Lemon Clary sage Freund, 2000 Saeki and Shiohara, 2001 Nathan, 2000 Tiran, 1996 Tiran, 1996 Tiran, 1996 28 30 31 34 34 34 Reducing fear and anxiety Lavender Roman chamomile Rose Hadfiele, 2001 Yamada et al., 1996 Manly, 1993 41 46 51 Methicillin-resistant Staphylococcus aureaus Tea tree Lavender Juniper Peppermint Lemongrass Eucalyptus Clove Thyme Nelson, 1997 Nelson, 1997 Nelson, 1997 Nelson, 1997 Sherry et al., 2001 Sherry et al., 2001 Sherry et al., 2001 Sherry et al., 2001 22 22 22 22 26 26 26 26
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مقدمه: عمل باي پس عروق کرونر بعنوان یکی از متداول ترین روش هاي جراحی قلب توأم با عوارض روانی شایعی از قبیل اضطراب و افسردگی است که می تواند پیامدهاي منفی براي افراد داشته باشد. به نظر می رسد در این دسته از بیماران، اضطراب قبل از عمل در بالاترین سطح خود قرار دارد و تا یک هفته پس از آن نیز، بالاتر از حد طبیعی خواهد بود. لذا مطالعه حاضر با هدف تعیین میزان اضطراب در این دسته از بیماران انجام گردید. مواد و روش ها: در این مطالعه توصیفی – مقطعی، میزان اضطراب 100 بیمار تحت جراحی باي پس عروق کرونر بستري در بیمارستان نفت اهواز، که به روش نمونه گیري در دسترس انتخاب شده بودند، مورد بررسی قرار گرفت. داده ها با استفاده از پرسشنامه اضطراب آشکار اشپیل برگر در روز قبل و یک هفته پس از جراحی بصورت خود گزارش دهی جمع آوري و بوسیله آمار توصیفی و تی تست تحلیل شدند. 38 و /86 ±12/ یافته ها: میانگین و انحراف معیار اضطراب قبل و یک هفته پس از جراحی باي پس عروق کرونر به ترتیب 23 (P=0/ 36/34±10/86 بود. مقایسه میزان اضطراب روز قبل و یک هفته پس از جراحی، از نظر آماري اختلاف معناداري را نشان داد ( 014 که بیانگر کاهش معنی دار اضطراب یک هفته پس از جراحی قلب باز در بیماران می باشد. نتیجه گیري: بیماران تحت عمل جراحی گرافت باي پس عروق کرونر بایستی به طور معمول از نظر اضطراب قبل از عمل بررسی شده و مداخلاتی در جهت پیشگیري یا کاهش اضطراب آن ها طراحی گردد. واژه هاي کلیدي: اضطراب، جراحی باي پسعروق کرونري، بیماران
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6/1±1/72)‬ ‫توده‬ ‫شاخص‬ ‫اساس‬ ‫بر‬ ‫وزن‬ ‫اضافه‬ ‫دارای‬ ‫زن‬ 32 ‫کل‬ ‫در‬ ‫بررسی:‬ ‫روش‬ ‫کنترل(دارونما‬ ‫و‬ ‫اسپنینگ+دارونما(11=‪)n‬‬ ‫سبز(11=‪)n‬‬ ‫اسپنینگ+چای‬ ‫گروه‬ ‫سه‬ ‫به‬ ‫تصادفی‬ ‫طور‬ ‫به‬ ‫سال)‬ 24/9±3/6 ‫سنی‬ ‫میزان‬ 11-17 ‫شدت‬ ‫با‬ ‫را‬ ‫اسپنینگ‬ ‫تمرینات‬ ‫هفته‬ ‫هشت‬ ‫مدت‬ ‫به‬ ‫تمرینی،‬ ‫های‬ ‫گروه‬ ‫شدند.‬ ‫تقسیم‬ ‫تمرین)(01=‪)n‬‬ ‫بدون‬ ‫آخرین‬ ‫از‬ ‫پس‬ ‫ساعت‬ 48 ‫سپس‬ ‫و‬ ‫مداخالت‬ ‫شروع‬ ‫از‬ ‫قبل‬ ‫ساعت‬ 48 ‫خونی‬ ‫گیری‬ ‫نمونه‬ ‫دادند.‬ ‫انجام‬ ‫فشار‬ ‫درک‬ ‫فیبرینوژن‬ ‫خونی‬ ‫سطح‬ ‫و‬)high sensitive C-reactive protein(hs-CRP ‫سرمی‬ ‫غلظت‬ ‫شد.‬ ‫انجام‬ ‫تمرینی‬ ‫ی‬ ‫جلسه‬ ‫انجام‬ ‫ایمپدانس‬ ‫بیوالکتریکال‬ ‫تحلیل‬ ‫و‬ ‫تجزیه‬ ‫روش‬ ‫به‬ ‫بدن‬ ‫چربی‬ ‫درصد‬ ‫و‬ ‫بدنی‬ ‫ی‬ ‫توده‬ ‫شاخص‬ ‫عالوه‬ ‫به‬ ‫شد.‬ ‫گیری‬ ‫اندازه‬ ‫شد.‬ ‫داشت(500/0=‪.)P‬‬ ‫معنادار‬ ‫کاهش‬ ‫سبز‬ ‫اسپنینگ+چای‬ ‫گروه‬ ‫در‬ ‫فقط‬ hs-CRP ‫مداخالت،‬ ‫هفته‬ ‫هشت‬ ‫از‬ ‫پس‬ ‫ها:‬ ‫یافته‬ ‫تمرینی‬ ‫گروه‬ ‫دو‬ ‫هر‬ ‫در‬ ‫بدن(100/0=‪)P‬‬ ‫ی‬ ‫توده‬ ‫شاخص‬ ‫و‬ ‫بدن(100/0=‪)P‬‬ ‫چربی‬ ‫درصد‬ ‫فیبرینوژن(100/0=‪،)P‬‬ ‫عالوه‬ ‫به‬ ‫گروه‬ ‫بین‬ ‫اما‬ ‫داشت(820/0=‪)P‬‬ ‫وجود‬ ‫تمرینی‬ ‫های‬ ‫گروه‬ ‫بین‬ hs-CRP ‫معنادار‬ ‫تفاوت‬ ‫همچنین‬ ‫داشتند.‬ ‫معنادار‬ ‫کاهش‬ ‫بین‬ ‫بدن‬ ‫چربی‬ ‫درصد‬ ‫و‬ ‫فیبرینوژن‬ ‫غیرمعنادار‬ ‫تفاوت‬ ‫چند‬ ‫هر‬ ‫شد(100/0=‪.)P‬‬ ‫معنادار‬ ‫تفاوت‬ ‫کنترل‬ ‫با‬ ‫اسپنینگ+مکمل‬ ‫تفاوت‬ ‫کنترل‬ ‫گروه‬ ‫با‬ ‫اسپنینگ+دارونما‬ ‫و‬ ‫اسپنینگ+مکمل‬ ‫های‬ ‫گروه‬ ‫در‬ ‫فیبرینوژن‬ ‫مورد‬ ‫در‬ ‫نشد.‬ ‫دیده‬ ‫تمرینی‬ ‫های‬ ‫گروه‬ ‫کنترل‬ ‫و‬ ‫اسپنینگ+مکمل‬ ‫گروه‬ ‫بین‬ ‫تنها‬ BMI ‫و‬ ‫بدن‬ ‫چربی‬ ‫درصد‬ ‫داشت.‬)P=0/014(‫و‬ ‫ترتیب(400/0=‪)P‬‬ ‫به‬ ‫که‬ ‫معنادار‬ .)P=0/007(‫و‬)P=0/006(‫ترتیب‬ ‫به‬ ‫که‬ ‫بود‬ ‫معنادار‬ ‫است.‬ ‫شده‬ ‫بدنی‬ ‫ترکیب‬ ‫و‬ ‫قلبی-عروقی‬ ‫خطرزای‬ ‫عوامل‬ ‫بهبود‬ ‫موجب‬ ‫اسپنینگ‬ ‫تمرینات‬ ‫که‬ ‫رسد‬ ‫می‬ ‫نظر‬ ‫به‬ ‫گیری:‬ ‫نتیجه‬ ‫است.‬ ‫داده‬ ‫افزایش‬ ‫را‬ ‫اسپنینگ‬ ‫تمرینات‬ ‫اثربخشی‬ ‫سبز‬ ‫چای‬ ‫دهی‬ ‫مکمل‬ ‫واقع‬ ‫در‬ ‫فیبرینوژن‬ ‫سبز،‬ ‫چای‬ ‫اسپنینگ،‬ ‫تمرینات‬ ‫بدنی،‬ ‫ترکیب‬ ‫باال،‬ ‫حساسیت‬ ‫با‬ ‫سی‬ ‫ی‬ ‫دهنده‬ ‫واکنش‬ ‫پروتئین‬ ‫کلیدی:‬ ‫های‬ ‫واژه
During recent years, complementary medicine (CM) has grown as a significant provider of health care in the UK, the majority of this provision being allocated through the small private business sector to privately paying clients. Given the substantial demand for CM, the government acknowledges its structural integration with orthodox medicine (OM) to be a logical progression. However, although the time frame, evidence bases and regulatory structures are as yet undetermined, key to the current emphasis on integration is an underlying assumption that private sector providers would be willing participants, potentially alongside nurses. In this context, using a combined questionnaire (n=426) and interview (n=49) survey, this paper makes an initial exploration and considers the current connections that private therapists have with OM and their attitudes towards collaborating with and working within the NHS. The majority of therapists claimed not to have existing business connections with NHS providers, though many stated that they had established some form of informal arrangements. In general, therapists were happy that they had experienced increasingly positive reactions from orthodox clinicians towards their therapies. The overwhelming majority of therapists were positive about the proposition of working within OM but did have certain reservations. Given the range and intensity of opinion found in this initial investigation, the paper concludes by signposting some substantive avenues of focused research inquiry on the structural integration of CM and OM.
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Ninety-six adult Leghorn chickens each had the flexor profundus tendon in each middle toe sharply divided in Zone II with immediate repair (pentabarbital, ketamine anesthesia). Animals were then randomly assigned to receive unsupplemented standard chick chow or the chow supplemented with vitamin A (150,000 IU/kg chow), Vitamin E (1000 IU/kg chow), or β-carotene (90 mg/kg chow). Eight animals from each of the four groups were examined at 7, 30, or 45 days post repair. After sacrifice, in situ composite wound breaking strength was measured in the amputated toe by constant speed tensiometry. Vitamin A-supplemented animals demonstrated breaking strength more than double that of control at each post-operative test day, while those animals receiving supplemental Vitamin E had breaking strength less than half that of control at Day 7 and Day 45. These results are statistically significant. Tensiometry curves differed markedly at all time points among the groups: Vitamin A curves being broader, higher, and having more spikes. These differences in the tensiometry curves, both qualitative and quantitative, may be due to differences in intrinsic tendon healing or to differences in adhesion formation or a combination of both. β-Carotene supplementation had modest effect. We conclude that supplemental dietary vitamin A increases the breaking strength of composite tendon wounds and that supplemental dietary vitamin E decreases it.
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The effectiveness of two techniques for preparing patients to undergo a stressful medical examination was assessed using observer self-report, and physiological measures of distress during gastrointestinal endoscopy. Patients were either informed about expected sensations, trained in systematic muscle relaxation, or received normal hospital procedures. The influence of coping styles on the effectiveness of information and relaxation techniques was examined for measures of fear, avoidance, emotional control, arousability, and independence.Information and relaxation interventions reduced heart rate increases and observer ratings of distress during tube insertion. Relaxation training also increased positive mood change following the procedure. Interactions between coping styles and recovery measures suggested patients benefited most from preparation that matched their preferred coping style, but were not harmed by preparation that did not match their preferred style. Discussion focuses on how coping styles may interact with preparation procedures and suggests that the use of coping styles as criteria for excluding patients from certain preparation techniques is inappropriate.
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Among the essential trace elements in mammals, zinc is somewhat unique in that it is a constituent of numerous metallo-enzymes having biologic significance in many respects. The discovery of zinc deficiency in man induced the remarkable progress of studies on its physiology and it is now recognized that zinc deficiency manifests itself differently in different areas of clinical medicine. It also appears reasonable to say that no trace elements have been more closely related to surgery than zinc. We discuss herein, its significance, implications and role in such areas as; (1) wound healing: where the usefulness of zinc for promoting wound healing in the presence of low plasma zinc levels has been firmly established; (2) total parenteral nutrition (TPN): zinc free TPN may cause skin eruptions associated with abdominal symptoms presenting a picture closely resembling that of acrodermatitis enteropathica; (3) specific pathological conditions: patients with Crohn's disease and other benign diseases accompanied by mal-digestion or-absorbtion are often predisposed to zinc deficiency, similar to those manifesting clinical signs in the early stage of TPN; and (4) surgical stress: which triggers the release of various mediators, possibly increasing hepatic zinc deposition and decreasing plasma and skin zinc levels.
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The effects of therapy with vitamin A on immune responsiveness after extensive surgical treatment were studied in vitro. Postoperatively, in control patients, there was depression of the total lymphocyte count and the response in the mixed lymphocyte reaction to a pool of stimulating cells. Treatment with pharmacologic dosages of vitamin A prevented depression of these parameters in the postoperative period. The mitogenic response to phytohemagglutinin and monocyte mediated hemolysis was not consistently altered by operation in control patients, but there was a trend toward increased activity in those receiving vitamin A. Thus, vitamin A appears to be an immunostimulant in man.
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Studied anxiety during the stressful medical procedure of endoscopy as a function of the number of prior viewings of an explicit preparation videotape and of repression–sensitization coping style. 60 naive patients aged 22–80 yrs viewed a videotaped endoscopy either 0, 1, or 3 times. Dependent measures included heart rate, behavioral ratings, tranquilizer required, and self-report (State–Trait Anxiety Inventory and Post-Endoscopy Interview Schedule). On each dependent measure, 3 viewings generally resulted in the least distress; 1, more distress; and 0, the most distress. Most comparisons reached significance. Results are interpreted as resulting from extinction and/or habituation of anxiety. The repression–sensitization factor interacted with heart rate change. Sensitizers showed a monotonic decrease in heart rate as a function of number of tape exposures. Repressors showed an inverted-U-shaped function, with 1 viewing producing the highest heart rate; this is interpreted as resulting from a disruption of repressing defenses by 1 tape exposure followed by extinction of fear by 3 exposures. (29 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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The literature relating psychic factors to pathogenesis, onset, and complication of acute myocardial infarction was selectively reviewed. A study which suggests that psychic factors affect six-month mortality rate after myocardial infarction was described. Specifically, patients showing a trend toward emotional adjustment early in their hospitalization had a far smaller mortality rate than those who did not show early adjustment trends. Severity of the heart attack, measured by the extent of complication, proved also to be predictive of six-month mortality. The findings were discussed with an emphasis on the acute-care staff's potential for changing patient behavior patterns, and hence, improving eventual patient mortality rates.
Article
Forty healthy volunteer hospital patients who had been admitted For therapeutic abortions were given anxiety scale questionnaires during the afternoon of the day before operation. That evening. the anesthesiologist conducted either a “cursory” (brief and minimally informative) or “supportive” (long and relatively) informative with maximal rapport) preoperative interview. The following morning the Skin Conductance Anxiety Test (SCAT), a physiological measure of anxiety level, was carried out as part of the induction procedure on the non-premedicated patients. The random order determining the type of interview was known only to the anesthesiologist and no scoring was carried out until after the conclusion of all testing. The investigation showed that highly anxious patients had their anxiety level significantly reduced by both cursory and supportive interviews, while the relatively non-anxious patients had their anxiety levels significantly increased by cursory interviews. It was again demonstrated that the level of anxiety is a determinant of the amount of thiopental sodium required for induction.
Article
Groups of healthy wounded rats with and without comminuted femoral fractures, and maintained on nutritionally complete commercial rat chow with and without supplemental vitamin A, were studied. The test wounds were standard dorsal skin incisions and s.c. polyvinyl alcohol sponge implants. In some experiments the rats were pair-fed; the rats with femoral fracture not receiving supplemental vitamin A were the lead group for determining food allowanced. In other experiments, the rats were allowed food ad libitum. We found that wound healing of rats with femoral fracture was increased when supplemental vitamin A was given, but the supplemental vitamin A did not completely obviate the adverse effects of fracture. The ratio of the breaking strengths of the skin incisions after formalin fixation to the breaking strengths of the incisions in the fresh state was higher in the unsupplemented rats, supporting the results of our earlier experiments that vitamin A increases the rate of collagen cross-linking.
Article
We studied 32 coronary bypass patients to examine the effect of hypnosis on recovery from surgery. The patients were assessed for hypnotizability with the Hypnotic Induction Profile (HIP) and assigned to experimental groups with a random stratification procedure to equate for differences in hypnotizability, age, and severity of illness. We taught patients in groups one and two formal hypnosis with different treatment strategies; patients in group three were not taught formal hypnosis or a treatment strategy. Scores on the HIP were significant predictors of recovery, independent of experimental treatment with formal hypnosis. Patients who scored "Midrange" stabilized more quickly in the intensive care unit (ICU) than those who scored "High" or "Low" (p = < .05). Patients who scored "High" had more labile blood pressure in the ICU compared to the "Midrange" and "Lows" (p = < .05). Measured hypnotizability was associated with the recovery sequence from surgery.
Article
It has been argued that surgery is a form of psychological stress, and that the response to it should therefore be modifiable by psychological means. To test this hypothesis, we assessed the effect of preoperative relaxation instructions on endocrine, cardiovascular, and subjective responses in 21 patients undergoing minor abdominal surgery. Controls (N = 19) received general procedural information. In the relaxation group only, there was a significant increase in cortisol and adrenaline concentration from immediately before induction of anesthesia to immediately after surgery. Noradrenaline values were unaffected by relaxation. In contrast, relaxation reduced state-anxiety on the preoperative day and the two postoperative days; maximal peroperative systolic and diastolic blood pressures were also reduced. The results are consistent with previous evidence that adrenaline and cortisol responses to surgery are greater in less anxious patients.
Article
To test our hypothesis that supplemental vitamin A would mitigate the impaired healing that occurs in tumor-bearing animals, six groups of C3H mice, eight per group, eating a standard commercial mouse chow ad libitum that supports normal growth, reproduction, and longevity were innoculated with 200,000 C3HBA cells. When tumors measured approximately 6 mm in diameter, the mice were anesthesized and wounded (dorsal skin incisions and subcutaneous polyvinyl alcohol sponges). Twenty-four hours later, two groups (one continued on the chow and the other started on the chow supplemented with 150,000 IU vitamin A/kg chow) underwent local tumor irradiation; two groups, one ingesting the chow, the other the vitamin A supplemented chow, were started on cyclophosphamide therapy; two groups, one ingesting the chow, the other the vitamin A supplemented chow, received neither local tumor irradiation nor cyclophosphamide therapy. An additional two groups ingesting the chow, one group neither innoculated with tumor nor wounded, the other wounded by not innoculated, served as controls. Wound breaking strength and sponge reparative collagen accumulation (assessed by hydroxyproline proline measurement) were used as indicators of wound healing. The mice were killed 12 days after wounding. Tumor presence decreased wound breaking strength and sponge hydroxyproline content; these effects were largely negated by supplemental vitamin A. Local tumor irradiation diminished the adverse effect of tumor on sponge reparative collagen content but to a lesser extent than the supplemental vitamin A. Supplemental vitamin A added to the irradiation effect on healing but irradiation did not add to the vitamin A effect. Cyclophosphamide, a systemic radiomimetic anti-tumor agent, did not alter the impaired wound healing of the tumor-bearing mice. Supplemental vitamin A mitigated the impaired wound healing in the cyclophosphamide-treated tumor-bearing mice. Supplemental vitamin A also moderated the effects of wounding, tumor, and tumor therapies (local irradiation and cyclophosphamide) on the increase in adrenal size, leukopenia, thrombocytopenia, and thymic involution (except the last was not moderated in the cyclophosphamide-treated tumor-bearing rats). The splenic enlargement in the untreated tumor-bearing wounded rats and in those treated with cyclophosphamide was lessened by supplemental vitamin A. We hypothesize that these anti-stress effects of vitamin A underlie, in part, its action in mitigating the impaired wound healing of tumor-bearing mice, including those treated by local irradiation or cyclophosphamide. These findings have implications for the care of patients with malignant tumors.
Article
The literature on pre-surgical psychological interventions designed to improve psychological adjustment to and recovery from surgery, as well as increase cost-effectiveness, is reviewed. Three broad classifications of interventions (information-based interventions, behaviorally-oriented interventions, and insight-oriented interventions) are discussed based on previous studies aimed at demonstrating the utility of each approach. Limitations of the research in this area are presented and recommendations are made for effective implementation of pre-surgical interventions.
Article
Twenty patients undergoing cardiac surgery were seen 1 or more times by a psychiatrist who performed 2 functions. In a supportive fashion he cleared up any misconceptions the patient had about the forthcoming surgery and taught him a simple autohypnotic technique. Twenty controls, matched for relevant variables, received routine preoperative care. Contrary to other reports, a single visit by the psychiatrist did not influence the incidence of postoperative delirium, anxiety, depression, pain, or medication requirements. However, there was a trend for patients receiving a greater number of preoperative visits to have a lower incidence of detected delirium. Age was the only factor in this study that differed significantly between delirious and nondelirious patients.
Article
Three groups of women (ns = 10) undergoing hysterectomy were subjects in an evaluation of biofeedback and relaxation techniques applied to recovery from psychological trauma of hysterectomy. Dependent measures included requests of pain medications, anxiety levels, finger-tip temperature, subjective units of discomfort, and number of days post-operative care. Although the results were mixed on most variables, the number of days post-operative care was significantly less in the relaxation/biofeedback group.
Article
Forty male and female albino rats received a standardized gingival wound (gingivectomy) between the mandibular incisor teeth. One half of the animals received 60 I.U. of d-alpha-tocopheryl acetate daily, administered orally by pipette. An additional control group of 20 animals was not wounded and half of these animals received 60 I.U. of d-alpha-tocopheryl daily. Four animals in each of the two gingivectomy groups (Groups 1, 2) were sacrificed at periods of 1, 2, 4, 7 and 14 days following gingivectomy. Two animals in each of two control unwounded groups (Groups 3, 4) were sacrificed at similar times. Gingival healing was studied grossly and histologically. The animals receiving the vitamin E supplements healed more rapidly, with almost complete restoration of gingiva by 7 days. Complete healing was seen in both control and experimental groups by 14 days. Vitamin E was shown to accelerate gingival wound healing in experimental animals.
Article
Orthotopic heart transplantation has been established as a routine clinical operation. In this study, we were interested in: (a) how patients cope emotionally with the situation pre- and postsurgically, especially with regard to anxiety and depression; and (b) whether the patient's perceived locus of control is related to emotional adjustment before and after heart transplantation. Twenty patients who were on the waiting list for heart transplantation with highest priority provided complete psychological questionnaires presurgically and 20 days after surgery when intensive care was no longer required. During the waiting period, patients rated high on depression, state and trait anxiety in comparison with healthy references while ratings on perceived locus of control scales were within the norm ranges. After surgery, heart transplant patients experienced significantly less state/trait anxiety and depression reaching levels which were no longer statistically different from health references. While postsurgical ratings of anxiety (state and trait) and depression were not significantly correlated with presurgical ratings, both were closely related to ratings of locus of control. Belief in powerful others was positively correlated with pre- and postsurgical anxiety and depression. Chance control orientation was related only to presurgical emotional disturbances. It can be concluded that emotional adjustment after heart transplantation is more likely to be predicted by presurgical ratings of locus of control than by presurgical emotional adjustment.
Article
This is not an exhaustive study of all nutritional supplements that patients may be taking. The most frequently used and those potentially most detrimental or most beneficial for surgical patients have been chosen for review of pertinent effects. It is essential to ask patients specifically about supplements or unusual dietary habits that may affect their surgical outcome prior to their invasive procedure and to keep in mind the supplements that may improve their outcome.
Article
We postulated that patients with an internal locus of control, i.e. those who like to control their health problems themselves, would adapt more adequately to the 'patient-controlled analgesia' technique as compared to patients with an external health locus of control, who do not believe in their own control. Since contradicting studies have been published on this matter, we investigated relations between the demand for analgesics, perceived pain in the postoperative phase, and the health locus of control in the postoperative context of cardiac surgery. Findings demonstrate distinct utilization patterns between subjects with internal or external locus of control concerning total morphine consumption, number of unsatisfied demands and reduction of perceived pain.
Article
Dietary nutrients may have pharmacological value in modulating the immune system. We studied the effects of two enteral diets, which differed in their content of arginine, fat source, and select trace elements, on immune function in critically injured patients. Leukocytes were isolated from healthy volunteers and severely injured (ISS > 13) patients on the first, sixth, and tenth day of receiving either a standard diet or experimental diet. Monocytes were assayed for tumor necrosis factor, procoagulant activity, and prostaglandin E2 following endotoxin exposure. Neutrophil oxidant production and lymphocyte blastogenesis was assessed. Leukocyte function was uniformly depressed compared to normal patients on day 1. The response of leukocytes from patients receiving experimental diet improved or "normalized" by day 6, while remaining depressed in patients receiving standard diet. Dietary nutrient modification can effect cellular immune responses to inflammatory stimuli in severely injured patients.
The specific aim of this study was to evaluate the effectiveness of therapeutic touch in reducing the adverse immunological effects of stress in a sample of highly stressed students. Long-term goals are to develop methods by which a variety of stress-reduction techniques can be tested for efficacy. Experimental. A large urban medical university in a southern coastal city. Healthy medical and nursing students who are taking professional board examinations. Therapeutic touch. T-lymphocyte function (CD25) and immunoglobulin levels. Subjects who received therapeutic touch and subjects who did not had significantly different levels of IgA and IgM; CD25 (mitogen-stimulated T-lymphocyte function) and IgG levels differed in the expected direction between the two groups, but the differences were not statistically significant. Apoptosis (programmed cell death) was significantly different between the two groups. The small sample size requires cautious interpretation of the results. This is a pilot study designed to provide evidence to show that further study of therapeutic touch as an intervention that may be useful in reducing the adverse immunologic consequences of anxiety related to stress in otherwise healthy students is warranted. Change in immune function related to anxiety and the relief of anxiety can be measured. Subsequent power analysis suggests sample sizes of 90 subjects per group are required to confirm the conclusions.
Article
To identify which perioperative information outpatients want from their anesthesiologist. Cross-sectional study. Outpatient center. 197 ASA physical status I and II patients undergoing outpatient surgery. A questionnaire examining for "desire for information". Demographic data including age, ethnicity, gender, socioeconomic status, and history of previous surgery were obtained. Trait, situational anxiety, and coping strategy were assessed using a validated behavioral instrument and a questionnaire adopted from previous studies conducted in Australia, Scotland, and Canada. Each questionnaire contained 14 statements regarding specific perioperative details. An index of the overall patient desire for information (PDI) was calculated for each subject. More than 85% of subjects gave a high priority to being informed for all the 14 items. Scores on the overall index were found to be higher for females than for males (32 +/- 6 vs. 30 +/- 6; p = 0.03), and this finding persisted in a multivariable model that also included coping strategies and anxiety (DF = 1,175, F = 4.6, p = 0.01). Subjects also had higher PDI scores if a first degree relative had a history of previous surgery (33 +/- 5 vs. 31 +/- 6; p = 0.007). On analysis of individual questionnaire items, Latino Americans were significantly less likely than European Americans or African Americans to desire perioperative information (p < 0.05). Similarly, females had a significantly higher desire for information than males. Subjects who were divorced demonstrated a higher desire for information than did single or married subjects. Ethnicity, gender, coping mechanism, marital status, and a history of previous surgery in a relative have been identified as predictors for the desire for information.
Article
A series of five innovative experiments conducted by Wirth et al. which examined the effect of various complementary healing interventions on the reepithelialization rate of full thickness human dermal wounds was assessed as to specific methodological and related factors. The treatment interventions utilized in the series included experimental derivatives of the Therapeutic Touch (TT), Reiki, LeShan, and Intercessory Prayer techniques. The results of the series indicated statistical significance for the initial two experiments and nonsignificance or reverse significance for the remaining three studies. This review article examines the methodological designs of the series of studies, along with the TT practitioners' phenomenologically based journal reports, to provide potential contributing correlative factors for the differential results obtained. These factors include: (1) methodological design restrictions, (2) a transference/inhibitory effect (3) the influence of experimental assistants, (4) healer visualization /imagery techniques, (5) variations in subject populations, and (6) a potential cancellation effect. While the placebo controlled double-blind methodological designs used in the series were as stringent as those used in other fields of scientific inquiry, the overall results of the experiments were inconclusive in establishing the efficacy of the treatment interventions for accelerating the rate of reepithelialization of full thickness dermal wounds.
Article
Oligo-elements such as zinc (Zn), selenium (Se) and copper (Cu) have a significant influence on the function of the immune system. Various immunological and inflammatory changes are known to occur in patients undergoing cardiopulmonary bypass. The aim of this study was to evaluate changes in serum oligo-elements levels during and following cardiopulmonary bypass. The serum levels of Zn, Se and Cu were determined in 67 consecutive patients, with coronary artery disease admitted for coronary artery bypass grafting. Blood samples for oligo-elements, analysis were withdrawn into metal-free tubes just prior to the start of cardiopulmonary bypass; at 30, 60 and 90 min into cardiopulmonary bypass; following weaning from cardiopulmonary bypass; 30 min after termination of cardiopulmonary bypass; at 24 h; and on the 5th postoperative day. Trace elements analyses were performed using atomic absorption spectrophotometry. Interleukin 6 and 8, as well as serum albumin, creatine phosphokinase, lactate dehydrogenase and creatine phosphokinase-MB fractions were also analyzed. The mean age was 63 +/- 9 years and 91% (61) were men. The mean preoperative left ventricular function was 52 +/- 12%, Canadian Cardiovascular Society (CCS) angina class was 3.7 +/- 0.5 and 30% (20) of the operations were re-do's. All patients had normothermic cardiopulmonary bypass. Mean cardiopulmonary bypass-time was 85 +/- 31 min. One patient was lost for the recovery sampling (hospital mortality, 1.5%). Nine patients had a postoperative cardiac index < 2.0 liter/min per m2, which required pharmacological support and additional intra-aortic balloon pump in two of them. Other postoperative complications were few. There was a rapid depletion of S-selenium and S-Zn levels, which were halved at 30 min after cardiopulmonary bypass and remained low throughout the study period. The Cu/Zn ratio increased significantly at the start of cardiopulmonary bypass, which indicated an inflammatory reaction and was not normalized until the 5th postoperative day. Length of ischemia time, presence of diabetes. hypertension and hyperlipidemia did not influence the results, while a prolonged cardiopulmonary bypass-time > 120 min resulted in a higher Cu/Zn ratio than observed for shorter cardiopulmonary bypass-times. This indicates a more profound inflammatory response. Inflammatory parameters responded in the same manner as described earlier by others. These data indicate that severe loss of various oligo elements occur in patients undergoing coronary artery bypass grafting and suggests that a supplementary administration of zinc and perhaps also selenium could be appropriate during cardiopulmonary bypass.
Article
To obtain preliminary data and determine the feasibility of a large-scale experimental study to test the efficacy of the Rogerian Science of Unitary Human Beings-based intervention of dialogue and therapeutic touch (TT) on pre- and postoperative anxiety and mood and postoperative pain from breast cancer surgery. Experimental. Mid-Atlantic region; ambulatory. 29 Caucasian and 2 African American English-speaking women with positive breast cancer biopsy (experimental, n = 14; control, n = 17), ranging in age from 31-84 years old (F = 55.6). Treatments administered in subjects' homes within seven days prior to surgery and 24 hours after hospital discharge. Experimental treatment consisted of 10 minutes of TT and 20 minutes of dialogue. Control treatment consisted of 10 minutes of quiet time and 20 minutes of dialogue. Data (Spielberger State-Trait Anxiety Inventory. Affects Balance Scale, and Visual Analog Scale-Pain) were collected at the conclusion of each home visit. Anxiety, mood, and pain. The experimental group had lower preoperative state anxiety than the control groups (p = 0.008). No difference was found for preoperative mood. No differences were found for any postoperative measure. A large-scale study of dialogue and TT would require changes in design and recruitment strategies. Nurses may provide more comprehensive care by incorporating dialogue and TT or quiet time into their pre- and postoperative care. Additional research, however, is recommended to determine the differential effects of dialogue, TT, and quiet time on women's experiences with breast cancer prior to incorporating these noninvasive modalities into clinical practice.