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Impact of healing touch on pediatric oncology outpatients: Pilot study
Abstract
Healing Touch (HT) is a biofield therapy used to enhance well-being. We conducted a pilot study to assess its effects in pediatric oncology patients. We enrolled patients in the continuation or consolidation phase of therapy. Patients or their parent completed simple visual analogue scales (VASs; 0-10) for relaxation, vitality, overall well-being, stress, anxiety, and depression before and after a 20-minute period of rest and a standardized HT treatment. Patients' heart rates were monitored and later analyzed for heart rate variability (HRV) characteristics. Of the nine patients, all completed VASs and six had usable HRV data. The average age was 9 years. VAS scores for stress decreased significantly more for HT treatment than for rest (HT: 4.4-1.7; rest: 2.3-2.3; p = .03). The HRV characteristic of total power was significantly lower during HT than for rest (HT 599 +/- 221; rest: 857 +/- 155; p = .048), and sympathetic activity was somewhat but not significantly lower (HT: 312 +/- 158; rest: 555 +/- 193; p = .06). HT is associated with lowered stress and changes in HRV. Further studies are needed to understand the mechanisms of these effects in larger samples and to explore the impact on additional clinically relevant measures.
... Only the relaxation item showed a significant result after the intervention with the music (HF, p < 0.01). Kemper et al. 2009 Five subjects with leukemia and one with another type of cancer (three men). Mean age: 8.7 ± 4.3 years old. ...
... In this study, two articles addressed HRV and alternative treatments [18,19]. Kemper et al. in order to evaluate complementary relaxation treatments, directed two studies [18,19]. ...
... In this study, two articles addressed HRV and alternative treatments [18,19]. Kemper et al. in order to evaluate complementary relaxation treatments, directed two studies [18,19]. The first study applied energy healing-based therapies as a tool to assess the relaxation state of children with leukemia [18]. ...
Impaired cardiovascular and autonomic function during treatment and during recovery from leukemia has been indicated. In this context, heart rate variability (HRV) is a non-invasive measure that describes the oscillations of the intervals between consecutive heart beats (RR intervals), influenced by the autonomic nervous system. We intend to review literature showing HRV changes in leukemia subjects. The articles selected in the current review were attained up to March 2018, and the search was limited to articles in English language, published in peer-reviewed journals, with both adult and child age samples. The articles were investigated in the five electronic databases: PubMed, Physiotherapy Evidence Database (PEDro), Cochrane Clinical Trials, Scientific Electronic Library Online (SciELO), and Excerpta Medica dataBASE (EMBASE). Towards the end of the research, 9 studies were included. Subjects undergoing treatment for leukemia have reduced HRV, signifying decreased vagal control of heart rate. The subjects that undertook leukemia treatment and their survivors experienced a reduction in HRV with subsequent recovery, but the recovery time is ill defined. HRV is reduced in leukemia subjects who progress to neuropathy secondary to chemotherapy, accompanied by cardiac dysfunction. We advocate the use of HRV to evaluate autonomic function and decide the treatment to prevent autonomic impairment in leukemia subjects.
... The therapy began as a pilot program in 1989 and grew into a multi-level, standardized curriculum and continuing education program, originally in nursing, that is for any individual who has an interest in integrative approaches to health. Healing Touch research covers several areas that include symptom reduction (e.g., pain, stress, anxiety, fatigue, mood, and nausea) for patients with illnesses such as cancer (Aghabati et al., 2010;Coakley & Barron, 2012;Cook, Guerrerio, & Slater, 2004;Danhauer, Tooze, Holder, Miller, & Jesse, 2008;Kemper et al., 2009;Olson et al., 2003;Post-White et al., 2003;Wilkinson et al., 2002), cardiovascular disease (Krucoff et al., 2005;MacIntyre et al., 2008;Maville, Bowen, & Benham, 2008;Seskevich, Crater, Lane, & Krucof, 2004;), posttraumatic stress disorder (Collinge, Wentworth, & Sabo, 2005;Jain et al., 2012), and dementia (Lu, Hart, Lutgendorf, Oh, & Schilling, 2013). ...
... The empirical research on Healing Touch and Reiki prior to 2014 points to efficacy in diminishing anxiety, improving mood, and supporting wellness. For example, Healing Touch studies addressing anxiety, mood, and mental aspects of quality of life (QoL) have demonstrated beneficial results (Jain et al., 2012;Kemper et al., 2009;Krucoff et al., 2001;Krucoff et al., 2005;Maville et al., 2008). Reiki improved relaxation, anxiety/worry, mood, attitude, loneliness/isolation in patients with cancer (Marcus et al., 2013). ...
... Relaxation is a key factor in understanding the deeper processes that underlie anxiety-stress diminishing and mood improving with the integrative use of biofield therapies. Studies have emerged that provide insight into relaxation and the relaxation response (Coakley & Duffy, 2010;Kemper et al., 2009;Lutgendorf et al., 2010;Mackay et al., 2004;Maville et al., 2008;Post-White et al., 2003;Taylor et al., 2010;Wilkinson et al., 2002). The salient features of these studies point to biofield therapies influencing the nervous system, specifically supporting a shift from the orthosympathetic to the parasympathetic branch, which has a direct influence on the stress response (Mackay et al., 2004;Maville et al., 2008). ...
Biofield therapies such as Healing Touch and Reiki increase relaxation, decrease anxiety and stress, and improve mood. Understanding the efficacy of these therapies in terms of mental health wellness is important for nurses interested in complementary and integrative care. The goal of the present integrative review was to investigate the state of knowledge regarding biofield therapies and the impact on anxiety, mood, and mental health wellness. Electronic databases were searched for articles available in English and published from 2014 to 2016. Biofield therapies show safety and promise in reducing anxiety, improving mood, and cultivating mental health and wellness.
... 5 In the study of Debs and Aboujaoude (2017), they found that moderate gagging occurred in 42.9% of children during impression taking. 6 According to Katsouda et al.(2019), 28.5% of children aged 4-12 years gagged on the gagging problem assessment. 7 The appearance of a gag reflex during dental treatment and even during tooth brushing can severely limit both the patient's ability to accept quality dental care and the clinician's ability to provide it. ...
... 26,27 In addition, in children with a history of hospitalisation, anxiety and gagging may be triggered due to painful procedures, exposure to bad smells, separation from parents, restricted movements. 28 Number of dental visits also associated with gagging; children who visited the dentist more were found to have a reduced risk of gag. The result was consistent with the fact that the children's experiences with the dentist helped them learn to cope with having instruments in their mouth and gagging. ...
Background:
Gag reflex may occur in patients of all ages and often considered having a multifactorial etiology.
Objective:
The aim of the study was to evaluate the prevalence and influencing factors of gag reflex in Turkish children aged 7-14 years in the dental setting.
Methods:
This cross-sectional study was carried out among 320 children aged between 7-14 years. First, an anamnesis form which include sosyodemographic status, monthly level of income, children past medical, and dental experiences was filled by mothers. Children's fear levels were evaluated using the Dental Subscale of Children's Fear Survey Schedule(CFSS-DS) while mother's anxiety levels using the Modified Dental Anxiety Scale(MDAS). The revised dentist section of gagging problem assessment questionnaire (GPA-R-de) were used for both children and mothers. Statistical analysis were done with SPSS program.
Results:
The prevalence of gag reflex among children was 34.1%, among mothers was 20.3%. The association between child and mother gagging was found statistically significant (χ2=53.121, p<0.001). When the mother of the child gagged, the risk of child gagging increases 6.83 times (p<0.001). Higher CFSS-DS scores of children increase risk of gagging (OR=1.052, p=0.023). Children who were previously treated mostly in public hospitals significantly more likely to gag compared with private dental clinics (OR=10.990, p<0.001).
Conclusion:
It was concluded that negative past dental experiences, previous dental treatments with local anesthesia, history of hospital admission, number and place of previous dental visits, dental fear level of children, and low education level and gagging of mother have an influence on the gagging of children.
... 23,24 Biofield therapies, such as HT, are categorized as mind-body therapies and involve the direction of healing energy through the practitioner's hands to facilitate general health and well-being by modifying the patient's energy field. 25,26 These biofield modalities are most demonstrable when used to treat symptoms affecting patient-centered outcomes encompassing HQoL. To date, most published research on the use of biofield therapies, including HT, in clinical settings and studies has been among cancer, pain, and palliative care patients. ...
... Previous studies examining Healing Touch have relied on volunteer practitioners to provide the study intervention. 26,44,64 The current study expands the possibilities of conducting research of Healing Touch interventions by demonstrating the feasibility and acceptability of the delivery of Healing Touch in the acute care setting to examine the impact on patientcentered outcomes. Many studies of complementary therapies suffer from a demographically homogenous sample. ...
Given the growth in the number of bariatric surgeries, it is important for healthcare practitioners to maximize symptom management for these patients, including the option of complementary therapies such as Healing Touch.
A quasi-experimental study was conducted to determine the feasibility of a Healing Touch intervention for reducing pain, nausea, and anxiety in patients undergoing laparoscopic bariatric surgery.
Following surgery, a nurse administered the Healing Touch intervention once daily. Study participants reported levels of pain, nausea, and anxiety immediately before and after the Healing Touch intervention using separate numeric rating scales.
Significant decreases in pain, nausea, and anxiety were observed immediately following the intervention on post-operative days one and two, and in pain and anxiety on post-operative day three compared with pre-intervention levels. These findings indicate that the Healing Touch intervention is feasible and acceptable to patients undergoing bariatric surgery, and significantly improved pain, nausea, and anxiety in these patients.
Copyright © 2015 Elsevier Inc. All rights reserved.
... 7 Complementary modalities are utilized by patients with cancer in an effort to enhance the benefits of conventional treatments, including radiation and chemotherapy, as well as to improve overall well-being and HQoL. 3,7,11,13,14 Use of CAM by patients with cancer is significantly associated with receiving multiple treatments, management of illness and treatment-related symptoms, improving survival, and decreasing recurrence, 2,3,7,12 with patients using CAM during adjuvant chemotherapy, radiation therapy, palliative therapy, and phase I clinical trials. 1 Additionally, data from the 2002 NHIS reveal that patients with cancer are more apt to utilize complementary modalities provided by a practitioner. 12 The goals of the present study were to examine and describe the national patterns of CAM use with regard to services, practices, and products among individuals with cancer compared to those who did not report cancer, as well as the impact that HQoL symptoms (i.e., pain, insomnia, fatigue, and depression) experienced by patients with cancer have on CAM use. ...
... These diseaseand treatment-related symptoms are the impetus for many patients with cancer to combine conventional care with complementary modalities to improve HQoL. 3,7,11,13,14 The most common categories of complementary modalities used by individuals with a self-reported diagnosis of cancer were natural products, including vitamins, minerals, and herbal therapies, and mind-body practices, including meditation, relaxation techniques, deep breathing exercises, yoga, t'ai chi, qigong, biofeedback, hypnosis, and energy healing therapies (Table 2). Research suggests that guided imagery may aid the reduction of cancer pain. ...
Complementary therapies are often used as adjuncts to conventional treatment by individuals with cancer. Patterns of use of these practices and products represent important data for health care providers in delivering adequate patient care.
This study compared use of complementary therapies between the cancer and noncancer populations in the United States through secondary analyses of the 2007 National Health Interview Survey data. The analysis compared use by cancer survivors (those individuals self-reporting a diagnosis of cancer; n=1785) and individuals without cancer (n=21,585), as well as self-report of symptoms affecting health-related quality of life (HQoL).
Data suggest similar patterns of use between cancer survivors and the general population; however, a greater percentage of cancer survivors use complementary modalities. Individuals with cancer reported a greater percentage of use of complementary therapies overall, with cancer status significantly associated with ever having used complementary and alternative medicine (p<0.001). The five most common complementary practices and products used by individuals with cancer and controls were vitamin/mineral supplements, prayer for self, intercessory prayer, chiropractic/osteopathic manipulation, and herbal therapies. Additionally, as might be expected, individuals with cancer experience greater frequency of deleterious symptoms associated with decreased HQoL. Individuals with cancer were more likely to sleep fewer than 7 hours (p=0.0108) or greater than 9 hours (p=0.0108), and have increased insomnia (p<0.001), excessive sleepiness (p<0.001), depression (p<0.001), and anxiety (p<0.001) versus those without cancer.
The current findings may inform health care providers about the use of complementary and integrative practices and products by patients with cancer in an effort to manage symptoms of the disease. Additionally, these results may also be used to promote research to define the merits of the use of such complementary and integrative practices and products.
... Healing Touch is based on a foundation that, in addition to the physical dimension, humans have an energetic, spiritual dimension necessary for sustaining life that must be taken into account during the healing process (Aghabati, Mohammadi, & Pour Esmaiel, 2008;Forgues, 2009). In a healthy individual, the energy field is symmetrical and balanced, allowing energy to flow evenly (Jackson et al., 2008;Kemper, Fletcher, Hamilton, & McLean, 2009;Peters, 1999). Both physical and psychological symptoms may cause or arise from imbalances in the energy field, and Healing Touch is believed to restore, energize, and balance energy field disturbances (Jackson et al., 2008;Kemper et al., 2009;Peters, 1999). ...
... In a healthy individual, the energy field is symmetrical and balanced, allowing energy to flow evenly (Jackson et al., 2008;Kemper, Fletcher, Hamilton, & McLean, 2009;Peters, 1999). Both physical and psychological symptoms may cause or arise from imbalances in the energy field, and Healing Touch is believed to restore, energize, and balance energy field disturbances (Jackson et al., 2008;Kemper et al., 2009;Peters, 1999). Although biofield therapies are among the most ancient of healing practices, scientific quantification of the methods, mechanisms, safety, and effectiveness of these therapies is limited (Krucoff et al., 2005). ...
Hands-on healing and energy-based interventions have been found in cultures throughout history around the world. These complementary therapies, rooted in ancient Eastern healing practices, are becoming mainstream. Healing Touch, a biofield therapy that arose in the nursing field in the late 1980s, is used in a variety of settings (i.e., pain centers, surgical settings, and private practices) with reported benefits (i.e., decreased anxiety, pain, and depressive behaviors; increased relaxation and a sense of well-being). However, clinical trial data concerning the effectiveness of Healing Touch have not been evaluated using a systematic, evidence-based approach. Thus, this systematic review is aimed at critically evaluating the data from randomized clinical trials examining the clinical efficacy of Healing Touch as a supportive care modality for any medical condition.
... HT has been taught at our medical school and evaluated in studies of adult and pediatric oncology patients at our institution. [25][26][27][28] However, its effects on nurse leaders in an academic health center have not been evaluated. ...
... Based on our experience in providing HT therapy to patients and teaching it to medical students, we anticipated that nurses would report less stress and that measures of HRV would be improved. [25][26][27][28] As a practical matter, we were also interested in the feasibility of recruiting nursing leaders in an academic health center and to what extent they would practice after their initial training. ...
Chronic stress adversely affects performance. We evaluated the effect of Healing Touch training on subjective and objective measures of stress in nursing leaders in an academic health center.
In this quasi-experimental single group pretest-post-test study, we recruited nursing leaders at an academic health center and provided 17.5 hours of Healing Touch training over 2 days. We measured subjective measures of stress using visual analog scales as well as heart rate variability 1-2 weeks before and 4 weeks after the training.
Target enrollment was exceeded within 2 weeks; all participants were women and the mean age was 47 years. Of the 26 enrollees, 24 completed training, and 20 (77%) completed all pre- and post-training measures. There was significant improvement in self-reported stress, depression, anxiety, relaxation, well-being, and sleep. Heart rate variability changes were also significant for total power, high- and low-frequency power, and coherence, suggesting improved autonomic function consistent with greater well-being.
Training nurse leaders in an academic health center in Healing Touch is associated with significant improvements in subjective and objective measures of stress. Additional studies are needed to compare the impact of this training versus stress management training on the nurses themselves and on the quality of care.
... Most sitting meditation practices produce a sense of calm well-being as well as decreases in respiratory rate in the practitioner. [6][7][8][9][10][11][12][13][14][15][16][17] However, few authors have evaluated the interpersonal effects of meditation on another person who is not meditating. 5 Several factors may affect the response to NVCC. ...
... 44,45 Our study at Wake Forest showed that HT treatments helped pediatric oncology clinic patients, reducing anxiety levels. 46 Another Wake Forest study showed decreased nausea and improved fatigue among adult oncology patients who received HT. 47 ...
... 44,45 Our study at Wake Forest showed that HT treatments helped pediatric oncology clinic patients, reducing anxiety levels. 46 Another Wake Forest study showed decreased nausea and improved fatigue among adult oncology patients who received HT. 47 ...
... If it is not controlled, it lead to more complications such as life and different body systems, and agitation, anorexia, incontinence, restlessness, insomnia, fear at night (8)(9)(10). While, Psychological side effects as learning and memory impairment and mental illness may occur in the future (11). Invasive procedures such as biopsy, BMA and lumbar puncture (LP) are as an integral part of the diagnostic and therapeutic procedures in children with hematologic malignancies. ...
Background:
This study aimed to compare sedative and analgesic effects of oral Midazolam and Ketamine on Bone Marrow aspiration (BMA) and Lumbar Puncture (LP).
Material and methods:
This study was a randomized clinical trial and was performed in Amirkola Hospital in north of Iran, Babol during 2011 and 2012 .The study population consisted of 40 patients who underwent the first time of diagnostic BMA for any reason, patients were divided randomly in two groups: Oral Midazolam and combined Oral Midazolam and Ketamine. Each group consisted of patients with age of 3-7 years and over 7 years .Two methods of pain status and soothing were evaluated through CAMFORT scale checklist based on MAGNUSON National Institutes of Health Medical Center. Statistical analyses were done by Spss v.19.
Results:
In our study, 17(42.5%) and 23(57.5%) were female and male, respectively. 28(70%) patients were aged between 3 and 7 years and 13(30%) older than 7 years. The obtained findings revealed that the difference between Midazolam sedation and combination of Midazolam and Ketamine sedation was significant (P= 0.00). The sedation in older patients was more than young patients in combination of Midazolam and Ketamine group. (P= 0.22).
Conclusion:
These findings showed that Ketamine and Midazolam combination had more efficacy than Midazolam alone for decreasing pain and sedation.
... Positive results of biofield therapies have been reported in other populations, including those patients with dementia [40][41][42][43] and osteoarthritis, 44,45 as well as pediatric oncology outpatients. 46 In addition, there is need for investigation of biofield therapies in palliative care, where these therapies are often delivered. 47 Several reviews since the 2010 best evidence synthesis of Jain and Mills have examined clinical research based on the biofield modality. ...
Biofield therapies are noninvasive therapies in which the practitioner explicitly works with a client's biofield (interacting fields of energy and information that surround living systems) to stimulate healing responses in patients. While the practice of biofield therapies has existed in Eastern and Western cultures for thousands of years, empirical research on the effectiveness of biofield therapies is still relatively nascent. In this article, we provide a summary of the state of the evidence for biofield therapies for a number of different clinical conditions. We note specific methodological issues for research in biofield therapies that need to be addressed (including practitioner-based, outcomes-based, and research design considerations), as well as provide a list of suggested next steps for biofield researchers to consider.
... Reports of studies in other chronic disease populations measuring physiological parameters in response to biofield therapies reflect positive changes in heart and respiratory rates and blood pressure (Post-White et al., 2003), and heart rate variability (Kemper, Fletcher, Hamilton, & McLean, 2009); these changes suggest relaxation is reflected in the reduction of sympathetic tone and a shift to a more parasympathetic response, influencing activity of the HPA axis, which plays a role in the stress response (as described previously), as well as in exacerbat-ing the behavioral and psychological symptoms expressed by individuals with dementia. Biofield therapies appear to exert effects through a psychoneuroimmunological framework by reducing stress and improving immune function. ...
The current review addresses the need for increased use of evidence-based, nonpharmacological therapies for individuals with dementia. To facilitate understanding of the potential efficacy of nonpharmacological therapies on cognitive functioning for individuals with dementia, the mechanisms of action for selected therapies are described, including the assessment method used to identify the mechanism. The strength of evidence supporting each therapy was evaluated, with some therapies demonstrating strong support and others only moderate support for their effectiveness and mechanism of action. Therapies with the strongest support include (a) cognitive training/stimulation, (b) physical exercise, and (c) music. Therapies with moderate support include (a) biofield, (b) meditation, (c) engagement with a naturally restorative environment, and (d) social engagement. Although the strength of evidence varies, together these therapies offer treatments designed to improve cognitive functioning, have low risks and adverse effects, and have the potential for widespread accessibility, thereby increasing the potential range of therapies for individuals with dementia. [Res Gerontol Nurs. 20XX; X(XX):XX-XX.].
Copyright 2015, SLACK Incorporated.
... Small studies have suggested that Healing Touch can help decrease stress and improve autonomic balance in pediatric oncology patients. 82 Reiki is a similar practice that comes from a Japanese tradition. Practitioners are trained by a Reiki master through apprenticeship and spiritual and energetic initiation. ...
... One prospective study 54 found in 17 patients and their associated parents an improvement in anxiety (especially in parents), mood and stress reduction already after one single intervention. One prospective cohort pilot study 55 in pediatric oncology revealed that standardized healing touch is feasible, leads to a significant decrease of stress and is associated with a sympathetic activation. In another study, Nurse's soothing and gentle touch was reported to diminish the child's distress during lumbar puncture particularly in young children. ...
This overview aims to give a brief introduction for clinicians in the wide field of Mind—Body Therapies (MBTs), to summarize the current research status of MBTs in pediatric oncology and to mention challenges for future goals. Most used techniques (relaxation, hypnosis, yoga, massage, MBSR, eurythmy) will be described and efficacy will be discussed. MBTs are an enhancement of conventional medicine to motivate the patient to participate in his recovery. Most MBTs are of low risk and are accessible for patients and their families in nearly all stadium of cancer therapy. Positive results include increased self-confidence and a more optimistic view in coping with the illness. We encourage clinicians to be more aware of the promising field of MBTs and its use in pediatric oncology.
... We wished to test a form of NVCC associated with a calm face and lower respiratory rate. One type of mental activity that generally produces these effects in the practitioner is meditation141516171819202122232425. Among the many types of meditation, loving-kindness-focused meditation (LKM) is attractive because the desire for increased well-being and decreased suffering is an explicit part of health care, regardless of the modality. ...
Calm, compassionate clinicians comfort others. To evaluate the direct psychophysiologic benefits of non-verbal communication of compassion (NVCC), it is important to minimize the effect of subjects' expectation. This preliminary study was designed to a) test the feasibility of two strategies for maintaining subject blinding to non-verbal communication of compassion (NVCC), and b) determine whether blinded subjects would experience psychophysiologic effects from NVCC.
Subjects were healthy volunteers who were told the study was evaluating the effect of time and touch on the autonomic nervous system. The practitioner had more than 10 years' experience with loving-kindness meditation (LKM), a form of NVCC. Subjects completed 10-point visual analog scales (VAS) for stress, relaxation, and peacefulness before and after LKM. To assess physiologic effects, practitioners and subjects wore cardiorespiratory monitors to assess respiratory rate (RR), heart rate (HR) and heart rate variability (HRV) throughout the 4 10-minute study periods: Baseline (both practitioner and subjects read neutral material); non-tactile-LKM (subjects read while the practitioner practiced LKM while pretending to read); tactile-LKM (subjects rested while the practitioner practiced LKM while lightly touching the subject on arms, shoulders, hands, feet, and legs); Post-Intervention Rest (subjects rested; the practitioner read). To assess blinding, subjects were asked after the interventions what the practitioner was doing during each period (reading, touch, or something else).
Subjects' mean age was 43.6 years; all were women. Blinding was maintained and the practitioner was able to maintain meditation for both tactile and non-tactile LKM interventions as reflected in significantly reduced RR. Despite blinding, subjects' VAS scores improved from baseline to post-intervention for stress (5.5 vs. 2.2), relaxation (3.8 vs. 8.8) and peacefulness (3.8 vs. 9.0, P < 0.05 for all comparisons). Subjects also had significant reductions in RR (P < 0.0001) and improved HRV (P < 0.05) with both tactile and non-tactile LKM.
It is possible to test the effects of LKM with tactile and non-tactile blinding strategies; even with blinding in this small preliminary study, subjects reported significant improvements in well-being which were reflected in objective physiologic measures of autonomic activity. Extending compassion is not only good care; it may also be good medicine.
US National ClinicalTrials.gov registration number, NCT01428674.
Mind-body therapies frequently derive from Eastern philosophies and are becoming increasingly popular. These therapies, such as meditation, yoga, tai chi, qigong, biofield therapies, and guided imagery, have many reported benefits for improving symptoms and physiological measures associated with various chronic diseases. However, clinical research data concerning the effectiveness of these practices in individuals with dementia have not been evaluated using a synthesis approach. Thus, an integrative review was conducted to evaluate studies examining the efficacy of mind-body therapies as supportive care modalities for management of symptoms experienced by individuals with dementia. Findings from the studies reviewed support the clinical efficacy of mind-body practices in improving behavioral and psychological symptoms exhibited by individuals with dementia. [Res Gerontol Nurs. 2017; x(x):xx-xx.].
The American Academy of Pediatrics is dedicated to optimizing the well-being of children and advancing family-centered health care. Related to this mission, the American Academy of Pediatrics recognizes the increasing use of complementary and integrative therapies for children and the subsequent need to provide reliable information and high-quality clinical resources to support pediatricians. This Clinical Report serves as an update to the original 2008 statement on complementary medicine. The range of complementary therapies is both extensive and diverse. Therefore, in-depth discussion of each therapy or product is beyond the scope of this report. Instead, our intentions are to define terms; describe epidemiology of use; outline common types of complementary therapies; review medicolegal, ethical, and research implications; review education and training for select providers of complementary therapies; provide educational resources; and suggest communication strategies for discussing complementary therapies with patients and families.
Mind-body medicine focuses on the ways in which emotional, mental, social, spiritual, experiential, and behavioral factors can directly affect health. Mind-Body therapies are the least “alternative” of the integrative therapies. Many cognitive and expressive therapies, such as hypnosis, guided imagery, biofeedback, art, and music have been used since the 1980s to manage procedural pain and anxiety in children with cancer undergoing procedures and are now considered standard approaches in pediatric care. Randomized controlled trials provide evidence for the use of massage and Healing Touch to reduce cancer related anxiety, negative mood states, sleep disturbances, and fatigue, and emerging evidence supports movement therapies for physical conditioning in survivors. Children respond to interventions that foster creative expression and movement. Mind-body therapies are both healing and fun and offer perceived benefit with little risk. This chapter summarizes the evidence for the effectiveness of select mind-body therapies categorized as cognitive, expressive, physical/kinesthetic, sensory, and biofield/energy interventions and proposes applications for use in pediatric oncology. Actual case scenarios provide examples for integrating mind-body therapies into clinical pediatric oncology care.
There are many forms of CAM practiced in the US. This section focuses on the basics of Acupuncture, Aromatherapy, Ayurveda, Biofeedback, Biofield therapies, Chiropractic, Clinical hypnosis, Healing touch, Supplements and Herbs (Echinacea, Chamomile, Peppermint, St. John’s Wort, Butterbur, Melatonin, Curcumin, Prebiotics and Probiotics), Homeopathy, Massage therapy, Naturopathy, Osteopathy, Reiki, Therapeutic touch, Traditional Chinese Medicine, and Yoga.
Background and objectives:
Components of complementary and alternative medicine are increasingly being implemented at academic medical centers. These approaches include therapeutic touch or healing touch (HT), an energy-based therapy using light touch on or near the body. Limited data exist regarding complementary and alternative medicine use at children's hospitals. The aim of this study was to evaluate patterns and clinical characteristics of HT consultations among children hospitalized at Nemours/A.I. duPont Hospital for Children.
Methods:
We conducted a retrospective chart review of all patients hospitalized from January 2012 through December 2013, comparing patients who received HT consultations with those who did not.
Results:
There were 25 396 admissions during the study period; 882 (4%) of these, representing 593 individual patients, received an HT consultation. As compared with those without an HT consultation, patients receiving HT were older (median 12 years vs 5 years, P < .001), female (58% vs 46%, P < .001), and more likely to be admitted to the hematology/oncology or blood/bone marrow transplant units (P < .001). Patients with HT consultations had longer hospitalizations (median 121 hours vs 38 hours, P < .001) and more medical problems (median 12 vs 4, P < .001). Six attending physicians were responsible for placing the majority of HT consultations. Of the 593 patients receiving an HT consultation, 21% received ≥2 consultations during the study period.
Conclusions:
Certain patients, such as those with longer hospitalizations and more medical problems, were more likely to receive HT consultations. Many patients received multiple consultations, suggesting that HT may be an important aspect of ongoing care for hospitalized children.
Background: The treatment of paediatric cancer can take place in the in-patient hospital ward or in the out-patient setting, both of which have advantages and disadvantages. Aim: To assess parental opinions on the advantages and disadvantages of a paediatric oncology out-patient setting in comparison to the in-patient oncology ward. Method: The study sample consisted of 44 parents whose children had been diagnosed and were being treated for cancer in an Athens children's hospital with an oncology ward and an oncology out-patient department between May and August 2010. The response rate was 81.5%. Statistical analysis was made using the Statistical Package for Social Sciences (SPSS) v. 19, and test results were considered significant at an alpha level of 0.05. The study was approved by the Ethical Committee of the hospital and informed consent was obtained from each parent. Results: Mothers comprised 88.6% of the sample. The mean age of the patients was 7.6±4.7 years. The parents reported that they can maintain their daily routine and family life when their children are attending the out-patient department for treatment (x 2=24.86, p<0.001 and x 2=32.91, p<0.001, respectively). They also preferred the out-patient setting because the young patients can participate in their usual activities (x 2=8.14, p=0.02). The children were reported to be happier and less anxious and scared when they were attending daily clinic for oncology treatment, rather than being hospitalized (x 2=25.86, p<0.001). The parents considered that oncology ward was preferable for developing relations with other patients and parents (x 2=27.59, p<0.001) and the medical and nursing staff (x 2=21.32, p<0.001). In addition, the information given by the medical staff was reported to be better and the sense of security higher in the in-patient oncology ward than in the out-patient setting (x 2=20.46, p<0.001 and x 2=29.08, p<0.001, respectively), and the in-patient oncology ward was better adapted to the needs of the young patients (x 2=15.39, p<0.001). No significant difference was found for overall parental preference about the setting of treatment (x 2=0.1, p=0.88). Demographic factors which were found to have a statistically significant association with parental preferences were maternal age, the patient's gender, the phase of treatment and place of residence (p<0.05). Conclusions: According to their parents, the out-patient setting for treatment of children with cancer has many advantages. Improvements in the numbers of medical and nursing staff and in the organization of the daily out-patient clinic could result in the best quality of care for young patients with cancer.
We live in an age of unparalleled technological and scientific progress, juxtaposed with a cascading series of poor social, health, and environmental choices that could bring our species to the brink of catastrophe. Within the past 100 years alone, we have created significant advances in technologies to better control disease outbreaks, extend our lifespan, enhance global communication, increase our work productivity, and improve our overall quality of life. At the same time, we are facing major healthcare crises including diabetes, cardiovascular disease, cancer, and mental illness. Despite our best efforts and technological advances, we have not yet conquered these and other life- and health-interfering disorders. In addition, health disparities are increasing and the 100 year rise in life expectancy is flattening.1 This continuance of human suffering, in the face of all our advancements, is leading to substantial and exponentially growing costs to individuals and to society.
Biofield physiology is proposed as an overarching descriptor for the electromagnetic, biophotonic, and other types of spatially-distributed fields that living systems generate and respond to as integral aspects of cellular, tissue, and whole organism self-regulation and organization. Medical physiology, cell biology, and biophysics provide the framework within which evidence for biofields, their proposed receptors, and functions is presented. As such, biofields can be viewed as affecting physiological regulatory systems in a manner that complements the more familiar molecular-based mechanisms. Examples of clinically relevant biofields are the electrical and magnetic fields generated by arrays of heart cells and neurons that are detected, respectively, as electrocardiograms (ECGs) or magnetocardiograms (MCGs) and electroencephalograms (EEGs) or magnetoencephalograms (MEGs). At a basic physiology level, electromagnetic activity of neural assemblies appears to modulate neuronal synchronization and circadian rhythmicity. Numerous nonneural electrical fields have been detected and analyzed, including those arising from patterns of resting membrane potentials that guide development and regeneration, and from slowly-varying transepithelial direct current fields that initiate cellular responses to tissue damage. Another biofield phenomenon is the coherent, ultraweak photon emissions (UPE), detected from cell cultures and from the body surface. A physiological role for biophotons is consistent with observations that fluctuations in UPE correlate with cerebral blood flow, cerebral energy metabolism, and EEG activity. Biofield receptors are reviewed in 3 categories: molecular-level receptors, charge flux sites, and endogenously generated electric or electromagnetic fields. In summary, sufficient evidence has accrued to consider biofield physiology as a viable scientific discipline. Directions for future research are proposed.
Cancer-related fatigue (CRF) is the most stressful and prevalent symptom in paediatric oncology patients. This integrative review aimed to identify, analyse and synthesise the evidence of nonpharmacological intervention studies to manage fatigue and psychological stress in a paediatric population with cancer. Eight electronic databases were used for the search: PubMed, Web of Science, CINAHL, LILACS, EMBASE, SCOPUS, PsycINFO and the Cochrane Library. Initially, 273 articles were found; after the exclusion of repeated articles, reading of the titles, abstracts and the full articles, a final sample of nine articles was obtained. The articles were grouped into five categories: physical exercise, healing touch, music therapy, therapeutic massage, nursing interventions and health education. Among the nine studies, six showed statistical significance regarding the fatigue and/or stress levels, showing that the use of the interventions led to symptoms decrease. The most frequently tested intervention was programmed physical exercises. It is suggested that these interventions are complementary to conventional treatment and that their use can indicate an improvement in CRF and psychological stress.
Keywords:cancer-related fatigue, psychological stress, non-pharmacological intervention, symptom management, paediatric oncology.
Given the current transformation of traditional health care to provide more integrative and complementary modalities, health systems are implementing new programs and services to meet consumer and provider needs. One such integrative modality, Healing Touch, with a foundation in holistic nursing, is a gentle therapy that uses touch to promote health and well-being by balancing the human energy system. This article describes the perceptions of registered nurses regarding the implementation of a Healing Touch training program at a multihospital health system. Five themes were identified: benefit to the patient, benefit to the nurse, holism beyond task orientation, integrating Healing Touch into acute care, and barriers and challenges. Nurses recognize the importance of creating caring-healing relationships and a holistic approach to care. Training in Healing Touch provides one avenue for nurses and health care providers to provide compassionate care.
© The Author(s) 2015.
Forty children between the ages of 8 and 18 years, who were admitted to a hospital pediatric unit, were randomly assigned to an animal-assisted intervention (AAI) or an active control condition (working on an age-appropriate jigsaw puzzle). Ratings of pain and anxiety were taken both pre- and post-condition. The attachment Questionnaire and Family Life Space Diagram (FLSD) also were administered, and information on medications taken was recorded. A significant post-condition difference was found between groups for anxiety, with the aaI group having lower anxiety scores. However, no significant within- or between-group pre-post changes in either pain or anxiety were detected. Nearly two-thirds of the children (64%) reporting pain at baseline were receiving some type of analgesic, which may have influenced outcomes. Findings demonstrate some support that attachment may be a moderating variable: children with a secure attachment style reported lower pain and anxiety at baseline, with large effect sizes for differences in both anxiety (g = 1.34) and pain (g = 1.23). Although the aaI did not significantly reduce anxiety and pain in these hospitalized children, further investigation of the influence of analgesic use and the moderating effect of attachment style is indicated.
Relaxation; Hypnosis; Yoga; Massage; Mindfulness; Eurythmy; Mind—body therapy
Introduction
The treatment of children with cancer is one of the great medical success stories of the last half-century. In the field of pediatric oncology more than three-quarters of all children diagnosed with cancer will now be cured.1 Nev- ertheless, the side effects like distress, fatigue or pain of the numerous and repeated painful medical procedures are
∗ Corresponding author at: Department of Pediatric Oncology and Hematology, Task Force Integrative Medicine in Pediatric Oncology, Charité — Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany. Tel.: +49 450 566 087; fax: +49 30 450 566 965.
georg.seifert@charite.de (G. Seifert).
1 Contributedequallytothiswork.
still prevalent.2,3 Families report that symptoms of anorexia, nausea, vomiting and pain are not adequately treated with conventional medicine.4,5 Side effects influence quality of life, months, years, even decades beyond treatment6,7 and also the family functioning decreases over the first year after diagnosis.8
CAM is defined as a group of diverse medical health care system practices and products that are not presently con- sidered to be a part of conventional medicine. In general they tend to help and re-structure the recovery of health and quality of life in cancer patients promoting symptom reduction after invasive treatments.
Mind—Body Therapies (MBTs), as part of CAM, comprise various techniques based on body work and relaxation to enhance the mind’s capacity to affect bodily function and symptoms promoting cure. Mind—Body interventions have a holistic approach towards health and care. These ther- apies include meditation, yoga, tai chi, deep-breathing
0965-2299/$ — see front matter © 2012 Elsevier Ltd. All rights reserved. doi:10.1016/j.ctim.2012.02.001
Summary This overview aims to give a brief introduction for clinicians in the wide field of Mind—Body Therapies (MBTs), to summarize the current research status of MBTs in pediatric oncology and to mention challenges for future goals. Most used techniques (relaxation, hypnosis, yoga, massage, MBSR, eurythmy) will be described and efficacy will be discussed. MBTs are an enhancement of conventional medicine to motivate the patient to participate in his recovery. Most MBTs are of low risk and are accessible for patients and their families in nearly all stadium of cancer therapy. Positive results include increased self-confidence and a more optimistic view in coping with the illness. We encourage clinicians to be more aware of the promising field of MBTs and its use in pediatric oncology.
© 2012 Elsevier Ltd. All rights reserved.
Purpose of the research:
The aim of this study was to assess parental opinions on the advantages and disadvantages of a pediatric oncology outpatient setting in comparison to the inpatient oncology ward.
Methods and sample:
The sample of the study consisted of 104 parents whose children were diagnosed and treated for pediatric cancer. The survey took place at the Pediatric Oncology Wards, as well as their respective outpatient settings of the two General Children's Hospitals in Athens, Greece from May 2010 to August 2010.
Key results:
According to parents' view the outpatient setting was preferable due to the maintenance keeping of their daily routine (x(2) = 75.9, p = 0.000), maintaining the family life (x(2) = 90.1, p = 0.000) and young patients' participation in activities (x(2) = 25.6, p = 0.000). Moreover, young patients were more happy, less anxious and less scared when they were attending in the daily clinic (x(2) = 25.9, p = 0.000).
Conclusions:
According to parents' view, the outpatient setting has many advantages. The judgment of children and parents on the services offered by the Pediatric Oncology Unit overall, in both inpatient and outpatient setting can give the necessary feedback to improve the qualitative provided care.
Hypotheses:
Healing Touch (HT) is an energy therapy that has been shown to lower stress, pain, and fatigue in adult oncology patients. This study evaluated the feasibility of administering HT in pediatric oncology inpatient and outpatient units at Kapi'olani Medical Center for Women and Children.
Study design:
This study was a 1-year randomized prospective study consisting of 2 study arms. The HT arm was considered the treatment group, and reading/play activity was designated as the control group. Participants were randomly assigned to each arm on enrollment in the study.
Methods:
They were recruited by the pediatric oncology social worker. Interested participants were asked to provide informed consent and were randomized to either the HT arm or the reading/play activity arm of the study. They received their designated intervention for 30 minutes at each inpatient or outpatient encounter. Participants, parents, and care providers were asked to complete preintervention and postintervention assessments.
Results:
In all, 15 participants, aged 3 to 18 years old, were approached about the study between July 2009 and June 2010. A total of 9 participants enrolled (recruitment rate of 60%); 6 patients were randomized to receive HT sessions, and 3 patients received reading/play activities; 2 participants dropped out of the study because of prolonged hospitalizations and complicated treatments. An additional participant expired while in the study because of disease progression. Those in the HT group showed significant decreases in the scores for pain, stress, and fatigue for participants, parents, and caregivers. Furthermore, parents' perception of their children's pain decreased significantly for the HT group when compared with the group receiving reading/play activity.
Conclusion:
This study demonstrates the feasibility of using energy therapy in the pediatric oncology patient population. There also seems to be an interest in this treatment modality for this patient population. Furthermore, these findings suggest that HT has a positive impact on pain, stress, and fatigue related to oncology treatment.
Compassion is critical for complementary and conventional care, but little is known about its direct physiologic effects. This study tested the feasibility of delivering two lengths of time (10 and 20 minutes) and two strategies (tactile and nontactile) for a practitioner to nonverbally communicate compassion to subjects who were blind to the interventions.
Healthy volunteers were informed that we were testing the effects of time and touch on the autonomic nervous system. Each subject underwent five sequential study periods in one study session: (1) warm-up; (2) control-with the practitioner while both read neutral material; (3) rest; (4) intervention-with practitioner meditating on loving-kindness toward the subject; and (5) rest. Subjects were randomized to receive one of four interventions: (1) 10 minutes tactile; (2) 20 minutes tactile; (3) 10 minutes nontactile; or (4) 20 minutes nontactile. During all interventions, the practitioner meditated on loving-kindness toward the subject. For tactile interventions, the practitioner touched subjects on arms, legs, and hands; for nontactile interventions, the practitioner pretended to read. Subjects' autonomic activity, including heart rate, was measured continuously. Subjects completed visual analog scales for well-being, including relaxation and peacefulness, at warm-up; postcontrol; immediately postintervention; and after the postintervention rest and were asked about what they and the practitioner had done during each study period.
The 20 subjects' mean age was 24.3 ± 4 years; 16 were women. The practitioner maintained a meditative state during all interventions as reflected in lower respiratory rate, and subjects remained blind to the practitioner's meditative activity. Overall, interventions significantly decreased heart rate (P < .01), and although other changes did not reach statistical significance, they were in the expected direction, with generally greater effects for the tactile than nontactile strategies and for 20-minute than 10-minute doses.
Two strategies are feasible for blinding subjects to nonverbal communication of compassion; even with blinding, nonverbal communication of compassion affects subjects' autonomic nervous system. These results should be replicated in larger samples, including patient populations, and mechanisms sought to explain observed effects. Compassion is not only good care; it may also be good medicine.
The public and healthcare professionals have become increasingly aware and accepting of the benefit in physical, psychological, social, and spiritual support for patients with cancer. Patients with cancer often seek nonpharmacologic interventions to complement conventional care and decrease the pain associated with cancer and its treatment. Most often referred to as complementary and alternative medicine (CAM), these supportive therapies consist of a heterogeneous group of modalities used as adjuncts to allopathic health care. Biofield therapies are CAM modalities that involve the direction of healing energy through the hands to facilitate well-being by modifying the energy field of the body. This critical review of studies of biofield therapies emphasizes research using these modalities to decrease pain in patients with cancer. Although the therapies have demonstrated clinical efficacy, additional research is warranted. Oncology nurses should familiarize themselves with biofield therapies so they can offer informed recommendations to patients with cancer experiencing pain.
Central neuropathic itch can be a lifelong debilitating condition and treatment challenge. We report a patient with a traumatic brain injury with severe intractable pruritus who failed extensive pharmacologic and nonpharmacologic treatment but responded to a holistic approach using healing touch. We discuss the complexity of this type of neuropathic itch and present a holistic approach as an adjunct to therapy in reducing itch intensity. This case presentation along with the literature discussed suggests a therapeutic strategy for the management of complicated central neuropathic itch.
A prior national survey documented the high prevalence and costs of alternative medicine use in the United States in 1990.
To document trends in alternative medicine use in the United States between 1990 and 1997.
Nationally representative random household telephone surveys using comparable key questions were conducted in 1991 and 1997 measuring utilization in 1990 and 1997, respectively.
A total of 1539 adults in 1991 and 2055 in 1997.
Prevalence, estimated costs, and disclosure of alternative therapies to physicians.
Use of at least 1 of 16 alternative therapies during the previous year increased from 33.8% in 1990 to 42.1% in 1997 (P < or = .001). The therapies increasing the most included herbal medicine, massage, megavitamins, self-help groups, folk remedies, energy healing, and homeopathy. The probability of users visiting an alternative medicine practitioner increased from 36.3% to 46.3% (P = .002). In both surveys alternative therapies were used most frequently for chronic conditions, including back problems, anxiety, depression, and headaches. There was no significant change in disclosure rates between the 2 survey years; 39.8% of alternative therapies were disclosed to physicians in 1990 vs 38.5% in 1997. The percentage of users paying entirely out-of-pocket for services provided by alternative medicine practitioners did not change significantly between 1990 (64.0%) and 1997 (58.3%) (P=.36). Extrapolations to the US population suggest a 47.3% increase in total visits to alternative medicine practitioners, from 427 million in 1990 to 629 million in 1997, thereby exceeding total visits to all US primary care physicians. An estimated 15 million adults in 1997 took prescription medications concurrently with herbal remedies and/or high-dose vitamins (18.4% of all prescription users). Estimated expenditures for alternative medicine professional services increased 45.2% between 1990 and 1997 and were conservatively estimated at $21.2 billion in 1997, with at least $12.2 billion paid out-of-pocket. This exceeds the 1997 out-of-pocket expenditures for all US hospitalizations. Total 1997 out-of-pocket expenditures relating to alternative therapies were conservatively estimated at $27.0 billion, which is comparable with the projected 1997 out-of-pocket expenditures for all US physician services.
Alternative medicine use and expenditures increased substantially between 1990 and 1997, attributable primarily to an increase in the proportion of the population seeking alternative therapies, rather than increased visits per patient.
The purpose of this study was to examine the effects of listening to high-uplifting or low-uplifting music after a stressful
task on (a) immune functions, (b) neuroendocrine responses, and (c) emotional states in college students. Musical selections
that were evaluated as high-uplifting or low-uplifting by Japanese college students were used as musical stimuli. Eighteen
Japanese subjects performed stressful tasks before they experienced each of these, experimental conditions: (a) high-uplifting
music, (b) low-uplifting music, and (c) silence. Subjects' emotional states, the Secretory IgA (S-IgA) level, active natural
killer (NK) cell level, the numbers of T lymphocyte CD4+, CD8+, CD16+, dopamine, norepinephrine, and epinephrine levels were measured before and after each experimental condition. Results indicated
low-uplifting music had a trend of increasing a sense of well-being. High-uplifting music showed trends of increasing the
norepinephrine level, liveliness, and decreasing depression. Active NK cells were decreased after 20 min of silence. Results
of the study were inconclusive, but high-uplifting and low-uplifting music had different effects on immune, neuroendocrine,
and psychological responses. Classification of music is important to research that examines the effects of music on these
responses. Recommendations for future research are discussed.
Growing evidence suggests that alterations in autonomic function contribute to the pathophysiology of panic disorder (PD). This retrospective study employed 24-h heart rate variability (HRV) analysis of Holter records to compare autonomic function in PD patients (n=38) with healthy, age- and gender-matched controls. Both time and frequency domain measures were calculated, and a circadian rhythm analysis was performed. The SDNN index, 5-min total power, very low frequency (VLF) and low frequency (LF) power were significantly lower in panic patients relative to controls over the 24-h period. Hourly means were significantly lower during some of the waking hours as well as the latter part of the sleep cycle. In contrast, the mean RR interval, RMSSD and high frequency (HF) power were comparable in patients and controls. Results suggest that sympathetic activity is depressed in PD patients under usual life conditions, leading to a relative predominance of vagal tone. Findings of low HRV in PD patients are consistent with the high rate of cardiovascular morbidity and mortality in this population, as well as with the emerging view of panic as a disorder involving reduced flexibility and adaptability across biological, affective and behavioral dimensions.
This article presents theory and research on the scientific study of emotion thatemphasizes the importance of coherence as an optimal psychophysiological state. Adynamic systems view of the interrelations between psychological, cognitive andemotional systems and neural communication networks in the human organism providesa foundation for the view presented. These communication networks are examined froman information processing perspective and reveal a fundamental order in heart-braininteractions and a harmonious synchronization of physiological systems associated withpositive emotions. The concept of coherence is drawn on to understand optimalfunctioning which is naturally reflected in the heart’s rhythmic patterns. Research ispresented identifying various psychophysiological states linked to these patterns, withneurocardiological coherence emerging as having significant impacts on well being.These include psychophysiological as well as improved cognitive performance. Fromthis, the central role of the heart is explored in terms of biochemical, biophysical andenergetic interactions. Appendices provide further details and research on;psychophysiological functioning, reference previous research in this area, details onresearch linking coherence with optimal cognitive performance, heart brainsynchronization and the energetic signature of the various psychophysiological modes.
In summary, this work extends previous findings by demonstrating that anger produces a sympathetically dominated power spectrum, whereas appreciation produces a power spectral shift toward MF and HF activity. Results suggest that positive emotions lead to alterations in HRV, which may be beneficial in the treatment of hypertension and in reducing the likelihood of sudden death in patients with congestive heart failure and coronary artery disease.
Adults with type 1 diabetes may have abnormal alterations in heart rate variability (HRV) due to cardiac autonomic neuropathy. This prospective study was performed to determine whether HRV can be used to detect subclinical autonomic neuropathy in diabetic children.
We examined five time domain and three frequency domain HRV indices determined from 24-h Holter recordings in 73 diabetic children and adolescents aged 3-18 years (mean 12.1 years) with a mean duration of diabetes of 55 months. The measures were compared with normal ranges. Z scores were established for each parameter and were compared with classic risk factors of other diabetic complications.
Most HRV indices were significantly depressed in children aged > or = 11 years, and the levels of HRV abnormalities were significantly correlated with long-term metabolic control (mean GHb for 4 years) in that age-group. In younger patients, HRV indices were within the normal range and were not correlated with the level of metabolic control. Illness duration and microalbuminuria but not short-term metabolic control (most recent GHb) were also independently predictive of HRV abnormalities.
These results suggest that early puberty is a critical period for the development of diabetic cardiac autonomic dysfunction. Therefore, all type 1 diabetic patients should be screened for this complication by HRV analysis beginning at the first stage of puberty regardless of illness duration, microalbuminuria, and level of metabolic control.
(1) to determine the clinical effectiveness of Healing Touch (HT) on variables assumed to be related to health enhancement; (2) to determine whether practitioner training level moderates treatment effectiveness.
Mixed-method repeated measures design with quasi-experimental and naturalistic approaches, paired with nomothetic and idiographic analyses.
Practitioner's offices or client's home.
Twenty-two (22) clients who had never experienced HT. Interventions: Three treatment conditions: no treatment (NT), HT only (standard HT care), and HT+ (Standard HT care plus music plus guided imagery).
Secretory immunoglobulin A (sIgA) concentrations in saliva, self-reports of stress levels, client perceptions of health enhancement, and qualitative questionnaires about individual effects.
Clients of practitioners with more training experienced statistically significant positive sIgA change over the HT treatment series, while clients of practitioners with less experience did not. Clients reported a statistically significant reduction of stress level after both HT conditions. Perceived enhancement of health was reported by 13 of 22 clients (59%). Themes of relaxation, connection, and enhanced awareness were identified in the qualitative analysis of the HT experience. Pain relief was reported by 6 of 11 clients (55%) experiencing pain.
The data support the clinical effectiveness of HT in health enhancement, specifically for raising sIgA concentrations, lowering stress perceptions and relieving pain. The evidence indicates that positive responses were not exclusively as a result of placebo, that is, client beliefs, expectations, and behaviors regarding HT.
Analysis of heart rate variation (HRV) has become a popular noninvasive tool for assessing the activities of the autonomic nervous system (ANS). HRV analysis is based on the concept that fast fluctuations may specifically reflect changes of sympathetic and vagal activity. It shows that the structure generating the signal is not simply linear, but also involves nonlinear contributions. Linear parameters, Power spectral indice (LF/HF) is calculated with nonlinear indices Poincare plot geometry(SD1,SD2), Approximate Entropy (ApEn), Largest Lyapunov Exponent (LLE) and Detrended Fluctuation Analysis(DFA). The results show that, with aging the heart rate variability decreases. In this work, the ranges of all linear and nonlinear parameters for four age group normal subjects are presented with an accuracy of more than 89%. As a pre-analysis step, the HRV data is tested for nonlinearity using surrogate data analysis and the results exhibited a significant difference in the ApEn, LLE, SD1/SD2 and DFA parameters of the actual data and the surrogate data.
The heart rate is analyzed using the various time domain parameters, frequency domain parameter and nonlinear parameters like Poincare geometry, ApEn, LLE and DFA.
In this work, the different linear and nonlinear parameters evaluated show a particular range for various cardiac abnormalities. And the results of these were subjected to 't' test with more than 89% confidence interval giving excellent 'p' values in all cases.
Heart rate variability (HRV) signal can be used as a reliable indicator of state of the heart. It becomes less random with the aging(less chaotic). This is evaluated by using various time domain, frequency domain and nonlinear parameters like SD1/SD2, ApEn, LLE alphas and alphal. Different ranges of non-linear parameters for various age groups are presented with 'p' value < or = 0.12.
Spectral analysis of heart rate variability (HRV) during overnight polygraphic recording was performed in 11 healthy subjects. The total spectrum power, power of the VLF, LF and HF spectral bands and the mean R-R were evaluated. Compared to Stage 2 and Stage 4 non-REM sleep, the total spectrum power was significantly higher in REM sleep and its value gradually increased in the course of each REM cycle. The value of the VLF component (reflects slow regulatory mechanisms, e.g. the renin-angiotensin system, thermoregulation) was significantly higher in REM sleep than in Stage 2 and Stage 4 of non-REM sleep. The LF spectral component (linked to the sympathetic modulation) was significantly higher in REM sleep than in Stage 2 and Stage 4 non-REM sleep. On the contrary, a power of the HF spectral band (related to parasympathetic activity) was significantly higher in Stage 2 and Stage 4 non-REM than in REM sleep. The LF/HF ratio, which reflects the sympathovagal balance, had its maximal value during REM sleep and a minimal value in synchronous sleep. The LF/HF ratio significantly increased during 5-min segments of Stage 2 non-REM sleep immediately preceding REM sleep compared to 5-min segments of Stage 2 non-REM sleep preceding the slow-wave sleep. This expresses the sympathovagal shift to sympathetic predominance occurring before the onset of REM sleep. A significant lengthening of the R-R interval during subsequent cycles of Stage 2 non-REM sleep was documented, which is probably related to the shift of sympathovagal balance to a prevailing parasympathetic influence in the course of sleep. This finding corresponds to a trend of a gradual decrease of the LF/HF ratio in subsequent cycles of Stage 2 non-REM sleep.
Heart rate variability (HRV) is an umbrella term for a variety of measures that assess autonomic influence on the heart. Reduced beat-to-beat variability is found in individuals with a variety of cardiac abnormalities. A reduced HRV positively correlates with obesity, poor aerobic fitness, and increasing age. Racial (black-white) differences are apparent in adults and adolescents. We aimed to evaluate (i) Asian-Caucasian differences in HRV and (ii) differences in HRV between girls and boys. Sixty-two children (30 male (15 Caucasian, 15 Asian) and 32 female (15 Caucasian, 17 Asians)) with a mean age of 10.3 +/- 0.6 y underwent 5 min resting HRV recording, fitness testing (Leger's 20 m shuttle), and self-assessed maturity. Outcome HRV measures were a ratio of low to high frequency power (LF:HF), standard deviation of R-R intervals (SDRR) and root mean square of successive R-R intervals (RMSSD). Data were compared between groups using analysis of covariance (ANCOVA). There were no race or sex differences for time domain variables, mean R-R, body mass index, or blood pressure. Compared with Caucasian children, Asian children displayed a higher adjusted (fitness, R-R interval) LF:HF ratio (72.9 +/- 59.4 vs. 120.6 +/- 85.3, p < 0.05). Girls demonstrated a higher adjusted LF:HF power than boys (117.2 +/- 85.1 vs. 76.6 +/- 62.4, p = < 0.05). In conclusion, Asian and Caucasian children display different frequency domain components of heart rate variability.
In situations where children are unable or unwilling to respond for themselves, measurement of quality of life (QOL) is often obtained by parent proxy-report. However the relationship between child self and parent proxy-reports has been shown to be poor in some circumstances. Additionally the most appropriate statistical method for comparing ratings between child and parent proxy-reports has not been clearly established. The objectives of this study were to assess the: 1) agreement between child and parent proxy-reports on an established child QOL measure (the PedsQL) using two different statistical methods; 2) effect of chronological age and domain type on agreement between children's and parents' reports on the PedsQL; 3) relationship between parents' own well-being and their ratings of their child's QOL.
One hundred and forty-nine healthy children (5.5 - 6.5, 6.5 - 7.5, and 7.5 - 8.5 years) completed the PedsQL. One hundred and three of their parents completed these measures in relation to their child, and a measure of their own QOL (SF-36).
Consistency between child and parent proxy-reports on the PedsQL was low, with Intra-Class correlation coefficients ranging from 0.02 to 0.23. Correlations were higher for the oldest age group for Total Score and Psychosocial Health domains, and for the Physical Health domain in the youngest age group. Statistically significant median differences were found between child and parent-reports on all subscales of the PedsQL. The largest median differences were found for the two older age groups. Statistically significant correlations were found between parents' own QOL and their proxy-reports of child QOL across the total sample and within the middle age group.
Intra-Class correlation coefficients and median difference testing can provide different information on the relationship between parent proxy-reports and child self-reports. Our findings suggest that differences in the levels of parent-child agreement previously reported may be an artefact of the statistical method used. In addition, levels of agreement can be affected by child age, domains investigated, and parents' own QOL. Further studies are needed to establish the optimal predictors of levels of parent-child agreement.
The PedsQL Present Functioning Visual Analogue Scales (PedsQL VAS) were designed as an ecological momentary assessment (EMA) instrument to rapidly measure present or at-the-moment functioning in children and adolescents. The PedsQL VAS assess child self-report and parent-proxy report of anxiety, sadness, anger, worry, fatigue, and pain utilizing six developmentally appropriate visual analogue scales based on the well-established Varni/Thompson Pediatric Pain Questionnaire (PPQ) Pain Intensity VAS format.
The six-item PedsQL VAS was administered to 70 pediatric patients ages 5-17 and their parents upon admittance to the hospital environment (Time 1: T1) and again two hours later (Time 2: T2). It was hypothesized that the PedsQL VAS Emotional Distress Summary Score (anxiety, sadness, anger, worry) and the fatigue VAS would demonstrate moderate to large effect size correlations with the PPQ Pain Intensity VAS, and that patient" parent concordance would increase over time.
Test-retest reliability was demonstrated from T1 to T2 in the large effect size range. Internal consistency reliability was demonstrated for the PedsQL VAS Total Symptom Score (patient self-report: T1 alpha = .72, T2 alpha = .80; parent proxy-report: T1 alpha = .80, T2 alpha = .84) and Emotional Distress Summary Score (patient self-report: T1 alpha = .74, T2 alpha = .73; parent proxy-report: T1 alpha = .76, T2 alpha = .81). As hypothesized, the Emotional Distress Summary Score and Fatigue VAS were significantly correlated with the PPQ Pain VAS in the medium to large effect size range, and patient and parent concordance increased from T1 to T2.
The results demonstrate preliminary test-retest and internal consistency reliability and construct validity of the PedsQL Present Functioning VAS instrument for both pediatric patient self-report and parent proxy-report. Further field testing is required to extend these initial findings to other ecologically relevant pediatric environments.
This pilot study assessed the role of Healing Touch (HT), an energy-based therapy, in modulating chronic neuropathic pain and the associated psychological distress from post spinal cord injury. Twelve veterans were assigned to either HT or guided progressive relaxation for six weekly home visits. The instruments selected showed sensitivity, although there was a large variation among the groups. There was a significant difference in the composite of interference on the Brief Pain Inventory (t = -2.71, p = .035). The mean score of the fatigue subscale of the Profile of Moods decreased (ns) in the HT group and in the subscale of confusion yet remained stable in the control group. The Diener Satisfaction With Life Scale showed increased well-being in the HT group and no change in the control group. Participants reported various experiences with HT sessions indicating that it may have benefit in the complex response to chronic pain.
Health-related quality of life (HRQOL) measurement has emerged as an important health outcome in clinical trials, clinical practice improvement strategies, and healthcare services research and evaluation. While pediatric patient self-report should be considered the standard for measuring perceived HRQOL, there are circumstances when children are too young, too cognitively impaired, too ill or fatigued to complete a HRQOL instrument, and reliable and valid parent proxy-report instruments are needed in such cases. Further, it is typically parents' perceptions of their children's HRQOL that influences healthcare utilization. Data from the PedsQL DatabaseSM were utilized to test the reliability and validity of parent proxy-report at the individual age subgroup level for ages 2-16 years as recommended by recent FDA guidelines.
The sample analyzed represents parent proxy-report age data on 13,878 children ages 2 to 16 years from the PedsQL 4.0 Generic Core Scales DatabaseSM. Parents were recruited from general pediatric clinics, subspecialty clinics, and hospitals in which their children were being seen for well-child checks, mild acute illness, or chronic illness care (n = 3,718, 26.8%), and from a State Children's Health Insurance Program (SCHIP) in California (n = 10,160, 73.2%).
The percentage of missing item responses for the parent proxy-report sample as a whole was 2.1%, supporting feasibility. The majority of the parent proxy-report scales across the age subgroups exceeded the minimum internal consistency reliability standard of 0.70 required for group comparisons, while the Total Scale Scores across the age subgroups approached or exceeded the reliability criterion of 0.90 recommended for analyzing individual patient scale scores. Construct validity was demonstrated utilizing the known groups approach. For each PedsQL scale and summary score, across age subgroups, healthy children demonstrated a statistically significant difference in HRQOL (better HRQOL) than children with a known chronic health condition, with most effect sizes in the medium to large effect size range.
The results demonstrate the feasibility, reliability, and validity of parent proxy-report at the individual age subgroup for ages 2-16 years. These analyses are consistent with recent FDA guidelines which require instrument development and validation testing for children and adolescents within fairly narrow age groupings and which determine the lower age limit at which reliable and valid responses across age categories are achievable. Even as pediatric patient self-report is advocated, there remains a fundamental role for parent proxy-report in pediatric clinical trials and health services research.
Although parent-proxy reports of health-related quality of life (HRQOL) are only moderately correlated with child reported HRQOL, it remains unknown why these scores differ. The aim of this study was to use a qualitative methodology to examine why parents and children report different levels of HRQOL.
The sample consisted of 15 parent-child pairs. A think-aloud technique was used where parents and children were given a generic HRQOL instrument (KIDSCREEN) and instructed to share their thoughts with the interviewer. Qualitative analyses were conducted to assess whether parents and children base their answer on different experiences or reasoning, have different response styles, or interpret the items differently.
There was discordance between parents and children, in terms of rating scale and in terms of the reasoning for their answer. Children tended to have different response styles to parents, where for example, children tended to provide extreme scores (highest or lowest score) and base their response on one single example, more than parents. Parents and children interpreted the meaning of the items very similarly.
This study provides evidence to suggest that discordance among parent-child pairs on KIDSCREEN scores may be as a result of different reasoning and different response styles, rather than interpretation of items. These findings have important implications when parent-proxy reported HRQOL is used to guide clinical/treatment decisions.
Music is widely used to enhance well-being, reduce stress, and distract patients from unpleasant symptoms. Although there are wide variations in individual preferences, music appears to exert direct physiologic effects through the autonomic nervous system. It also has indirect effects by modifying caregiver behavior. Music effectively reduces anxiety and improves mood for medical and surgical patients, for patients in intensive care units and patients undergoing procedures, and for children as well as adults. Music is a low-cost intervention that often reduces surgical, procedural, acute, and chronic pain. Music also improves the quality of life for patients receiving palliative care, enhancing a sense of comfort and relaxation. Providing music to caregivers may be a cost-effective and enjoyable strategy to improve empathy, compassion, and relationship-centered care while not increasing errors or interfering with technical aspects of care.
Parent-proxy report of their children's health-related quality of life: an analysis of 13 878 parents' reliability and validity across age subgroups using the PedsQL 4.0 Generic Core Scales . Varni J. W., Limbers C. A. & Burwinkle T. M. ( 2007 ) Health and Quality of Life Outcomes , 5 , 2 . DOI:10.1186/1477-7525-5-2.
Background Health-related quality of life (HRQOL) measurement has emerged as an important health outcome in clinical trials, clinical practice improvement strategies, and healthcare services research and evaluation. While paediatric patient self-report should be considered the standard for measuring perceived HRQOL, there are circumstances when children are too young, too cognitively impaired, too ill or fatigued to complete an HRQOL instrument, and reliable and valid parent-proxy report instruments are needed in such cases. Further, it is typically parents' perceptions of their children's HRQOL that influences healthcare utilization. Data from the PedsQL DatabaseSM were utilized to test the reliability and validity of parent-proxy report at the individual age subgroup level for ages 2–16 years as recommended by recent Food and Drug Administration (FDA) guidelines.
Methods The sample analysed represents parent-proxy report age data on 13 878 children ages 2–16 years from the PedsQL 4.0 Generic Core Scales DatabaseSM. Parents were recruited from general paediatric clinics, sub-specialty clinics and hospitals in which their children were being seen for well-child checks, mild acute illness or chronic illness care (n = 3,718, 26.8%), and from a State Children's Health Insurance Program in California (n = 10 160, 73.2%).
Results The percentage of missing item responses for the parent-proxy report sample as a whole was 2.1%, supporting feasibility. The majority of the parent-proxy report scales across the age subgroups exceeded the minimum internal consistency reliability standard of 0.70 required for group comparisons, while the total scale scores across the age subgroups approached or exceeded the reliability criterion of 0.90 recommended for analysing individual patient scale scores. Construct validity was demonstrated utilizing the known groups approach. For each PedsQL scale and summary score, across age subgroups, healthy children demonstrated a statistically significant difference in HRQOL (better HRQOL) than children with a known chronic health condition, with most effect sizes in the medium-to-large effect size range.
Conclusion The results demonstrate the feasibility, reliability and validity of parent-proxy report at the individual age subgroup for ages 2–16 years. These analyses are consistent with recent FDA guidelines which require instrument development and validation testing for children and adolescents within fairly narrow age groupings and which determine the lower age limit at which reliable and valid responses across age categories are achievable. Even as paediatric patient self-report is advocated, there remains a fundamental role for parent-proxy report in paediatric clinical trials and health services research.
This study assessed the impact of an elective for second-year students on cultivating compassion through complementary and alternative medicine practices including therapeutic touch and healing touch. Course participants completed demographic questions, precourse and postcourse questions about confidence and practice in compassion, and the Maslach Burnout Inventory. Those who completed the elective reported significant improvements in confidence, practice, and sense of personal achievement. For example, for the statement, “I am confident in being calm, peaceful and focused (centered) before and during patient encounters,” scores improved from 1.7 to 8.0 on a 10-point scale (p < .01). Optimism about future practice improved from 5.5 before to 7.9 after the course (p < .05). Scores significantly improved for confidence and practice of compassion and optimism about future practice. Such electives may improve desired skills and help reduce burnout. Additional research is needed to determine the impact of such electives on quality of care.
Our results indicate the following. 1. HRV is markedly depressed in inducible SCD survivors, a group at high risk of a subsequent episode of SCD. 2. Studies on patients who developed SCD during Holter monitoring indicate that HRV is depressed prior to SCD. 3. HRV is markedly depressed in inducible "asymptomatic ventricular ectopy" patients, with the degree of reduction paralleling that observed in inducible SCD survivors. In contrast, HRV of noninducible "asymptomatic ventricular ectopy" patients did not differ statistically from normal. 4. The findings provide additional evidence that cardiac parasympathetic function is depressed in patients prone to development of SCD and that altered autonomic function contributes to the development of electrical instability in such individuals. This accords with findings that such risk factors for sudden death as coronary artery disease, myocardial infarction, congestive failure, and hypertension all have been associated with reduced parasympathetic activity or attenuation of parasympathetically mediated reflexes. It is tempting to believe that diminished cardiac parasympathetic activity, perhaps by failing to counter excess sympathetic activity, contributes to SCD. 5. It may be inferred that HRV measurements have potential for serving as an independent predictor of inducibility in response to programmed ventricular stimulation and that they could represent a noninvasive screen for patients referred for evaluation of risk of SCD because of asymptomatic ventricular ectopy or other causes. In a larger sense, the data suggest that HRV measurements may provide information pertinent to the identification of individuals at increased risk of SCD that is independent of that provided by other risk factors. Given the human and economic stakes, further study is clearly warranted.
To assess the interaction between the sympathetic and parasympathetic systems in patients with fibromyalgia syndrome (FM), using power spectrum analysis (PSA) of heart rate variability (HRV). In addition, we explored the association between HRV, measures of tenderness, FM symptoms, physical function, psychological well being and quality of life.
We studied 22 women with FM and 22 age-matched healthy women. Twenty-minute electrocardiogram recordings were obtained in a supine position during complete rest. Spectral analysis of R-R intervals was done by the fast-Fourier transform algorithm.
Heart rate was significantly higher in FM patients compared with controls (P < .006). FM patients had significantly lower HRV compared with controls (P= .001), and higher low-frequency (LF) and lower high-frequency (HF) components of PSA than controls (P < .001). Quality of life, physical function, anxiety, depression, and perceived stress were moderately to highly correlated with LF, HF (in normalized units), and LF/HF. No association was observed between HRV parameters and measures of tenderness and FM symptoms.
The basal autonomic state of patients with FM is characterized by increased sympathetic and decreased parasympathetic tones. Autonomic dysregulation may have implications regarding the symptomatology, physical and psychological aspects of health status.
The newly inaugurated Research Resource for Complex Physiologic Signals, which was created under the auspices of the National Center for Research Resources of the National Institutes of Health, is intended to stimulate current research and new investigations in the study of cardiovascular and other complex biomedical signals. The resource has 3 interdependent components. PhysioBank is a large and growing archive of well-characterized digital recordings of physiological signals and related data for use by the biomedical research community. It currently includes databases of multiparameter cardiopulmonary, neural, and other biomedical signals from healthy subjects and from patients with a variety of conditions with major public health implications, including life-threatening arrhythmias, congestive heart failure, sleep apnea, neurological disorders, and aging. PhysioToolkit is a library of open-source software for physiological signal processing and analysis, the detection of physiologically significant events using both classic techniques and novel methods based on statistical physics and nonlinear dynamics, the interactive display and characterization of signals, the creation of new databases, the simulation of physiological and other signals, the quantitative evaluation and comparison of analysis methods, and the analysis of nonstationary processes. PhysioNet is an on-line forum for the dissemination and exchange of recorded biomedical signals and open-source software for analyzing them. It provides facilities for the cooperative analysis of data and the evaluation of proposed new algorithms. In addition to providing free electronic access to PhysioBank data and PhysioToolkit software via the World Wide Web (http://www.physionet. org), PhysioNet offers services and training via on-line tutorials to assist users with varying levels of expertise.
To evaluate heart rate variability (HRV) by power spectral analysis of heart rate and its relationship to intracranial pressure (ICP), cerebral perfusion pressure (CPP), and outcomes in children with acute traumatic head injury.
Prospective, case series.
Pediatric intensive care unit in a level II trauma center/children's hospital.
Fifteen critically ill children with documented acute traumatic brain injury and four control subjects.
None.
The normalized total power from 0.04 to 0.15 Hz was used to quantify low-frequency HRV and from 0.15 to 0.40 Hz to quantify high-frequency HRV. The ratio of low- to high-frequency (LF/HF) power was used as a measure of sympathetic modulation of heart rate. The power spectral data from the 5-min samples were averaged over each hour of data collection, and an hourly LF/HF ratio was obtained based on a 60-min electrocardiogram collection (twelve 5-min segments). The daily mean LF/HF ratio was calculated from the hourly LF/HF measurements. We found no linear correlation between the LF/HF ratio and either ICP or CPP (p = NS). There was a significant decrease in the LF/HF ratio when the intracranial pressure was >30 mm Hg (p < .001) or the cerebral perfusion pressure was <40 mm Hg (p < .001). Children with a Glasgow Coma Scale score of 3-4 had a lower LF/HF ratio compared with those who had a Glasgow Coma Scale score of 5-8 (p < .005). Patients who progressed to brain death had a markedly lower LF/HF ratio (p < .001), with a significant decrease after the first 4 hrs of hospitalization. Patients with more favorable outcomes had significantly higher LF/HF ratios.
Our findings suggest that an ICP of >30 mm Hg or a CPP of <40 mm Hg may be associated with marked autonomic dysfunction and poor outcome. We speculate that HRV power spectral analysis may be a useful adjunct in determining the severity of neurologic insult and the prognosis for recovery in children. The LF/HF ratio may be helpful not only in identifying those patients who will progress to brain death but also in predicting which patients will have favorable outcomes.
This article explores how nurses can use energetic principles and Healing Touch to enhance the healing of their patients, for their own personal healing and growth, for improving job satisfaction, and for identifying educational resources available for more intense study.
This study was designed to determine whether power spectral analysis (PSA) of heart rate variability (HRV) can detect change in autonomic tone following a relaxation intervention called therapeutic touch (TT). Thirty healthy subjects underwent TT by one of three TT practitioners using the steps developed by Krieger and Kunz (The Therapeutic Touch, Prentice-Hall, 1979). Both subjects and TT practitioners were monitored by continuous electrocardiographic monitoring (Holter) before (15 minutes), during, and after (15 minutes) TT was administered. Subjects and TT practitioners completed a visual analogue scale (VAS) of perceived stress before and after TT. Change scores for VAS and PSA of high-frequency/low-frequency (HF/LF) ratios were compared for the 2-minute interval before TT began and the end of TT and the end of the recovery period, using t tests. VAS scores decreased (less stress) from before to after TT for both subjects (p < 0.0005) and TT practitioners (p < 0.0005). Mean HF/LF ratios increased significantly to reflect greater parasympathetic dominance from before TT to the end of treatment for subjects (p = 0.006), but not for TT practitioners. However, further analysis revealed that this change was due to an exaggerated HF/LF response from four outliers (p < 0.0005). Data collected in this study did not reveal differences between these four subjects and the rest of the sample. There were no significant changes in HF/LF ratios from the end of TT to end of recovery for either group. Further research is needed to determine why some subjects may have greater change in autonomic tone in response to relaxation in order to be able to predict who will demonstrate physiologic response to relaxation interventions.
The analysis of heart rate variability (HRV) provides information about autonomic cardiovascular control in healthy subjects. In the past 15 years, several articles have been published regarding HRV and chronic heart failure (CHF). The results of these papers substantially demonstrated that HRV is significantly different in CHF patients compared to controls. Moreover, some variables derived from HRV analysis showed significant independent prognostic capacity. In particular, the reduction of variance (expressed as SDNN) and low-frequency spectral component of HRV (ranging from 0.03 to 0.15 Hz) seem related to an increased mortality in CHF. Nevertheless, these variables are not yet considered in clinical practice. A better understanding of the physiopathological basis of the reported alterations of HRV in CHF patients is required in order to permit its use as a clinical tool for prognosis and tailored therapy in individual CHF patients.
Time-frequency or time-variant methods have been extensively applied in the study of the heart-rate variability (HRV) signal. In fact, the frequency content of HRV signal has a strong correlation with the control system assessing heart rate. In particular, the power related to the low-frequency (LF) and high-frequency (HF) components have been demonstrated to correlate to the action of sympathetic and parasympathetic branches of the autonomic nervous system. However, the analysis is restricted to stationary conditions, unless time-frequency methods are employed for detecting dynamic changes that may occur during physiological and pathological conditions. This article reviews the most diffused tools for time-frequency analysis, starting from linear decomposition of the signal (including short-time Fourier transform and wavelet and wavelet packet decomposition), to quadratic time-frequency distributions (including Wigner-Ville transform and Cohen's class of distributions), and finally to adaptive or time-variant autoregressive (AR) models, in both the mono- and bivariate forms. In the past few years, these approaches have been applied in several studies related to cardiovascular responses during nonstationary pathophysiological events. Among them, we will recall and discuss myocardial ischemia (spontaneous or induced), drug infusion, rest-tilt maneuver and syncope, neurophysiological, and sleep investigations.
HT and TT are unique touch techniques with origins in the nursing profession. They are widely available in pediatric hospitals and often are used as adjunct therapies to decrease stress, anxiety, and pain. Practitioners, as well as patients, may notice improved sense of well-being during and after treatments. Additional research is needed to determine the mechanisms by which these effects occur, the optimal duration and frequency of treatments, factors predictive of treatment response, and the overall costs and benefits of including TT and HT in treatment in addition to traditional therapies. These therapies are safe and readily available.
To review studies of healing touch and its implications for practice and research.
A review of the literature from published works, abstracts from conference proceedings, theses, and dissertations was conducted to synthesize information on healing touch. Works available until June 2003 were referenced.
The studies were categorized by target of interventions and outcomes were evaluated.
Over 30 studies have been conducted with healing touch as the independent variable. Although no generalizable results were found, a foundation exists for further research to test its benefits.
Complementary and alternative medicine (CAM) use by US adults increased substantially between 1990 and 1997, yet little is known about more recent trends.
Compare CAM therapy use by US adults in 2002 and 1997.
Comparison of two national surveys of CAM use by US adults: (1) the Alternative Health/Complementary and Alternative Medicine supplement to the 2002 National Health Interview Survey (NHIS, N = 31,044) and (2) a 1997 national survey (N = 2055), each containing questions about 15 common CAM therapies.
Prevalence, sociodemographic correlates, and insurance coverage of CAM use.
The most commonly used CAM modalities in 2002 were herbal therapy (18.6%, representing over 38 million US adults) followed by relaxation techniques (14.2%, representing 29 million US adults) and chiropractic (7.4%, representing 15 million US adults). Among CAM users, 41% used two or more CAM therapies during the prior year. Factors associated with highest rates of CAM use were ages 40-64, female gender, non-black/non-Hispanic race, and annual income of dollar 65,000 or higher. Overall CAM use for the 15 therapies common to both surveys was similar between 1997 and 2002 (36.5%, vs. 35.0%, respectively, each representing about 72 million US adults). The greatest relative increase in CAM use between 1997 and 2002 was seen for herbal medicine (12.1% vs.18.6%, respectively), and yoga (3.7% vs. 5.1%, respectively),while the largest relative decrease occurred for chiropractic (9.9% to 7.4%, respectively).
The prevalence of CAM use has remained stable from 1997 to 2002. Over one in three respondents used CAM in the past year, representing about 72 million US adults.
Assessment of quality of life (QOL) of children is complex due to the developmental differences in understanding the content being measured. The validity of parent-proxy reports versus children's self-reports remains to be clarified.
To examine the agreement on QOL measures between children's self-reports and parent-proxy reports at different points in time, including at baseline and at 6-month follow up, as well as the change in scores between 6-month follow up and baseline.
A longitudinal study of QOL assessment of children with cancer for parents and children was conducted. At baseline assessment, 126 children with cancer and at least one of their parents participated (n = 252). Forty boys, 25 girls, and their parents (n = 130) completed the 6-month follow up assessment.
Parents tended to report better QOL than did the children at both baseline and 6-month follow up assessments in both the on- and off-treatment groups. Agreement on QOL measure between children and parent proxies varied as a result of the following factors: treatment status (on and off treatment), time (at baseline vs. at 6-month follow up), and changes in score between the time of the baseline assessment and the 6-month follow up. The effects of time, age, gender, and severity of illness had different degrees of significance as predictors on various subscales.
The predictors of agreement between patients' reports and parent-proxy reports, including the passage of time (from baseline to 6-month follow up), gender, age, and illness severity, have not been conclusively determined. Further studies are needed to examine patient-proxy agreement during a longer follow up period at more than two points in time and using the same patients through the stages of confirmation of diagnosis, acceptance of diagnosis, treatment, and after treatment.
An uncontrolled, preliminary evaluation of healing by gentle touch in clients with cancer was carried out at The Centre for Complementary Care in Eskdale, Cumbria. All clients attending The Centre between 1995 and 2001 were invited to participate. Data were collected from 35 clients with cancer. Outcome measures included pre- to post-treatment changes in physical and psychological functioning. Assessments were made using a questionnaire with visual analogue scales for subjective rating of symptoms and the EuroQoL (EQ-5D), a generic state of health measure. Wilcoxon Signed Ranks tests showed statistically significant improvements in psychological and physical functioning, with positive effects on quality of life. The most pronounced improvements were seen in ratings for stress and relaxation, severe pain/discomfort, and depression/anxiety, particularly in those with the most severe symptoms on entry. The study found no adverse effects resulting from the treatment. These findings indicate that healing is a safe and effective adjunct to conventional medical treatment with the potential to ameliorate some of the more stressful aspects of cancer, including those inherent in current cancer treatment strategies. Rigorous evaluation of this modality by prospective, randomised, controlled trial is strongly warranted, as are investigations into its potential for use in palliative care.
Meditation is a specific consciousness state in which deep relaxation and increased internalized attention coexist. Autonomic nervous activity during meditation was reported to be characterized by decreased sympathetic activity and increased parasympathetic activity. And concerning EEG power, slow alpha power and fast theta power increased during meditation. On the other hand, mental arithmetic (MA) tasks have been reported to induce an increase in blood pressure and heart rate with enhanced sympathetic activity. However, changes in autonomic nervous activity and EEG power during MA tasks and their mutual relationship have not been adequately studied. In the present study, we quantitatively analyzed the changes in autonomic nervous activity using heart rate variability (HRV) and EEG power during MA task in 30 healthy volunteers. MA task induced significant increases in normalized LF, LF/HF ratio (as a sympathetic index), and a decrease in normalized HF (as a parasympathetic index). On the other hand, significant decrease in EEG power (slow theta: 4-6 Hz and fast alpha: 10-13 Hz in the posterior region and fast theta: 6-8 Hz and slow alpha: 8-10 Hz in all the regions) were induced by MA task. Further evaluation of these changes showed a negative correlation between the change rates (with the control resting condition as the baseline) in fast alpha power and that in LF/HF. These results suggest that specific correlated relationships exist between the change in autonomic nervous activity and EEG power depending on the difference in mental task (i.e., meditation or MA).
Hypertension is more frequent and more severe in older individuals and in African Americans. Differences in autonomic nervous system activity might contribute to these differences. Autonomic effects on the heart can be studied noninvasively through analysis of heart rate variability (HRV). We examined the effects of age and ethnicity on HRV.
We studied 135 subjects (57 African Americans and 78 Caucasian Americans), aged 23 to 54 years. Using their surface electrocardiogram (ECG) data, we calculated the HRV indices with spectral analyses. High frequency (HF) power was used to index parasympathetic activity, whereas the ratio of low to high frequency power (LF/HF) was used to index sympathovagal balance.
Three HRV indices (HF, LF power, and LF/HF) were significantly related to age in Caucasian Americans but not in African Americans. The effect of age, ethnicity, and the age-by-ethnicity interaction on HF and LF power was significant, even after controlling for gender, body mass index, and blood pressure.
Young African Americans manifested a pattern of HRV response similarly to older Caucasian Americans. These results suggest that young African American individuals might show signs of premature aging in their autonomic nervous system.
Johrei has been shown to decrease exam stress responses but its immediate effects have not been assessed.
In a randomised, blinded, counter-balanced design, 33 medical students were asked to calculate mental arithmetic in the Paced Auditory Serial Addition Task (PASAT), which served as an acute stressor prior to two conditions, 10 min of Johrei or a control resting condition involving 10 min without Johrei in a cross-over trial; after each, saliva was collected and mood tested.
University EEG laboratory.
Johrei, a non-touch healing method.
Profile of mood states (POMS-Bi); state anxiety (STAI); salivary variables: cortisol, DHEA, IgA.
Mood scores on 5/6 of the POMS-Bi subscales were slightly but significantly more positive in the Johrei condition. State anxiety was similarly decreased. IgA levels were unchanged but cortisol levels were found to be slightly but non-significantly lower after Johrei than after the control condition and DHEA levels slightly but non-significantly raised, with a negative correlation between cortisol and DHEA levels.
This study gives some indication that Johrei can reduce negative mood and increase positive mood states after the acute effects of a laboratory stressor in comparison to a resting control condition.
Many medical schools offer electives on complementary medicine, but little is known about the characteristics of students who sign up for such electives compared with those who do not.
Compare enrollees to nonenrollees in an elective course on therapeutic touch and healing touch (TTHT).
Cross-sectional survey.
Wake Forest University School of Medicine, second-year course on medicine as a profession.
Second-year medical students who returned surveys: 22 who signed up for an elective on TTHT and 58 who did not.
Anonymous surveys included questions about demographics, attitudes, practices, and the Maslach Burnout Inventory (MBI).
Those who signed up for the elective were more likely to be women (73% for TTHT vs 33% for others, P < .01). Nearly all students thought that being centered and compassionate were very important. Students who signed up for TTHT were less likely to report feeling confident in being able to be centered when it was quiet (41% vs 64%, respectively, very confident, P < .04) and less confident in their ability to demonstrate nonverbal comforting behaviors (9% vs 43%, respectively, very confident, P = .02). Only 18% of elective vs 66% of others reported being centered during patient encounters (P < .001). The TTHT students and their classmates reported comparable levels of burnout.
Elective students were no more likely than classmates to believe that it is very important to be centered and to extend compassion toward patients; they reported being less confident and practicing these skills less often than their classmates. Burnout was not less common among those in the elective. Electives may not be "preaching to the choir." Future studies need to determine whether training enhances confidence and skills and whether it protects against developing burnout.
Posttraumatic stress symptoms (PTSS) and posttraumatic stress disorder (PTSD) were assessed in young adult survivors of childhood cancer, including the role of four sets of variables in understanding PTSD in this population: demographic characteristics, disease and treatment factors, psychosocial and functional outcomes, and cancer-related beliefs.
One hundred eighty-two survivors of pediatric malignancies, ages 18-37 years old completed a psychiatric interview and self-report measures. Survivors were >or=5 years from diagnosis and >or=2 years from the completion of cancer treatment for a variety of cancers.
Nearly 16% of the sample had PTSD. Most survivors reported re-experiencing symptoms. There were no significant differences between survivors with and without PTSD on demographic or disease and treatment variables. Survivors with PTSD reported more psychological problems and negative beliefs about their illness and health status than those without PTSD. A logistic regression model predicted 50% of the variance in PTSD.
PTSD affects a subset of young adult cancer survivors. These survivors experience more psychological problems in general. Beliefs about the cancer experience are more potent predictors of PTSD than demographic or disease and treatment factors. Screening for PTSS and PTSD in cancer survivors is recommended.
Traumatic stress offers a helpful framework by which the ongoing reactions of children with cancer and their families can be understood. Family systems interventions in pediatric oncology are reviewed, with a focus on reducing pediatric medical traumatic stress (PMTS) across members of the family.
A recently developed model of PMTS is presented and applied to the pediatric cancer population. Two family interventions to decrease traumatic stress systems are reviewed. Reductions in traumatic stress symptoms were observed at postintervention follow-ups for family members in both studies.
The pediatric medical traumatic stress model provides a useful heuristic for understanding the psychological consequences of pediatric cancer on the child and their family over the course of treatment and beyond. Two family systems interventions show promise in improving outcomes for childhood cancer survivors and their parents. Although interventions are promising, future development of these interventions to modify them for dissemination is needed.
The health of the middle-aged and elderly people is a major concern given the rapid aging population and rising costs of medical care. Low-impact exercise on a regular basis is ideal for maintaining the well-being of an aging population. Tai Chi Chuan (TCC) is the most well-known and most widely practiced form of low-impact martial arts therapy and has been shown to have positive health effects. A lesser-known form of martial arts therapy is Wai Tan Kung (WTK), which our previous study found to have positive health effects as well. The present study compares the effects of TCC and WTK on autonomic nervous system modulation and on hemodynamics in adults among non-exercising control (30), TCC practitioners (30) and WTK practitioners (30). Our study found that in a short-term, WTK and TCC exercises enhanced the vagal modulation, lowered the sympathetic modulation and lowered arterial blood pressures in the practitioners. It was also observed that the forced vital capacity of TCC practitioners was significantly higher than that of WTK practitioners before exercise. There were no significant differences in the percentage changes in HRV measures and hemodynamics between WTK and TCC practitioners 30 and 60 min after exercise, indicating that the effects of WTK and TCC were similar in magnitude. In conclusion, TCC and WTK are comparable to each other in terms of their effects on autonomic nervous system modulation and hemodynamics, thus suggesting that WTK can be just as beneficial as TCC as a form of low-impact exercise for elderly adults.
Acute Stress Disorder (ASD) and subclinical symptoms of acute stress (SAS) may be a useful framework for understanding the psychological reactions of mothers and fathers of children newly diagnosed with a pediatric malignancy.
Mothers (N = 129) and fathers (N = 72) of 138 children newly diagnosed with cancer completed questionnaires assessing acute distress, anxiety, and family functioning. Demographic data were also gathered. Inclusion criteria were: a confirmed diagnosis of a pediatric malignancy in a child under the age of 18 years without prior chronic or life threatening illness and fluency in English or Spanish.
Descriptive statistics and multiple linear regressions were used to examine predictors of SAS. Fifty-one percent (N = 66) of mothers and 40% (N = 29) of fathers met DSM-IV diagnostic criteria for ASD. The majority of the sample reported experiencing at least one SAS. General anxiety, but not family functioning, was a strong predictor of SAS in both mothers and fathers even after controlling for demographic characteristics.
Immediately following their child's diagnosis of cancer, most mothers and fathers experience SAS, with a subsample meeting criteria for ASD. More anxious parents are at heightened risk of more intense reactions. The findings support the need for evidence-based psychosocial support at diagnosis and throughout treatment for families who are at risk for acute distress reactions.
Research on touch therapies is still in the early stages of development. Studies of Therapeutic Touch, Healing Touch, and Reiki are quite promising; however, at this point, they can only suggest that these healing modalities have efficacy in reducing anxiety; improving muscle relaxation; aiding in stress reduction, relaxation, and sense of well-being; promoting wound healing; and reducing pain. The multidimensional aspects of healing inherent in patient care continue to be expanded and facilitated by our understanding and application of energy therapies.
Heart rate variability (HRV) is reported increasingly in pediatric research, but different strategies used to identify and manage potential outlier beats impact HRV parameter values in adults and animals. Do they in pediatrics? To compare the impact of different strategies to identifying and managing outliers, we used interbeat interval (IBI) data from three different populations: 10 stable premature infants, 33 stable pediatric oncology patients, and 15 healthy adults. Five commonly reported HRV parameters were compared using three identification and two management strategies to filter potential outliers. The three populations had different resting heart rates: 155 +/- 9 beats per minute (bpm) in infants, 105 +/- 17 bpm in children, and 87 +/- 12 bpm in adults. All three identification strategies flagged fewer than 2% of IBIs; the threshold identification strategy, excluding IBIs denoting heart rates <30 or >300 bpm, identified significantly fewer outliers than the other two strategies and generated higher HRV parameters in all populations (p < 0.001). There were no significant differences in HRV parameters calculated by managing identified outliers by "tossing" them versus "interpolating" values. Different strategies for identifying potential outliers are associated with significant differences in HRV parameters. Pediatric researchers who report HRV should detail their outlier filtering strategies.
This study aims at investigating changes in heart rate variability (HRV) measured during meditation. The statistical and spectral measures of HRV from the RR intervals were analyzed. Results indicate that meditation may have different effects on health depending on frequency of the resonant peak that each meditator can achieve. The possible effects may concern resetting baroreflex sensitivity, increasing the parasympathetic tone, and improving efficiency of gas exchange in the lung.
We examined the effects of a short-term low-calorie diet on the activity of the autonomic nervous system during stress tests in obese patients with hypertension by analysis of heart rate and blood pressure variability. Eighteen obese inpatients with essential hypertension were given a regular-calorie diet (1,600 kcal, NaCl 7 g) for 4 days, and then a low-calorie diet (1,100 kcal, NaCl 7 g) for 11 days. During both the regular-calorie diet and low-calorie diet, power spectral analysis of heart rate and blood pressure variability at rest and during mental arithmetic test, deep breathing test, isometric handgrip test or cold pressor test was performed. Body weight and 24-h ambulatory blood pressure were significantly lower during the low-calorie diet than during the regular-calorie diet. Systolic and diastolic blood pressure significantly increased over the handgrip test and cold pressor test during both diets. The low frequency component (LF) of systolic blood pressure, a marker of sympathetic activity to the vasculature, during the deep breathing test and cold pressor test were significantly lower on the low-calorie diet than the regular-calorie diet. The blood leptin concentration was also significantly lower on the low-calorie diet than the regular-calorie diet. The decrease in body weight was positively correlated with the decrease in blood leptin concentration. The LF/high frequency component (HF) ratio of the RR interval at rest on the regular-calorie diet was negatively correlated with the decrease in blood leptin concentration. These results suggest that the autonomic nervous function assessed by analysis of heart rate and blood pressure variability during stress tests may be improved by weight loss due to a short-term low-calorie diet in obese patients with hypertension.
Healing Touch: a guidebook for practitio-ners
- Hover-Kramer Dm
- Jl Mentgen
- V Slater
- Geddes S N Scendrett-Hibdon
Hover-Kramer DM, Mentgen JL, Slater V, Scendrett-Hibdon S, Geddes N, et al. Healing Touch: a guidebook for practitio-ners. 2nd ed. Denver (CQ): Delmar Learning; 2001.
Heart rate variability: standards of measurement, physiological interpretation and clinical use. Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology
23. Heart rate variability: standards of measurement, physiological interpretation and clinical use. Task Force of the European
Society of Cardiology and the North American Society of
Pacing and Electrophysiology. Circulation 1996;93:1043-65.
King RR The integration of healing touch with conventional care at the Scripps Center for Jntegrative Medicine
King RR The integration of healing touch with conventional
care at the Scripps Center for Jntegrative Medicine. Explore
(NY)2005;l:144-5.
Healing Touch: a guidebook for practitioners
- D M Hover-Kramer
- J L Mentgen
- V Slater
- S Scendrett-Hibdon
- N Geddes
Hover-Kramer DM, Mentgen JL, Slater V, Scendrett-Hibdon
S, Geddes N, et al. Healing Touch: a guidebook for practitioners. 2nd ed. Denver (CQ): Delmar Learning; 2001.