Mel Haberman

Effect of Iyengar yoga practice on fatigue and diurnal salivary cortisol concentration in breast cancer survivors

Purpose: To examine the effect of regular Iyengar yoga practice on measures of self‐perceived psychosocial function and diurnal salivary cortisol secretion in stage II–IV breast cancer survivors (n = 18). Data sources: Women were randomly assigned to attend yoga practice for 90 min twice weekly for 8 weeks (n = 9) or to a wait‐listed, noninterventional control group (n = 9). Traditional Iyengar yoga routines that progressively increased in difficulty as participants gained strength and flexibility were used. At baseline and after the 8‐week study period, women completed self‐report instruments to document various aspects of psychosocial and physical functioning, and collected salivary samples for cortisol analysis four times during the day for two consecutive days. Conclusions: The yoga group had lower morning and 5 p.m. salivary cortisol and improved emotional well‐being and fatigue scores. Implications for practice: Breast cancer survivors are at risk for chronic psychosocial distress that may alter activity of the hypothalamic–pituitary–adrenal axis, resulting in aberrant regulation of cortisol secretion and increased risk of immune dysfunction and cancer progression. Regular yoga practice may be a low‐risk, cost‐effective way to improve psychosocial functioning, fatigue, and regulation of cortisol secretion in breast cancer survivors. These findings require validation with a larger randomized study.

Development, feasibility and compliance of a web-based system for very frequent QOL and symptom home self-assessment after hematopoietic stem cell transplantation

We believe that many adverse events following hematopoietic stem cell transplantation (HSCT), particularly relapse and chronic graft-versus-host disease (CGVHD), are preceded by a subclinical period of development that is accessible by frequent psychometric assessment. Documenting these associations could improve future clinical care by extending the potential window for intervention. However, conventional methods of assessing quantity of lite (QOL) in patients in their homes, typically by mailed self-assessment questionnaires, are impractical for very frequent administration. We have developed and implemented a web-based system for measuring short-term (dynamic) changes in QOL by employing brief, online, daily QOL assessments and more extensive, monthly online assessments from patients’ homes. Here we report the feasibility of collecting very frequent patient home self-assessments of QOL via the web for a 52 week participation period; we detail incidence of home web access, accrual, compliance, and satisfaction with the system in an HSCT patient sample. We also describe our integrated web-systems for administering patient recruitment, scheduling, monitoring, and analysis. Our results suggest that very frequent routine collection of QOL outcomes is entirely feasible using our web-based home assessment tool, with good patient compliance and high user satisfaction. We believe our methodology shows great promise for use with other cancer and health populations.

Issues that impact type-2 diabetes self-management in rural communities

Purpose:To evaluate and synthesize the evidence related to issues that impact type‐2 diabetes self‐management in rural communities. Data sources:A systematic review of the literature from 2008 to 2013 was conducted using the following health science databases: CINAHL, PubMed, Cochrane Library, and OVID. Other databases searched included the clearinghouses of the Centers for Disease Control (CDC); National Rural Health Association (NRHA), State Offices of Rural Health (SORH), and Rural Health Research & Policy Centers (RHRPC). Keywords used to obtain relevant articles included rural, type‐2 diabetes self‐management, health disparities, and nursing. Conclusion:Three themes emerged from the literature examined: barriers to type‐2 diabetes self‐management, provider tools and education enhance type‐2 diabetes self‐management, and recommendations and guidelines for diabetes self‐management efficacy. Implications for practice:The information presented here will support healthcare providers in improving preventative care, providing optimal disease management, and assisting with successful type‐2 diabetes self‐management in rural populations.

Review of the Effectiveness of Enteral Feeding in Pediatric Oncology Patients

Enteral supplementation for nutritional support in pediatric oncology patients remains nonstandardized across institutions and between providers. Pediatric oncology patients frequently fail to meet their growth curve percentiles, lose weight, and/or are malnourished due to both the oncologic process as well as side effects from chemotherapy and radiation treatments. Methods of increasing weight include enteral feeding (nasogastric, nasoduodenal/jejunal, or gastrostomy), parenteral intravenous feeding, and oral supplementation. Indications for feeding and feeding protocols are highly variable, in part due to parental and familial choices, and in part due to the lack of guidelines available for providers. This article provides a comprehensive literature review of 8 published studies regarding the effectiveness and safety of enteral feeding in maintaining or increasing weight in pediatric oncology patients to help inform practice. The review concludes that enteral feeding in pediatric oncology patients is an effective and safe method to affect weight positively. However, further research is needed for developing treatment guidelines, including establishing a timeline for initiation of feeding, and determining which patients are most likely to benefit from enteral feeding.

Building the Ship of Death: Part II

ESEARCH AND USIC-AS-MEDICINE s “contemplative musicians” music-thanatologists practice “human capacities such as creativity, informed intuition, inspiation and aesthetic sensitivity” as well s dedicated musical skill. Clinical pracice acknowledges multiple levels of knowng and the cocreative interaction between he music-thanatologist and the patient. xcerpts from clinical narratives highlight he exquisite interrelatedness of the music elivery with the dying person and their amilies. One of the great expositors, in he field of music and medicine, David ldridge has written extensively on the roblem of “facilitating the emergence of discipline” that will not coerce artists nto using the language and methods of cience to the exclusion of language derived rom the realm of the sacred and the cretive. To address that challenge, musichanatologists routinely use two types of ata collection tools, both of which were sed in this research study.