The implementation and evaluation of HIV symptom management guidelines: A preliminary study in China

Objective:The overarching objective of this study was to examine the effectiveness of HIV symptom management guidelines in China in reducing the incidence and severity of symptoms and improving patients'quality of life.Methods:We conducted a controlled,pre-and post-implementation design in the HIV/AIDS inpatient unit in Shanghai.Patients recruited from November 2014 to February 2015 were in the intervention group and those from October 2013 to February 2014 were in the control group.There were 74 patients in each group.Participants in the intervention group received interventions based on the HIV symptom management guidelines.Overall symptom severity,depression,and quality of life were measured in two groups at baseline,week 4,and week 8.Results:Totally 126 patients completed the research,65 in the intervention group and 61 in the control group.The total symptom severity scores showed a statistically significant difference between groups across time(P<0.05).It showed that frequencies of fatigue(36.9%vs.44.3%),fever(6.2%vs.11.5%),loss in weight(9.2%vs.16.4%),mouth ulcers(12.3%vs.16.4%),headaches(9.2%vs.19.7%)and depression(F=1.09,P>0.05)in the intervention group were lower than those in the control group in week 8 without statistical significance.The multilevel growth mixture model indicated a greater increase in the total score of quality of life for the group treated according to the symptom management guidelines(P=0.04).Conclusion:The evidence-based HIV symptom management guidelines can improve a patient's quality of life and relieve negative symptoms.The guidelines can be applied in a similar context to other HIV/AIDS units or clinics.

Research progress of yoga in symptom management of cancer patients

The survival rate of cancer patients is rising,but the treatment of cancer will bring a series of physiological and psychological symptoms to patients,which will seriously affect the quality of life of patients.As a complementary and alternative therapy,yoga is more and more used in symptom management and quality of life improvement of cancer patients.This paper introduces the overview,implementation methods and application status of yoga,summarizes the application effect of yoga in the symptom management of cancer patients,analyzes the shortcomings in the application process at this stage,and puts forward the prospect,in order to provide a reference for the better application of yoga in the symptom management of cancer patients in the future.

Understanding Patients’ Symptoms Management Using Objective and Subjective Indicators among Patients with Systemic Lupus Erythematosus

Background: Descriptive statistics have been used to document the high prevalence of sleep disorders, fatigue, and pain in patients with systemic lupus erythematosus (SLE). Objectives: To describe day-to-day variations in sleep indicators, physical activity level, pain, and fatigue measured using objective and subjective indicators in lupus patients with sleep disorders. Methods: We selected three patients with sleep disorders, measured by the Pittsburgh Sleep Quality Index score (≥9), out of 20 participants followed up for 4 weeks. We compared the self-rated quality of life (QoL) measured using the Pittsburgh Sleep Quality Index (PSQI) with that of objectively measured sleep indicators monitored using the Nemuri scan. The detailed data collection methods have been previously published. Results: The sleep status generated by the Nemuri scan revealed that Case A with a flare and Case B without a flare required frequent daytime rest. The PSQI sleep duration and sleep latency were generally in agreement with the monitored data, although the PSQI failed to capture the complexity of sleep disorders, particularly the fluctuations in the quality of sleep indicators. Patient C approximately 4 hours on weekdays and 10 hours on Saturday nights. All three cases had high fatigue levels, and their moderate-to-vigorous physical activity duration was less than one-half of duration that recommended by the World Health Association. Conclusion: Visual display for objective monitoring of sleep quality is an excellent tool for understanding patients who require frequent resting and irregular sleep indicators. Objective monitoring of sleep quality, along with self-rated pain and fatigue, promotes an understanding of how patients with SLE cope with severe symptoms.

Symptom experience and symptom burden of patients following first-ever stroke within 1 year： a cross-sectional study

Symptoms that are multidimensional and concurrent should be assessed from different dimensions and managed together. Few studies have evaluated concurrent and multidimensional symptoms in patients with stroke. Most studies of stroke focused on dysfunctions and complications. We hypothesize that patients with stroke have a heavy symptom burden within 1 year. This study aimed to describe multidimensional and concurrent symptoms within 1 year after stroke. This study recruited 230 patients with stroke from the Rehabilitation Department of Xuhui District Center Hospital of Shanghai and the Shanghai Sunshine Rehabilitation Center in China from March to September 2017. The patients＇ multidimensional symptom experience and symptom burden were analyzed using a self-made structured questionnaire and the influential factors for symptom burden were identified. The mean number of symptoms in patients with stroke was 11.7 ± 3.5. More than two thirds of the participants suffered from at least 10 co-occurring symptoms. Unilateral limb weakness had the highest prevalence and frequency. Participation restriction had the highest symptom dimensions of severity and distress. Lack of self-care ability（severity）, memory deterioration（frequency）, imbalance of body（distress）, moodiness（distress）, being unable to move limbs at will（distress）, shoulder pain（distress）, and slower response（frequency） were independent factors of the total symptom burden score. These findings can provide essential information for efficient symptom management of patients with stroke.

A Review of the Research on Symptom Clusters in Cancer Survivors

Cancer survivors often experience multisymptom clusters, substantial discomfort and lower QOL (quality of life) than the general population. This article summarized the progress of the research on symptom clusters in cancer survivors, and reviewed the definitions, influencing factors, and identified approaches and interventions regarding symptom clusters. The findings allow recommendations to be made in clinical nursing to improve the QOL of cancer survivors. In future studies, longitudinal, large-sample and multicenter studies are recommended to obtain more in-depth information about the changes in symptom and symptom cluster experience perceived by groups of cancer survivors.

Symptom Assessment and Management in Patients with Lung Cancer Undergoing Conventional or Traditional Chinese Medicine Care

Patients with lung cancer may experience various symptoms as the disease progresses,which may reduce the benefits of cancer treatment,reduce treatment compliance,delay cancer treatment,reduce the quality of life(QoL),and impact survival.This review discusses comprehensive symptom assessment and management,which are crucial for high-quality lung cancer treatment.Traditional Chinese medicine(TCM)is important in relieving cancer-related symptoms in patients with lung cancer.Including patient-reported outcomes(PROs)in clinical trials and practice can provide a better assessment of symptom burden and the effectiveness of symptom management.Patient-centered care with TCM in lung cancer patients may include six steps:Symptom screening,etiology investigation,comprehensive assessment,integrative management,reassessment,and regular symptom follow-up monitoring.PRO measures can be used to evaluate symptom intensity,the degree to which symptoms interfere with activities of daily living,and the QoL.Clearly defined and reliable PRO measures can enhance patient satisfaction and improve symptom control.Quantitative PRO measures developed from the TCM perspective should be considered one of the important outcome measurements in TCM care.A multidisciplinary collaborative symptom management model,including TCM and conventional therapy,will be the future goal for treating patients with lung cancer.

Clinical Trial Protocol: Randomized Controlled Trial of Cancer Pain Monitoring System (CAPAMOS) in Patients with Advanced Cancer

Purpose: This randomized controlled trial (RCT) protocol was designed to evaluate the effectiveness of the Cancer Pain Monitoring System (CAPAMOS), a telenursing system designed to alleviate pain in ambulatory patients with advanced cancer. Methods: The study design involved a randomized controlled trial consisting of an intervention group using CAPAMOS and a control group that received usual care. At the time of enrollment, both groups will be given a questionnaire regarding issues, such as concerns related to cancer pain and self-management of opioid medication. Patients will then receive pain relief education based on the results of the questionnaire. Subjects in the control group will receive a pain diary and pain-relief pamphlet that acts as an educational tool. They could also call the outpatient clinic if they wanted to ask for a nursing consultation. The intervention group will be able to use CAPAMOS to manage their pain and receive video consultation with a telenurse, who is an oncology nursing specialist. Educational tools will be built into CAPAMOS. The study will be conducted for one month. The primary endpoint of this study was to calculate the Japanese Brief Pain Inventory score. The secondary endpoints were to assess the opioid medication self-management, Barriers Questionnaire, Japanese EuroQol 5-dimensions 5-level, and economic evaluation. Assessment items will be evaluated at registration and 2 and 4 weeks after registration. Conclusions: A RCT based on this protocol is expected to validate the efficacy of telenursing using CAPAMOS in patients with advanced cancer and pain.

Reframing Palliative Care:An East-West Integrative Palliative Care Model

Convergence of principles of palliative care and integrative medicine has led to the introduction of the new practice of integrative palliative care in which integrative therapies(including mind-body modalities,traditional Chinese medicine,Ayurveda,and dietary supplements)are used to provide symptom management for patients who are dying or experiencing the sequelae of serious illness and its treatment.We propose an East-West Integrative palliative care model using non-drug therapies,such as acupuncture,diet,exercise,and stress management that shift the paradigm from suppressing the symptoms of illness to addressing both the root cause of the symptoms and the imbalance and declining homeostatic reserve that perpetuate these symptoms.This whole-person model expands the reach of palliative care,prolonging a better quality of life and allowing the patient to maintain as many activities as possible by preventing symptoms and improving function.Through this approach we reframe the dialogue such that patients are"living better"rather than"dying better"when faced with serious illness or death.In this article,we provide an overview of the principles of palliative care,integrative medicine,and the novel area of integrative palliative care,and propose an East-West integrative palliative care model that incorporates and broadens the scope of these existing approaches.

Alleviative effects of Cannabis flower on migraine and headache

Objective: Few studies to date have measured the real-time effects of consumption of common and commercially available Cannabis products for the treatment of headache and migraine under naturalistic conditions. This study examines, for the first time, the effectiveness of using dried Cannabis flower, the most widely used type of Cannabis product in the United States, in actual time for treatment of headache-and migraine-related pain and the associations between different product characteristics and changes in symptom intensity following Cannabis use.Methods: Between 06/10/2016 and 02/12/2019, 699 people used the Releaf Application to record realtime details of their Cannabis use, including product characteristics and symptom intensity levels prior to and following self-administration;data included 1910 session-level attempts to treat headache-(1328 sessions) or migraine-related pain(582 sessions). Changes in headache-or migraine-related pain intensity were measured on a 0–10 scale prior to, and immediately, following Cannabis consumption.Results: Ninety-four percent of users experienced symptom relief within a two-hour observation window. The average symptom intensity reduction was 3.3 points on a 0–10 scale(standard deviation = 2.28,Cohen's d = 1.58), with males experiencing greater relief than females(P < 0.001) and a trend that younger users(< 35 years) experience greater relief than older users(P = 0.08). Mixed effects regression models showed that, among the known(i.e., labeled) product characteristics, tetrahydrocannabinol levels 10% and higher are the strongest independent predictors of symptom relief, and this effect is particularly prominent in headache rather than migraine sufferers(P < 0.05), females(P < 0.05) and younger users(P < 0.001). Females and younger users also appear to gain greater symptom relief from flower labeled as ‘‘C. indica" rather than ‘‘C. sativa" or other hybrid strains.Conclusion: These results suggest that whole dried Cannabis flower may be an effective medication for treatment of migraine-and headache-related pain, but the effectiveness differs according to characteristics of the Cannabis plant, the combustion methods, and the age and gender of the patient.