Expressive writing as a therapeutic intervention for people with advanced disease: a systematic review.

BACKGROUND: Expressive writing involves writing about stressful or traumatic experiences. Despite trials in people with advanced disease, no systematic review to date has critiqued the evidence on expressive writing in this population. To synthesise the evidence of the effects of expressive writing on pain, sleep, depression and anxiety in people with advanced disease. METHODS: A systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. CINAHL, CENTRAL, PsycINFO and PubMed were searched from January 1986 to March 2018. Other sources included clinical data registers and conference proceedings. Studies were included if they were randomised controlled trials that assessed the impact of an intervention involving expressive writing for adults with advanced disease and/or studies involving linguistic analysis on the expressive writing output. Methodological quality was assessed using the Cochrane risk of bias tool and the Mixed Methods Appraisal Tool. The Grading of Recommendations Assessment, Development and Evaluation tool was used to assess the level of evidence for the outcomes of interest. The protocol of this systematic review has been registered on PROSPERO (CRD42017058193). RESULTS: Six eligible studies with a total of 288 participants were identified, including four randomised controlled trials. All of the trials were in cancer and recruited predominantly women. None of the interventions were tailored to the population. Studies had methodological shortcomings and evidence was generally of low quality. Combined analysis of the four trials, involving 214 participants in total, showed no clear difference in the effect of expressive writing on sleep, anxiety or depression compared to an active control. Pain was not evaluated in the trials. In contrast, analysis of the four studies that included linguistic analysis alluded to linguistic mechanisms for potential effects. CONCLUSION: Although the trial results suggest there is no benefit in expressive writing for people with advanced disease, the current evidence is limited. There is a need for more rigorous trials. It would be of benefit first to undertake exploratory research in trial design including how best to measure impact and in tailoring of the intervention to address the specific needs of people with advanced disease. TRIAL REGISTRATION: The protocol of this systematic review has been registered on PROSPERO, which can be accessed here (registration number: CRD42017058193 ).

Novel technique for investigation and quantification of bacteriol leaching by Thiobacillus ferrooxidans.

A novel, efficient, and simple technique for the in situ study and quantification of the heterogeneous Bacteriol activity and the Bacteriol degradation of metal sulfides by Thiobacillus ferrooxidans is presented. It consists of exposing an ultrathin (300-2500 A) metal sulfide layer, FeS(2) in the experiments, to Thiobacillus f. grown in Touvinen media and visually following the Bacteriol attack and development of Bacteriol corrosion patterns under a light microscope. The uniform pyrite layer, partially transparent for visible light, permits the optical characterization of Bacteriol attack in remarkable detail. Several open or little understood questions concerning Bacteriol leaching, such as those on the kinetics of adhesion, the interfacial Bacteriol reproduction, the density of surface active bacteria, and the rate and morphology of sulfide degradation can also be studied. The degree of Bacteriol activity can be distinguished on the basis of development of variable sizes of spots and halos around Bacteriol cells produced by light passing through differently sized corrosion pits. The information obtained and identification of microorganisms has additionally been accentuated by immunofluorescence techniques (FA). It is concluded that the described method can be developed as a convenient testing and control technique for use in mine laboratories and bioleaching operations.