Research priorities in HIV, aging and rehabilitation: building on a framework with the Canada-International HIV and Rehabilitation Research Collaborative.

BACKGROUND: In 2016, the Canada-International HIV and Rehabilitation Research Collaborative established a framework of research priorities in HIV, aging and rehabilitation. Our aim was to review and identify any new emerging priorities from the perspectives of people living with HIV, clinicians, researchers, and representatives from community organizations. METHODS: We conducted a multi-stakeholder international consultation with people living with HIV, researchers, clinicians and representatives of community-based organizations. Stakeholders convened for a one-day Forum in Manchester, United Kingdom (UK) to discuss research priorities via a web-based questionnaire and facilitated discussions. We analyzed data using conventional content analytical techniques and mapped emerging priorities onto the foundational framework. RESULTS: Thirty-five stakeholders from the UK(n = 29), Canada(n = 5) and Ireland(n = 1) attended the Forum, representing persons living with HIV or representatives from community-based organizations(n = 12;34%), researchers or academics(n = 10;28%), service providers(n = 6;17%), clinicians(n = 4;11%); and trainees(n = 4;11%). Five priorities mapped onto the Framework of Research Priorities across three content areas: A-Episodic Health and Disability Aging with HIV (disability, frailty, social participation), B-Rehabilitation Interventions for Healthy Aging across the Lifespan (role, implementation and impact of digital and web-based rehabilitation interventions) and C-Outcome Measurement in HIV and Aging (digital and web-based rehabilitation health technology to measure physical activity). Stakeholders indicated methodological considerations for implementing digital and web-based rehabilitation interventions into research and practice and the importance of knowledge transfer and exchange among the broader community. CONCLUSION: Results highlight the sustained importance of the Framework of Research Priorities and provide further depth and areas of inquiry related to digital and web-based rehabilitation interventions and technology aging with HIV.

Experiences of nurses and other health workers participating in a reflective course on compassion-based care.

BACKGROUND: the risk of compassion fatigue in healthcare staff is real, especially when considering the current financial pressures. A course in compassion-based care (CBC) was delivered to mental health staff at a hospital in north-west England, with the intention of rehabilitating ward culture and, subsequently, improving patient experience. AIMS: to explore staff experiences of participating in the CBC course. METHODS: a qualitative study using semi-structured interviews with participants (n=12) was conducted. All staff attending the course were eligible and were invited to participate. Interview transcripts were thematically analysed. FINDINGS: five themes characterising participant experience emerged from the data: meeting a need; creating the space; reorientation; prioritising self-care; and influencing team dynamics. Data overwhelmingly indicated the success of the CBC course. CONCLUSION: the CBC course appeared to have a profound effect on participants; it should be considered for further rollout and evaluation.

The meaning and perceived value of mind-body practices for people living with HIV: a qualitative synthesis.

Mind-body practices (MBPs) are a subset of complementary medicine that represents a selection of self-care activities that may promote the health of people living with HIV (PLWH). No synthesis of qualitative research in this context, which might inform service provision and research priorities, has yet been published. A systematic search of electronic databases was conducted, identifying papers exploring the experience of MBPs in PLWH. During thematic synthesis, all text under the headings "results" or "findings" was scanned line by line, and discrete, meaningful units of text were extracted as data items. Categories were identified, and second- and third-order constructs were developed. Concerns related to control and self-management appeared in the convergence of participants' worlds with the medical world and in being pragmatic about selecting MBPs and goal setting. The themes developed suggest a desire for more holistic and person-centered care, arguably marginalized as a result of effective antiretroviral therapy.

Providing therapies to the opposite sex: views of complementary therapists working in clinical and private practice settings.

AIM: The study explored the experiences of working with the opposite sex as a therapists in a cancer care centre (CCC). METHODOLOGY: Therapists (n = 17) participated in three focus groups. Audiotapes were transcribed verbatim and analysed. RESULTS: Themes and sub-themes were identified; these related to maintaining safety, the relevance of location to how safe therapists felt when working with men, the therapeutic relationship, safety precautions and being vigilant. LIMITATIONS: The participants were from one cancer care centre in the North West of England. Only two males participated. CONCLUSION: This exploratory study identified that the majority of the participants in this study had concerns about safety related to the gender or sex of their patient or client. This was more of an issue in private practice with concerns centred on inappropriate sexual responses from male clients. This has implications for training and safety in establishing and maintaining a practice.

Evaluation of acupuncture in the management of chemotherapy-induced peripheral neuropathy.

AIM: To clinically evaluate the effectiveness of acupuncture when used in the management of chemotherapy-induced peripheral neuropathy (PN). BACKGROUND: During cancer treatment, certain chemotherapies can cause varying degrees of PN. Patients' quality of life can be seriously impaired through loss of sensation, pain or mobility problems. Conventional medications routinely used to manage neuropathic symptoms have poor side-effect profiles and there is little or no evidence justifying their use to treat chemotherapy-related neurotoxicities. There are studies suggesting that acupuncture may be an effective therapy in treating PN across a number of different aetiologies. Design A retrospective service evaluation. METHOD: Patients (n=18) were referred for acupuncture by the medical staff and/ornurse specialists or they self-referred for treatment. A course of six weekly acupuncture sessions was offered to them, and their details were recorded on an evaluation form prior to session one. Points were selected by acupuncturists, based on patient presentation, and needles remained in situ for 30-45 min. Treatments took place in outpatient clinics, chemotherapy day case ward or a drop-in clinic based in a physiotherapy gym. The evaluation form was completed at the end of session 6 by a therapist who had not been involved in patient care. RESULTS: 82% (n=14) of patients reported an improvement in symptoms following their course of acupuncture; one patient with advanced disease died during the 6 weeks. Some patients derived additional benefits from the treatment including a reduction in analgesic use and improved sleeping patterns. The most common acupoints used were SP6 (n=18), ST36 (n=18) and LV3 (n=14). CONCLUSION: Although these results are encouraging, they are uncontrolled. They suggest that acupuncture could be an option for these patients and controlled trials using validated patient-reported outcome measures are justified.

Take me to a clinical reflexologist: an exploratory survey.

BACKGROUND: This paper reports the results of a questionnaire exploring the role, training and experience of a 'clinical reflexologist'. The sample (n=105) was delegates at a clinical reflexology conference held at a major cancer treatment centre in the North West of England. RESULTS: The majority of participants had completed diploma level training (n=73) and were female (n=99). 62% (n=65) of the delegates had been practising for 6+ years and were practising in private practice, hospices and NHS settings amongst others. 40% (n=42) of participants actually worked across more than one of these settings. Respondents also reported working with a variety of healthcare concerns, including recovery from surgery, fertility, pain, smoking cessation and maternity and cancer care. Additional information was gathered related to training, referral rates from health professionals and access to professional and peer support. LIMITATIONS: The questionnaire did not seek to explore what constitutes adequate training for clinical reflexology practice or respondents' view on whether being a registered nurse or allied health professional is a prerequisite for practising within a clinical environment. Additionally, caution must be taken with the reported findings as the respondents chose to attend the conference. CONCLUSION: This survey has provided, for the first time, some interesting information/views on what constitutes 'clinical reflexology' and how some practitioners are developing their roles in healthcare settings. Further research work is warranted.

Aromasticks in cancer care: an innovation not to be sniffed at.

AIM: To evaluate the effects of a new aromatherapy intervention introduced within an acute cancer care setting in the UK. BACKGROUND: Aromatherapy is a popular complementary therapy within oncology settings and is known to help relieve patients' anxiety. A new method of delivering aromatherapy to patients was adopted by a complementary therapy service at a UK hospital; aromasticks are similar in design to the Vicks® Vapour Inhaler®, with the intention of helping patients manage anxiety, nausea and sleep disturbance. DESIGN: A retrospective service evaluation. METHOD: Patients referred to the complementary therapy service were, if appropriate, offered an aromastick. If the offer was accepted patients' details were captured on an evaluation form. One week later the patients were followed up by a different therapist. Frequency of using the aromastick and perceived benefits were documented. A total of 160 patients were included in this evaluation. RESULTS: 77% (n = 123) of all patients reported deriving at least one benefit from the aromastick. In anxious patients, 65% reported feeling more relaxed and 51% felt less stress. 47% of nauseous patients said that the aromastick had settled their nausea and 55% of those experiencing sleep disturbances felt that aromastick helped them sleep. The results also suggest that the effects of the aromastick may be directly proportional to the frequency of their use. RELEVANCE TO CLINICAL PRACTICE: Evidence demonstrating physiological changes associated with aroma inhalation plus the data presented in this paper highlight the potential for aromasticks within the clinical setting. Although the results of this evaluation of patient perspectives are not controlled, the data does underline the worth of further investigation. Future research is needed to show that aromasticks represent a tool patients can use to self-manage their own symptoms and help them retain an internal locus of control.

Clinical supervision and complementary therapists: an exploration of the rewards and challenges of cancer care.

AIM: The study explored the experiences of therapists working in cancer care settings and more specifically, the value of clinical supervision. METHODOLOGY: Invitations for therapists to participate in three focus groups were sent to five cancer care settings. Each group responded to seven trigger questions, formulated from the literature review. Audiotapes were transcribed aided by notes taken during the sessions. FINDINGS: There were 15 therapists participated in the three groups. Themes and sub - themes were identified; these related to the rewards of being in a privileged and honoured position, the importance of prior experience and motivation, and supervision as a supportive resource. Participants acknowledged and explored shared experiences and identified common coping and 'taking care of self' strategies. LIMITATIONS: The participants were all from the North West of England cancer care centres with local support and supervision arrangements in place. Limited demographic details were collected. One group fell short of the recommended number of participants. CONCLUSION: This exploratory study identified that supervision was appreciated, with therapists reporting that the work itself helped sustain them. Individuals also reported that they used complementary therapies to manage work related stress.

Medical students and acupuncture: a short sharp placement experience!

BACKGROUND: Acupuncture and other complementary therapies (CTs) have become increasingly popular, with patients calling for more integrated care. It is questionable whether doctors know enough about these therapies to provide balanced and informed advice to patients and, given that most will come across patients accessing CTs, this is an area of concern. METHOD: This was an exploratory study of 40 students attending a placement at a CT service within an acute hospital trust in the UK. A questionnaire was given at the start of placement to record their scepticism towards CTs on a 0-10 scale and again, on placement completion. RESULT: Of the students attending, 73% (n=29) completed the questionnaire. There was a statistically significant reduction in scepticism scores assessed before and after placement (p<0.001). Of the respondents, 90% (n=26) were shown or attempted acupuncture. 76% of students reported that the placement would definitely influence the rate of CT referrals in their future practice. CONCLUSION: The placement experience provided students an opportunity to reconsider their attitudes towards CTs. The study was limited to one site and students independently elected to participate in the experience. Similar exposure could be of value to the wider medical student population, ultimately leading to more informed advice available to patients. Future research should include greater numbers, which could include a multi-site study.