ABSTRACT
BACKGROUND: Acupuncture is being used for treatment of cancer-related symptoms in numerous settings, yet empirical evidence supporting the effects of acupuncture in this setting is lacking. Group acupuncture is an economical way to provide acupuncture to patients at a reduced cost. OBJECTIVE: In this retrospective study we sought to evaluate the effects of group acupuncture on specific cancer-related symptoms in persons receiving outpatient cancer treatment. METHODS: Patients were receiving group acupuncture treatments through an integrative oncology program in a large community oncology practice in west central Florida. A short patient-completed assessment of seven basic cancer-related symptoms using a 0-10 numeric rating scale was completed at each acupuncture treatment. Basic demographic information, including age, gender, race/ethnicity, and cancer type was obtained from the medical record. Paired sample t-tests were used to evaluate differences in symptoms before the first treatment and at the fourth treatment. RESULTS: Fifty patients completed at least four weekly acupuncture treatments in 2014. Forty-three of them completed symptom assessments and were included in this analysis. The mean age of participants was 66.4 years. The majority of patients were white, non-Hispanic, and female. No significant improvement in symptoms were identified at the third treatment. At the time of the fourth group acupuncture, participants reported significantly less pain/numbness and problems with digestion. DISCUSSION: The results of this study provide evidence to support the efficacy of group acupuncture for pain, neuropathy, and digestive problems in persons with cancer. A minimum of four weekly treatments may be necessary before improvements are noted. Limitations include a retrospective design, incomplete symptom evaluation, and possible response bias. Future studies of group acupuncture for cancer-related symptoms should utilize a prospective, controlled design, use validated measures to thoroughly evaluate targeted symptoms, and include a more racially and ethnically diverse sample.
Subject(s)
Acupuncture Therapy/standards , Digestive System Diseases/therapy , Neoplasms/therapy , Neuralgia/therapy , Pain Management/methods , Acupuncture Therapy/economics , Acupuncture Therapy/methods , Adult , Aged , Aged, 80 and over , Ambulatory Care/economics , Ambulatory Care/methods , Digestive System Diseases/etiology , Female , Florida , Group Processes , Humans , Male , Middle Aged , Neoplasms/complications , Neuralgia/etiology , Retrospective StudiesABSTRACT
INTRODUCTION: In adults, hyperammonemia is generally associated with hepatic dysfunction or as a complication of urinary diversions when infected or obstructed. Hyperammonemia has also rarely been reported in association with multiple myeloma. With modest elevations, hyperammonemia often leads to encephalopathy. However, when ammonia reaches extreme levels cerebral edema and herniation may occur leading to coma, seizures, or death. CASE: We describe a 72-year-old Caucasian male with a history of end-stage renal disease (ESRD) and multiple myeloma who developed profound encephalopathy and eventual obtundation. He was found to have severe hyperammonemia that was not due to any identified hepatic impairment. His hyperammonemia proved to be refractory to medical therapy with cathartics and antibiotics, prolonged high-flux hemodialysis, and even continuous venovenous hemodialysis (CVVHD). This metabolic derangement as well as encephalopathy was eventually reversed with simultaneous CVVHD and extended daily hemodialysis (EDD). A more durable response was achieved after vincristine and dexamethasone were administered, which allowed the patient to resume his previous intermittent hemodialysis (IHD) schedule. The patient regained his full sensorium and was eventually discharged to home. CONCLUSIONS: Simultaneous double hemodialysis may be used as an important adjunct in treating refractory hyperammonemia.
Subject(s)
Hyperammonemia/therapy , Kidney Failure, Chronic/therapy , Multiple Myeloma/complications , Renal Dialysis/methods , Aged , Ammonia/blood , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Biomarkers/blood , Dexamethasone/administration & dosage , Encephalitis/etiology , Humans , Hyperammonemia/blood , Hyperammonemia/etiology , Kidney Failure, Chronic/blood , Kidney Failure, Chronic/complications , Male , Multiple Myeloma/drug therapy , Time Factors , Treatment Outcome , Vincristine/administration & dosageABSTRACT
OBJECTIVE: The purpose of this study was to explore the temporal trends and factors that are associated with cesarean deliveries and potentially unnecessary cesarean deliveries. STUDY DESIGN: The Louisiana birth certificate database was evaluated to identify a total of 57 potential indications/risk factors and maternal demographic factors that are associated with methods of delivery over the period from January 1993 to December 2000. A cesarean delivery without any potential indications/risk factors in the birth certificate was classified as unnecessary. RESULTS: The primary cesarean delivery rate decreased and the repeat cesarean delivery rate increased significantly during the study period. But neither the absence nor the presence of potential indications/risk factors accounted for these changes. The average potentially unnecessary primary and repeat cesarean deliveries in Louisiana were 17 and 43, respectively, per 100 cesarean deliveries over the years 1993 through 2000. CONCLUSION: The proportions of potentially unnecessary cesarean deliveries are relatively high in Louisiana. It is important to explore the influence of nonclinical factors on unnecessary cesarean delivery to reduce the cesarean rates.
