Effects of minimal acupuncture in children with infantile colic - a prospective, quasi-randomised single blind controlled trial.

BACKGROUND: Colic causes crying in 10-30% of infants and is one of the primary reasons parents seek health care. Treatments are generally not totally effective and some cause side effects. In this study we aimed to test the effect of light needling (minimal acupuncture) on crying. METHODS: Forty children (median six weeks of age) with excessive crying unresponsive to conventional therapies, were recruited from 21 Child Welfare Clinics within an area of western Sweden, and quasi-randomised to control or light needling treatment. Parents were unaware of which group their child was assigned to. Children were given light needling acupuncture on one point (LI4) on both hands for approximately 20 seconds on four occasions, or received the same care except needling. Parental assessment questionnaires were used pre- and post-treatment to assess crying intensity, frequency, duration of crying and pain related behaviour throughout the day in six hour periods. RESULTS: Light needling resulted in a significant reduction in the rated crying intensity (assessed by a numeric rating scale, 0 to 10). For example, during the morning time period 0600-1200 hours, the median (range) rated crying intensity changed from 6 (1 to 9) pre-treatment to 2 (0 to 5) post-treatment (P=0.002), in the light needling group. The corresponding ratings for the children in the control group was 6 (0 to 10) and 5 (0 to 10) respectively. The difference between the groups was significant (P=0.016). There were also significant differences between the groups for the afternoon (1200-1800 hours), and evening (1800-midnight) time periods. Pain related behaviour like facial expression, was also significantly less pronounced in the light needling group as compared to the control group post-treatment, (P=0.027). The parents rated the light needling as more effective in improving symptoms than the control group (P<0.001). CONCLUSION: Four treatments with light needling on one point in the hand may alleviate crying and pain related behaviour without any noted side effects.

Dyspnea experience in patients with lung cancer in palliative care.

The aim of this study was to describe the dyspnea experience and examine its relation to other symptoms, personal and health-related factors and its predictors in patients with lung cancer. The subjects were 105 patients diagnosed with lung cancer, approached when active anti-tumour treatment was closed. The patients completed a battery of questionnaires about several aspects of dyspnea experience, intensity of other symptoms and coping capacity. Medical data including performance status were obtained from medical records. Above 50% of the patients perceived dyspnea. Coping capacity, performance status and other symptoms correlated with different aspects of dyspnea experience. Dyspnea dimensions and activity-related dyspnea correlated with anxiety, depression, fatigue and cough as well as negatively to coping capacity. Performance status correlated with dyspnea intensity and activity-related dyspnea. Lower coping capacity predicted dyspnea; additional predictors were higher levels of anxiety and fatigue. Dyspnea in this group of patients was a complex experience, including physical and psychological aspects and should preferably be assessed in a comprehensive way. A nursing intervention to decrease dyspnea experience and anxiety could use knowledge from this study about the importance of coping capacity to better help patients with lung cancer to cope in their palliative phase of the disease.

The impact of symptoms, coping capacity, and social support on quality of life experience over time in patients with lung cancer.

The aims of the study were to investigate lung cancer patients' quality of life (QoL) over time in a palliative setting and to determine how QoL is influenced by symptoms, coping capacity, and social support. One hundred and five consecutive patients with incurable lung cancer were included. A comprehensive set of questionnaires was used at baseline, including the Assessment of Quality of Life at the End of Life, Cancer Dyspnea Scale, Visual Analog Scale of Dyspnea, Hospital Anxiety and Depression scale, Sense of Coherence Questionnaire, and Social Support Survey, of which the first four were used also at three, six, nine, and 12 months. Dyspnea, depression, and global QoL deteriorated over time. Performance status, anxiety, depression, components of dyspnea, pain, and the meaningfulness component of coping capacity correlated with global QoL at all, or all but one follow-up measurements. In a multivariate analysis with global QoL as the dependent variable, depression was a significant predictor at four out of five assessments, whereas coping capacity, anxiety, performance status, pain, and social support entered the model at one or two assessments. Emotional distress and coping capacity influence QoL and might be targets for intervention in palliative care.

Pressure ulcers in palliative care: development of a hospice pressure ulcer risk assessment scale.

The aim of this study was to construct a pressure ulcer risk assessment scale appropriate for palliative care patients. Risk assessments were performed using the modified Norton scale and nine newly constructed scales, consisting of the modified Norton scale with various changes. Data were collected from 98 patients in a Swedish hospice between April 1999 and September 2000. Pressure ulcer occurrence was registered weekly in the patient record. Increasing age, male gender, physical inactivity, immobility, decreasing food and fluid intake, incontinence, poor general physical condition and lean body constitution were shown to be significant risk factors for development of pressure ulcers in terminally ill cancer patients. After further testing of the data, one scale was found to be superior in identifying patients at risk, with higher validity than the modified Norton scale. The assessment items in this new scale, The Hospice Pressure Ulcer Risk Assessment Scale (in Swedish: Hospice Riskbedöming Trycksår, (HoRT)), are physical activity, mobility and age.

Rheumatoid arthritis: determination of pain characteristics and comparison of RAI and VAS in its measurement.

The purposes of this study were to determine pain characteristics in female patients with rheumatoid arthritis (RA) and to determine the relationship between the outcome of the Ritchie Articular Index (RAI) and pain intensity as measured by the visual analogue scale (VAS). The sample consisted of 30 female patients with a definite diagnosis of RA and a functional capacity of class II. The results indicated that the pain fluctuated during the day. The intensity level of present pain was lower than that of usual pain. Eight patients reported that their worse pain occurred several times/day. Ache was the word most frequently chosen by the subjects to denote their pain sensations. A high correlation r = 0.86 (P less than 0.01) was found between the scores of RAI and present pain on the VAS. This finding suggests that the pain in RA is associated with the hyperalgesic state induced by the inflammatory condition associated with RA. There was no significant correlation between blood tests like ERS, WBC and VAS or RAI.