Prevention and Treatment of Chemotherapy-Induced Peripheral Neuropathy (CIPN) with Non-Pharmacological Interventions: Clinical Recommendations from a Systematic Scoping Review and an Expert Consensus Process.

Background: Most individuals affected by cancer who are treated with certain chemotherapies suffer of CIPN. Therefore, there is a high patient and provider interest in complementary non-pharmacological therapies, but its evidence base has not yet been clearly pointed out in the context of CIPN. Methods: The results of a scoping review overviewing the published clinical evidence on the application of complementary therapies for improving the complex CIPN symptomatology are synthesized with the recommendations of an expert consensus process aiming to draw attention to supportive strategies for CIPN. The scoping review, registered at PROSPERO 2020 (CRD 42020165851), followed the PRISMA-ScR and JBI guidelines. Relevant studies published in Pubmed/MEDLINE, PsycINFO, PEDro, Cochrane CENTRAL, and CINAHL between 2000 and 2021 were included. CASP was used to evaluate the methodologic quality of the studies. Results: Seventy-five studies with mixed study quality met the inclusion criteria. Manipulative therapies (including massage, reflexology, therapeutic touch), rhythmical embrocations, movement and mind-body therapies, acupuncture/acupressure, and TENS/Scrambler therapy were the most frequently analyzed in research and may be effective treatment options for CIPN. The expert panel approved 17 supportive interventions, most of them were phytotherapeutic interventions including external applications and cryotherapy, hydrotherapy, and tactile stimulation. More than two-thirds of the consented interventions were rated with moderate to high perceived clinical effectiveness in therapeutic use. Conclusions: The evidence of both the review and the expert panel supports a variety of complementary procedures regarding the supportive treatment of CIPN; however, the application on patients should be individually weighed in each case. Based on this meta-synthesis, interprofessional healthcare teams may open up a dialogue with patients interested in non-pharmacological treatment options to tailor complementary counselling and treatments to their needs.

[Creating evidence for naturopathic nursing interventions in oncology - a systematic approach]. / Generierung von Evidenz zu naturheilkundlichen Pflegeinterventionen in der Onkologie ­ ein systematisches Verfahren.

BACKGROUND: Nurses working in oncology use a wide range of naturopathic interventions in their daily practice to alleviate symptoms and improve the quality of life of oncological patients. However, there is no external evidence for many of these interventions. Due to a lack of scientific studies in the field, the aim of the project described here is to develop a standardized procedure to generate evidence on naturopathic interventions, on the basis of which recommendations may be derived for nursing practice. METHOD: The systematic procedure presented here was developed by the working group (WG) Integrative Nursing in Oncology over a period of four years in an iterative process. This process is based on the expert panel members' experience with the development of guidelines and/or quality instruments such as practice standards. RESULT: The systematic methodological approach presented here consists of three successive steps where internal and external evidence have been combined: a scoping review, a structured consensus process with oncology nurses to collect and evaluate naturopathic interventions, and finally a further supplementary literature review based on additional findings of the consensus conference. The procedure was successfully carried out for mucositis, insomnia, fatigue, hand-foot syndrome and chemotherapy-induced polyneuropathy. CONCLUSION: Through the step-by-step synthesis of internal evidence and the best available external evidence, the evidence base for naturopathic nursing interventions in oncology can be generated and practice recommendations derived. The procedure represents a successful theory-practice transfer through structured cooperation between (nursing) scientists and nursing practitioners. In terms of the AWMF classification, the practice recommendations developed in the process described fall somewhere in between an S1 guideline (informal consensus of an expert group) and an S2e guideline (evidence-based).

Association of temporary Environmental Protection Agency regulation suspension with industrial economic viability and local air quality in California, United States.

BACKGROUND: This study seeks to answer two questions about the impacts of the 2020 Environmental Protection Agency's enforcement regulation rollbacks: is this suspension bolstering the economic viability of industries as oil and manufacturing executives claim they will and are these regulations upholding the agency's mission of protecting the environment? RESULTS: To answer the former question, we utilized 6 months of state employment level data from California, United States, as a method of gauging the economic health of agency-regulated industries. We implemented a machine learning model to predict weekly employment data and a t-test to indicate any significant changes in employment. We found that, following California's state-issued stay-at-home order and the agency's regulation suspension, oil and certain manufacturing industries had statistically significant lower employment values.To answer the latter question, we used 10 years of PM2.5 levels in California, United States, as a metric for local air quality and treatment-control county pairs to isolate the impact of regulation rollbacks from the impacts of the state lockdown. Using the agency's data, we performed a t-test to determine whether treatment-control county pairs experienced a significant change in PM2.5 levels. Even with the statewide lockdown-a measure we hypothesized would correlate with decreased mobility and pollution levels-in place, counties with oil refineries experienced the same air pollution levels when compared to historical data averaged from the years 2009 to 2019. CONCLUSIONS: In contrast to the expectation that the suspension would improve the financial health of the oil and manufacturing industry, we can conclude that these industries are not witnessing economic growth with the suspension and state shutdown in place. Additionally, counties with oil refineries could be taking advantage of these rollbacks to continue emitting the same amount of PM2.5, in spite of state lockdowns. For these reasons, we ask international policymakers to reconsider the suspension of enforcement regulations as these actions do not fulfill their initial expectations. We recommend the creation and maintenance of pollution control and prevention programs that develop emission baselines, mandate the construction of pollution databases, and update records of pollution emissions. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12302-021-00489-9.