Explore the vast range of titles available.

Massage, aromatherapy, reflexology and a variety of relaxation techniques are frequently used in hospices, supportive care settings and some hospitals. However, there are still gaps and limitations in the choices offered to patients. HEARTS (Hands-on, Empathy, Aromas, Relaxation, Textures, Sound) was devised to bridge this gap for complementary therapists, patients, carers and health care professionals. HEARTS can be used either on its own, or integrated with a conventional complementary therapy. It can also be used easily by health care workers (and carers) who are not qualified in any therapies. By discussing principles which may influence the effectiveness of touch and relaxation therapies, the book emphasises that there are 'easy' approaches that can be utilised when working with distressed and vulnerable patients. By developing an understanding of touch, aromas and the sound of the human voice, Combining Touch and Relaxation Skills for Cancer Care guides practitioners in helping their patients achieve a state of relaxation and calm as quickly and easily as possible.

The study aimed to evaluate the use of reflexology in improving the psychological and physical profile associated with multiple sclerosis. The evaluation was judged against outcomes achieved from supervised progressive muscle relaxation (PMR) training, both provided by nurse therapists. A crossover design was chosen to compare the interventions, with a four-week break between treatment phases. Short-term measures (pre and post weekly session) of blood pressure, heart rate, state anxiety inventory (SAI) and Salivary cortisol levels were included. Measures of health outcome (SF-36 and GHQ 28) were administered to evaluate change for each treatment phase. A pilot study (n=14) was completed then a larger study (n=50) followed, funded by the Multiple Sclerosis Society. The results identified statistically significant changes for within session measures for both treatments. Overall there were statistically significant changes in state anxiety (SAI), favouring reflexology. Changes in salivary cortisol levels were significant, pre and post the treatment phases and within sessions, favouring reflexology. Significant difference was also found for within session changes for Systolic pressure, favoured PMR. There were carry-over effects with improved mean scores for some SF-36 and GHQ 28 subscales after the four-week break, favouring reflexology, but not robust enough to be statistically significant. Analysis of the first phase of treatments only, identified SAI changes as significant favouring reflexology, but with systolic pressure differences favouring relaxation. Individual group analysis identified that both groups gained statistically significant improvements with reflexology in many of the SF-36 and GHQ 28 subscales. SAI changes over the weeks were significant for Group 2 receiving reflexology as a first treatment. Systolic pressure and heart rate differences were identified as statistically significant for reflexology for Group 2 as a first treatment only. Cortisol changes over the weeks were significant for Group 2 with PMR as a second treatment. Within session changes in systolic pressure were significant only with PMR for both groups. Audiotapes of the reflexology sessions revealed disclosures of worry and concerns and therapist-patient interactions. The project included an exploratory analysis of the effects of demographic variables; these findings are viewed as tentative, given the small numbers in the subgroups. New information has been obtained from this explorative study, including reduction in anxiety, with greater changes overall for reflexology. The differences observed for some of the demographic variables will also be of interest to future researchers. The analysis of audiotapes identified that reflexology also provided the majority of participants with the time and space to share worries and concerns, and receive additional support and advice from the nurse therapists.

ART THERAPY is traditionally associated with mental health services and, to some extent, dementia care and neurology in long-term settings.

ObjectivesIn lung cancer, three prominent symptoms, such as breathlessness, cough and fatigue, are closely related with each other forming a ‘respiratory distress symptom cluster’. The aim of this study was to determine the clinical and cost-effectiveness of the respiratory distress symptom intervention (RDSI) for the management of this symptom cluster in people with lung cancer.MethodsA single blind, pragmatic, randomised controlled trial conducted in eight centres in England, UK. A total of 263 patients with lung cancer were randomised, including 132 who received RDSI and 131 who received standard care. To be eligible, participants self-reported adverse impact in daily life from at least two of the three symptoms, in any combination. Outcomes were change at 12 weeks for each symptom within the cluster, including Dyspnoea-12 (D-12), Manchester Cough in Lung Cancer (MCLC) and Functional Assessment of Chronic Illness-Fatigue.ResultsAt baseline, nearly 60% of participants reported all three symptoms. At trial completion the total trial attrition was 109 (41.4%). Compared with the control group, the RDSI group demonstrated a statistically significant improvement in D-12 (p=0.007) and MCLC (p<0.001). The minimal clinically important difference MCID) was achieved for each outcome: D-12 –4.13 (MCID >3), MCLC −5.49 (MCID >3) and FACIT-F 4.91 (MCID >4).ConclusionRDSI is a clinically effective, low-risk intervention to support the management of the respiratory distress symptom cluster in lung cancer. However, the study did experience high attrition, which needs to be taken onto consideration when interpreting these results.Trial registration number NCT03223805.

It is clinically imperative to better understand the relationship between trauma, auditory hallucinations and dissociation. The personal narrative of trauma has enormous significance for each individual and is also important for the clinician, who must use this information to decide on a diagnosis and treatment approach. To better understand whether dissociation contributes in a significant way to hallucinations in individuals with and without trauma histories. Three groups of participants with auditory hallucinations were recruited, with diagnoses of: schizophrenia (without trauma) (n = 18), post-traumatic stress disorder (PTSD, n = 27) and comorbid schizophrenia and PTSD (SCZ+PTSD), n = 26). Clinician-administered measures included the PTSD Symptoms Scale Interview (PSSI-5), the Clinician-Administered Dissociative States Scale (CADSS) and the Psychotic Symptom Rating Scales (PSYRATS). Dissociative symptoms were significantly higher in participants with trauma histories (PTSD and SCZ+PTSD groups) and significantly correlated with hallucinations in trauma-exposed participants, but not in participants with schizophrenia (without trauma history). Hallucination severity was correlated with the CADSS amnesia subscale score, but depersonalisation and derealisation were not. Dissociation may be a mechanism in trauma-exposed individuals who hear voices, but it does not explain all hallucinatory experiences. The SCZ+PTSD group were in an intermediary position between schizophrenia and PTSD on dissociative and hallucination measures. The PTSD and SCZ+PTSD groups experienced dissociative phenomena much more frequently than the schizophrenia group, with a significant trend towards the amnesia subtype of dissociation.

ObjectiveTo explore the experience of training and performing self-needling from both the practitioners’ and patients’ perspective.MethodsA qualitative study was conducted using focus groups and interviews, nested within our multi-site randomised controlled trial, Acupuncture for Cancer-Related Fatigue in Patients with Breast Cancer. Patients allocated to self-needling across two UK study sites and all therapists who were involved in the trial were invited to participate. The interviews/focus groups were then transcribed verbatim and analysed thematically by the process of content analysis.ResultsOf the 67 eligible patients, 8 (12%) contributed to the focus groups and 15 practitioners (100%), contributed to the study by either attending a focus group or being interviewed. Themes identified for patients included: the allocation to self-needling, teaching techniques and practical considerations and whether they would self-needle again. Themes identified for practitioners included: views on self-needling, teaching self-needling and future implications of self-needling.ConclusionsSelf-needling was found to be acceptable to, and manageable by, patients, and enthusiastically adopted by most practitioners. Methods of teaching self-needling need to be developed and evaluated with guidelines recommended for best practice.

Background The term severe acute respiratory infection (SARI) encompasses a heterogeneous group of respiratory illnesses. Grading the severity of SARI is currently reliant on indirect disease severity measures such as respiratory and heart rate, and the need for oxygen or intensive care. With the lungs being the primary organ system involved in SARI, chest radiographs (CXRs) are potentially useful for describing disease severity. Our objective was to develop and validate a SARI CXR severity scoring system. Methods We completed validation within an active SARI surveillance project, with SARI defined using the World Health Organization case definition of an acute respiratory infection with a history of fever, or measured fever of ≥ 38 °C; and cough; and with onset within the last 10 days; and requiring hospital admission. We randomly selected 250 SARI cases. Admission CXR findings were categorized as: 1 = normal; 2 = patchy atelectasis and/or hyperinflation and/or bronchial wall thickening; 3 = focal consolidation; 4 = multifocal consolidation; and 5 = diffuse alveolar changes. Initially, four radiologists scored CXRs independently. Subsequently, a pediatrician, physician, two residents, two medical students, and a research nurse independently scored CXR reports. Inter-observer reliability was determined using a weighted Kappa (κ) for comparisons between radiologists; radiologists and clinicians; and clinicians. Agreement was defined as moderate (κ > 0.4–0.6), good (κ > 0.6–0.8) and very good (κ > 0.8–1.0). Results Agreement between the two pediatric radiologists was very good (κ = 0.83, 95 % CI 0.65–1.00) and between the two adult radiologists was good (κ = 0.75, 95 % CI 0.57–0. 93). Agreement of the clinicians with the radiologists was moderate-to-good (pediatrician:κ = 0.65; pediatric resident:κ = 0.69; physician:κ = 0.68; resident:κ = 0.67; research nurse:κ = 0.49, medical students: κ = 0.53 and κ = 0.56). Agreement between clinicians was good-to-very good (pediatrician vs. physician:κ = 0.85; vs. pediatric resident:κ = 0.81; vs. medicine resident:κ = 0.76; vs. research nurse:κ = 0.75; vs. medical students:κ = 0.63 and 0.66). Following review of discrepant CXR report scores by clinician pairs, κ values for radiologist-clinician agreement ranged from 0.59 to 0.70 and for clinician-clinician agreement from 0.97 to 0.99. Conclusions This five-point CXR scoring tool, suitable for use in poorly- and well-resourced settings and by clinicians of varying experience levels, reliably describes SARI severity. The resulting numerical data enables epidemiological comparisons of SARI severity between different countries and settings.

There is evidence of a causal link between smoking and cancer, and its effects on cancer survivorship. Smoking is common among the lesbian, gay, bisexual, trans (LGBT) population, but data on cancer rates, and engagement with smoking cessation services, are poor. This article describes, and reports results of, a survey of smoking and electronic cigarette use (vaping) among attendees of the annual Manchester LGBT Pride festival. Results suggest that smoking triggers include social situations, partners/friends smoking, stress, drinking alcohol, needing to take a break/move away from difficult situations and relieving boredom. There was also reported use of vaping, combining smoking and vaping, and slipping back to smoking in social situations. 'Trans' and 'in another way' are used in the article as inclusive terms to embrace transgender, gender non-conforming, gender variant, gender queer, non-binary and non-gender people.