Symptom Management Research Articles

NURSES’ KAP ANALYSIS FOR PALLIATIVE CARE PATIENTS WITH HEART FAILURE

Heart failure patients admitted for palliative care require specialized management to alleviate symptoms and enhance their quality of life. Nurses play a pivotal role in delivering palliative care; however, their knowledge, attitudes, and practices significantly influence patient outcomes. This study aims to assess these parameters in nurses working in intensive care and cardiology settings. Objective: T o evaluate the knowledge, attitudes, and practices of nurses working with palliative care patients with heart failure. Methods: A cross-sectional study was conducted in the Nursing Department of Nishtar Hospital, Multan from October 2023 to October 2024. A total of 100 nurses working in the ICU and Cardiology department with heart failure patients admitted for palliative care were included in the study. Data was collected through questionnaires. Knowledge was assessed by the 30-item Palliative Care Quiz for Nursing, attitude regarding death was evaluated by a 32-item Death Attitude Profile and practice was assessed by 6-item perceptions of preparedness and ability to care for the dying (PPACD) R-I scale. Results: The mean knowledge score was 13.8 ± 2.55 with a satisfactory score in only 46% of participants. Only 29% were aware of symptom management in terminally ill patients. The mean attitude score was 133.6 ± 108.4 and the mean practice score was 16.2 ± 5.1. No significant association between knowledge scores and previous palliative care training was noted (r=0.1) but attitude scores were positively related to age and experience. The approach acceptance (r=0.292) and neutral acceptance (r=0.339) were significantly associated with practice. Conclusion: Nurses working in the palliative care unit possessed unsatisfactory knowledge, attitudes, and practices to manage patients with heart failure. Intervention programs and the inclusion of palliative care subjects in the curriculum can improve these results and avert the healthcare hazard.

Symptom Cluster Trajectories Among Patients With Hepatocellular Carcinoma After Partial Hepatectomy: A Longitudinal Study.

To investigate types of symptom clusters in patients with hepatocellular carcinoma after partial hepatectomy and explore symptom cluster trajectories over time. A longitudinal observational study was conducted. Symptoms of patients with hepatocellular carcinoma were assessed on the second day, seventh day, third week, fourth week and twelfth week post-operation using the MD Anderson Symptom Assessment Inventory and the Symptom Module for Primary Liver Cancer. Symptom clusters were extracted using exploratory factor analysis, and symptom cluster trajectories were analysed using a latent class growth model. Two hundred and thirty patients with hepatocellular carcinoma completed the five-point investigation after partial hepatectomy. Three symptom clusters were identified: general somatic, psychological and liver impairment. Each symptom cluster was further categorised into three groups: severe, moderate and low. The severity of the three symptom clusters and subgroups decreased over time. Three symptom clusters were identified in patients who underwent partial hepatectomy for hepatocellular carcinoma, and symptom cluster trajectories decreased over time during the 12-week postoperative period. These findings will assist healthcare professionals in providing prompt symptom management and improve patient quality of life. Healthcare professionals should evaluate symptom clusters and their trajectories in patients with hepatocellular carcinoma after partial hepatectomy. This report was prepared in accordance with the Guidelines for Reporting Cohort Research. Hepatobiliary surgery nurses worked closely with the research team to ensure the questionnaires were fully assessed before being sent to patients. The active participation of patients provided valuable information for the study. Chinese Clinical Trial Registry (ChiCTR2400084232).

Community out-of-hours palliative care - 'It's a patchwork of services': A qualitative study exploring care provision.

People in receipt of community palliative care usually receive care from a range of services and require access to care 24/7. However, care outside of normal working hours varies, with little understanding of which models of care are optimal. To identify and characterise current models of out-of-hours community palliative care in the UK and explore healthcare professionals' views on the barriers and facilitators to providing high quality community out-of-hours care. Exploratory qualitative study using semi-structured interviews, analysed using reflexive thematic analysis. We recruited 39 healthcare professionals from 20 geographic areas. Participants were service leads from community palliative care, district/community nursing and primary care providers. Four overarching models of out-of-hours palliative care identified, characterised by levels of integration between services, balance between generalist and specialist providers, availability of care and type of care provided (hands-on clinical care/ advisory care). Analysis of barriers and facilitators generated three themes: (1) 'It's never one service': challenges of coordination of care across multiple services, (2) Need for timely skilled management of distressing symptoms, (3) 'We're just plugging gaps': prioritising patient care within limited resources. Patterns within the themes varied across the four models. This study identifies key characteristics of four common models of out-of-hours palliative care, from the perspectives of professionals. Facilitators of high quality out-of-hours care include: a palliative care specific single point of access for patients; formal structures to integrate generalist/specialist services; and timely/skilled management of symptoms. We provide recommendations for a potential model incorporating these factors.

A Survey of 251 Facial Paralysis Patients to Assess Their Educational Preparedness and Symptom Management after Treatment of Vestibular Schwannoma

Abstract Objective The aim of this study was to evaluate how patients with vestibular schwannoma (VS) were prepared for facial paralysis (FP). Study Design This study comprised an online survey of members of the Acoustic Neuroma Association of America who had FP. Methods A 28-question survey gathering information on the patient experience related to management of FP was created. Associations between treatment setting and presence of FP were analyzed using SAS Enterprise Guide 8.4. Significance was considered at p-values < 0.05 in a univariate and multivariable model. Results A total of 251 subjects with VS and FP responded. A total of 14% presented with FP, 70% were diagnosed with VS at least 6 months prior to treatment, and 61% were treated at academic centers. A total of 28% felt prepared for life with FP and 42% were confident their medical team understood management. Less than 30% of respondents received educational materials. After developing FP, speech and swallow difficulty and anxiety were common, but few respondents were referred for expert management. Subjects at academic centers were more often referred to specialists in the same location. Those with preoperative FP felt their medical teams better prepared them for it, had fewer complaints of difficulty speaking, and were happier with their recovery. Conclusion Significant gaps in preparation and management of FP were identified. Preoperative FP led to improved perception of care; however, the delivery was similar to those without it. Studies of surgeons who manage VS are needed to better understand how they prepare patients for the emotional and physical sequelae of FP.

Use of cannabis to manage symptoms of mental and physical health conditions during pregnancy: analysis of a pro-cannabis pregnancy forum

IntroductionRates of prenatal cannabis use (PCU) have increased in recent years. Despite evidence of developmental health consequences to offspring and birthing person, there has been a reduction in the perception of PCU-related harms. Due to the stigma and risk of legal consequences associated with disclosing PCU, individuals are often cautious to seek information from their healthcare providers. Thus, pregnant people are more likely to seek information from anonymous sources, such as online support forums. Information garnered from these anonymous online forums can shed light on the patterns and motives for cannabis use among this population. These insights can help to better inform prevention efforts aimed at reducing potential harms of PCU and improve intervention efforts.MethodsPosts (N = 120) from an online pro-cannabis pregnancy forum called “Ganja Mamas” on WhattoExpect.com were randomly selected and analyzed if they covered topics related to PCU. A qualitative coding structure based on the existing PCU literature was created and refined to include other emergent topics. The coding structure was used to apply thematic analysis to posts; associated codes were grouped into themes. Codes specific to symptom management for physical and mental health were subsequently subjected to further conceptual analysis for the current study.ResultsFour themes related to symptom management during pregnancy were identified: 1) cannabis use and impacts of use for a variety of mental health symptoms, including depression and anxiety; 2) cannabis use for physical health symptoms and conditions, such as nausea and pain; 3) use of cannabis to achieve homeostasis and manage stress; 4) decision-making about using cannabis for symptom management, such as using cannabis instead of prescription medications. Most discussions in this pro-cannabis forum reflected perceptions that cannabis was effective in treating the conditions for which it was used; however, limitations of cannabis’ efficacy were also mentioned.DiscussionThere is need for reduced stigma and open communication between pregnant persons who use cannabis and their providers in discussing how to manage their mental and physical health symptoms. Understanding the various symptoms for which individuals use cannabis during pregnancy to self-treat can inform these conversations and the expansion of harm reduction strategies.

Randomized control clinical trial to assess the effect of meditation on selected clinical outcomes in patients with Parkinson’s disease

Background: Parkinson’s disease (PD) is the second most common neurodegenerative disorder, characterized by progressive loss of dopaminergic neurons, leading to both motor and non-motor symptoms. Although dopaminergic therapy is the current goldstandard therapy in symptomatic management, it does not alter disease progression. Meditation, a complementary therapy, has shown promise in alleviating motor symptoms and improving neuroplasticity, but evidence on its effects on non-motor symptoms remains inconclusive. This randomized controlled trial (RCT) is designed to evaluate the impact of a meditation-based intervention on both motor and non-motor symptoms in patients with PD.Methods: This open-label, parallel-group, randomized clinical trial will be conducted at the National Hospital of Sri Lanka, a tertiary care center. Eligible participants, diagnosed with PD and classified in Hoehn and Yahr stages I–III, will be randomized into two groups: a meditation intervention group and a waitlisted control group receiving usual care. The intervention will include an 8-week meditation program with guided weekly sessions. Outcomes will be assessed using various scales: motor symptoms (SPES/SCOPA-Motor), non-motor symptoms (SENS-PD), cognitive function (RBANS), quality of life (PDQ-39), and gait performance (TUG test). Additionally, nerve conduction studies will evaluate peripheral motor nerve function.Discussion: This study aims to provide evidence on the effects of meditation on motor and non-motor symptoms in PD, which could support the integration of meditation into PD management protocols. The trial will explore the potential neuroplastic changes and improvements in quality of life mediated by meditation, providing further insights into non-pharmacological treatment options for PD patients.

Clinical and neuroimaging characteristics of diabetic striatopathy: a case series report.

Diabetic striatopathy (DS) is a rare disorder characterized by clinical manifestations of hemichorea, non-ketotic hyperglycemia, and high signal on T1-weighted MRI or high density on CT scan in basal ganglia, typically associated with poor glycemic control. This study aimed to analyze clinical characteristics of patients with diabetic striatopathy to raise awareness amongst physicians, especially endocrinologists, about this rare neurological manifestation in patients with diabetes. We retrospectively analyzed the data on clinical presentations, laboratory workups, and cranial CT and MRI of six patients with DS who were admitted to our hospital from October 2013 to June 2022. The mean age of onset among the six patients was 80.5 years, and the mean value of HbA1c was 13.65%. All six patients complained of involuntary movements, which primarily affected the arm and leg on one side of the body. Bilateral caudate nucleus hyperdensities were shown on the CT examination in Case 3,while the other 5 patients, unilateral caudate nucleus hyperdensity was shown. In addition, five patients (except Case 5) underwent MRI, all showing hypersignal lesions on the T1-weighted images. A low signal in the right basal ganglia was shown on MRI susceptibility weighted imaging (SWI) sequences in Case 6. All six patients exhibited carotid artery or cerebral artery stenosis. Following strict blood glucose control and symptomatic management, the symptoms of chorea improved significantly in all patients, and repeat images indicated that the lesions gradually disappeared. Both poor vascular conditions and severe hyperglycemia contribute to the development of diabetic striatopathy. The prognosis is usually good by active treatment.

Successful Treatment of Severe, Poorly Controlled Benign Essential Blepharospasm with DaxibotulinumtoxinA.

Benign essential blepharospasm is a focal dystonia characterized by involuntary contractions of the orbicularis oculi. Botulinum toxin type A injections are often first-line treatment, but patients may experience refractory symptoms or decreased response over time. DaxibotulinumtoxinA, a novel botulinum toxin type A product, has shown promise in cervical dystonia and facial rhytids but has not been previously reported for benign essential blepharospasm treatment. This case highlights a 57-year-old male with severe, poorly controlled benign essential blepharospasm despite high-dose injections of onabotulinumtoxinA and incobotulinumtoxinA. He subsequently received 100 units of daxibotulinumtoxinA in the same periorbital injection pattern with subjective faster onset, extended duration of effect, and improved symptom management compared to previous treatments. Notably, the patient experienced 50% to 75% efficacy retention at 3 months postinjection, significantly better than his response to other botulinum toxin type A products. This case suggests that daxibotulinumtoxinA may be an effective treatment for benign essential blepharospasm including patients experiencing poor symptom control with other botulinum toxin type A products.

Symptom Management Guideline Implementation Among Nurses in Cancer-Specific Outpatient Settings: A Scoping Review of Barriers, Facilitators, and Implementation Strategies.

Oncology outpatients experience high levels of distressing cancer-related symptoms. Nurses can provide high-quality outpatient cancer symptom management following clinical practice guideline recommendations; however, these guidelines are inconsistently used in practice. Understanding contextual factors influencing implementation is necessary to develop tailored implementation strategies. To identify and describe (1) barriers and facilitators influencing symptom management guideline adoption, implementation, and/or sustainability among nurses in cancer-specific outpatient settings and (2) components of strategies used to enhance guideline implementation. A scoping review was conducted following Joanna Briggs Institute methodology. CINAHL, EMBASE, EMCARE, MEDLINE, and gray literature sources were searched. Eligibility screening and data extraction were performed in duplicate. The updated Consolidated Framework for Implementation Research and Expert Recommendations for Implementing Change taxonomy informed data extraction and descriptive analysis. Thirty-six projects from 2004 to 2023 were included; most used quality improvement (n = 14) or quasi-experimental (n = 10) designs. Determinants were most often mapped to the "inner setting" and "individuals-roles/characteristics" Consolidated Framework for Implementation Research domains. Most projects used multiple discrete implementation strategies within the "train and educate stakeholders" (n = 29, 85%) and/or "develop stakeholder interrelationships" (n = 20, 59%) categories. Nurses may face several barriers to symptom management guideline implementation within cancer-specific outpatient setting workflows and may have limited opportunity to implement guidelines within their current roles. Most projects used educational strategies, which alone may be insufficient to address reported barriers. By identifying barriers, facilitators, and strategies, this scoping review can be used to design tailored strategies to implement symptom management guidelines within outpatient oncology nursing care.

Making sense of the literature on antipsychotics and long-term functioning: taking natural history and personalization seriously.

This review examines the relationship between long-term antipsychotic use and individual functioning, emphasizing clinical implications and the need for personalized care. The initial impression that antipsychotic medications may worsen long-term outcomes is critically assessed, highlighting the confounding effects of illness trajectory and individual patient characteristics. Moving beyond a focus on methodological limitations, the discussion centers on how these findings can inform clinical practice, keeping in consideration that a subset of patients with psychotic disorders are on a trajectory of long-term remission and that for a subset of patient the adverse effects of antipsychotics outweigh potential benefits. Key studies such as the OPUS study, Chicago Follow-up study, Mesifos trial, and RADAR trial are analyzed. While antipsychotics demonstrate efficacy in short-term symptom management, their long-term effects on functioning are less obvious and require careful interpretation. Research on long-term antipsychotic use and individual functioning isn't sufficient to favor antipsychotic discontinuation or dose reduction below standard doses for most patients, but it is sufficient to highlight the necessity of personalization of clinical treatment and the appropriateness of dose reduction/discontinuation in a considerable subset of patients.

Myotonic dystrophies: an update on clinical features, molecular mechanisms, management, and gene therapy.

Myotonic dystrophies (DM) encompass a group of complex genetic disorders characterized by progressive muscle weakness with myotonia and multisystemic involvement. The aim of our paper is to synthesize key findings and advancements in the understanding of DM, and to underline the multidisciplinary approach to DM, emphasizing the importance of genetic counseling, comprehensive clinical care, and symptom management. We discuss the genetic basis of DM, emphasizing the role of repeat expansions in disease pathogenesis, as well as cellular and animal models utilized for studying DM mechanisms and testing potential therapies. Diagnostic challenges, such as determining the size of disease expansions and assessing mosaicism, are elucidated alongside emerging genetic testing methods. Therapeutic strategies, mainly for DM1, are also explored, encompassing small molecules, nucleic acid-based therapies (NATs), and genome/transcriptome engineering. The challenges of such a therapeutic delivery and immunogenic response and the importance of innovative strategies, including viral vectors and AAV serotypes, are highlighted within the text. While no curative treatments have been approved, supportive and palliative care remains essential, with a focus on addressing multisystemic complications and maintaining functional independence. Continued exploration of these therapeutic advancements offers hope for comprehensive disease management and potentially curative therapies for DM1 and related disorders.

Unveiling the Future of Cardiac Care: A Review of Gene Therapy in Cardiomyopathies.

For years, the treatment of many cardiomyopathies has been solely focused on symptom management. However, cardiomyopathies have a genetic substrate, and directing therapy towards the pathophysiology rather than the epiphenomenon of the disease may be a winning strategy. Gene therapy involves the insertion of genes or the modification of existing ones and their regulatory elements through strategies like gene replacement and gene editing. Recently, gene therapy for cardiac amyloidosis and Duchenne muscular dystrophy has received approval, and important clinical trials are currently evaluating gene therapy methods for rare heart diseases like Friedreich's Ataxia, Danon disease, Fabry disease, and Pompe Disease. Furthermore, favorable results have been noted in animal studies receiving gene therapy for hypertrophic, dilated, and arrhythmogenic cardiomyopathy. This review discusses gene therapy methods, ongoing clinical trials, and future goals in this area.

Biliary sphincterotomy resets pancreaticobiliary pain refractory to intrasphincteric Botox injections in functional biliary pain.

The management of Type III sphincter of Oddi dysfunction or functional biliary pain (FBP) is challenging. A strategy of intermittent intrasphincteric botulinum toxin (Botox) injections into the sphincter of Oddi can alleviate pancreaticobiliary pain. In patients who lose response to intermittent Botox injections, endoscopic biliary sphincterotomy (ES) could potentially reset pain facilitating ongoing management of symptoms. A retrospective review of case notes over a seven-year period (2014-2021) was performed. All patients underwent blood tests, gastroscopy, trans-abdominal ultrasonography, cross-sectional imaging withmagnetic resonance cholangiopancreatography (MRCP)/computed tomography (CT) and endoscopic ultrasound (EUS)to rule out alternative causes for their symptoms of pancreaticobiliary pain. A diagnosis of FBP was made in patients with typical post-cholecystectomy pain and normal liver function tests and bile duct size on imaging. Patients with symptomatic FBP underwent intermittent endoscopic Botox injections to the sphincter of Oddi. Patients who lost response to Botox injections underwent ES and were followed up in an outpatient setting to assess response. One hundred and thirty (128 female, 2 male) patients with FBP underwent a mean of four (2-8) Botox injections over the study period. Of 130 (90%) patients, 117 reported a significant improvement in pain on post procedure review with 81% of patients managing to discontinue opioid medication post procedure. Fifty-one out of 130 (39%) lost response to Botox injections after a median of six (range 5-11) sessions (median eightmonths between sessions [range 6-18months]) and continued to have ongoing pancreaticobiliary pain and subsequently underwent biliary ES. Forty-one out of 50 (82%) reported a clinical improvement in their symptoms of pancreaticobiliary pain following ES, with response persisting at follow-up for up to mean of eight (5-15) months and no further hospital attendances due to severe pancreaticobiliary pain. ES can reset pancreaticobiliary pain in FBP once Botox injection therapy to the sphincter of Oddi becomes ineffective and may provide ongoing relief of symptoms.

Influence of menstrual- and hormonal contraceptive cycle on self-reported symptom severity and recovery measures across an annual season in female endurance athletes: The FENDURA project

ABSTRACT This longitudinal study investigated 1) differences in self-reported cycle-related symptom severity and recovery measures (sleep quality, readiness to train, resting heart rate) between pre-bleeding, bleeding, and non-bleeding days in athletes using/not using hormonal contraception (HC); 2) associations between symptom severity and recovery measures. Fifty-eight female endurance athletes recorded recovery measures, perceived symptom severity, and menstruation/withdrawal (bleeding) days for one year. Athletes were grouped as: intrauterine system (IUS)-, implant-, progestin-only oral contraceptive (POC)-, combined oral contraceptive (COC)- and non-HC users. All groups reported higher symptom severity during bleeding compared to pre-bleeding and non-bleeding days (both p < .001), while implant users reported less severe symptoms than IUS (p < .001) and non-HC users (p = .008). Perceived sleep quality was lower during pre-bleeding compared to bleeding days (p < .001) for all groups. However, IUS users reported higher sleep quality (p = .039) and physical readiness-to-train (p = .010) than non-HC users. Symptom severity was negatively associated with sleep quality and physical readiness-to-train (both p < .050). Pre-bleeding days and cycle-related symptom severity were found to negatively influence self-reported recovery measures in both HC- and non-HC users. Therefore, athletes and their support staff are advised to prioritize symptom management and the adjustment of recovery strategies on an individual basis throughout the athletes’ cycles.

End-of-life care for people with sickle cell disease: barriers to and facilitators of high-quality care.

End-of-life (EOL) care is a critical part of sickle cell disease (SCD) management. However, barriers to high-quality EOL care remain, including (1) disease-related barriers (prior opioid exposure, risk of vaso-occlusive crises, chronic conditions with conflicting needs, and limitations of receiving disease-directed therapy on hospice); (2) communication-related barriers (challenges of identifying and responding to religious and spiritual concerns, limited health literacy, and previous health care system experience); (3) systemic issues (social determinants of health, structural racism, and mistrust of the medical system). However, palliative care and interdisciplinary collaboration can overcome many of these barriers. In addition, we can improve EOL care by accounting for opioid exposures, multimodal symptom management, and exploring (1) who people want involved in decision-making, (2) the role of religion and spirituality in decision-making, and (3) previous experiences with EOL. Systemic barriers can be addressed through the social determinants of health screening, minimizing financial burdens of care, and building longitudinal relationships with people with SCD. This requires the continued education of SCD providers about primary palliative care and palliative care providers about SCD. With such strategies, high-quality EOL care is possible for this vulnerable population.

Effectiveness of non-pharmacological interventions in managing symptom clusters among lung cancer patients: a systematic review

BackgroundNon-pharmacological interventions, as complements to pharmacological treatments, are widely employed for managing symptom clusters in patients with lung cancer. Although numerous systematic reviews and meta-analyses have explored the effects of these interventions, most studies have centred on the broader cancer population and specific symptom clusters. This review aims to consolidate existing non-pharmacological interventions and assess their effectiveness in managing symptom clusters among lung cancer patients.MethodsA comprehensive literature search, encompassing eight databases from inception to October 1, 2024, was conducted. Two independent reviewers carried out the study selection, quality assessment, and data extraction. Methodological quality was evaluated using the Cochrane Risk-of-Bias 2 tool and the Risk of Bias in Non-randomized Studies of Interventions. The findings were synthesized narratively based on intervention type and supplemented by meta-analysis using RevMan 5.4 software. The study protocol was registered with PROSPERO (CRD42023467406).ResultsThis systematic review comprised 15 relevant studies involving 1,692 patients, published between 2011 and 2024. The analysis revealed the effectiveness of psychological, educational, and complementary or alternative medicine interventions in alleviating the severity of most symptom clusters. However, the efficacy of exercise-based and multimodal interventions remained inconclusive. The meta-analysis demonstrated a positive impact of non-pharmacological interventions on depression compared with the control conditions (SMD = -0.30, 95% CI [-0.46, -0.15], p < 0.01, I2 = 6%). Additionally, the educational intervention subgroup showed low heterogeneity and effectively improved fatigue (SMD = -0.50, 95% CI [-0.68, -0.33], p < 0.01, I2 = 0%).ConclusionsPsychological and educational interventions have proven effective in managing symptom clusters in lung cancer patients. However, further research is needed to explore the effects of exercise, multimodal approaches, and complementary or alternative medicine. To enhance symptom management, future research could focus on core symptom clusters.

Intra-Articular Injection of Stem Cells for the Regeneration of Knee Joint Cartilage: a Therapeutic Option for Knee Osteoarthritis - a Narrative Review.

Current approaches to regulating osteoarthritis primarily focus on symptom management; however, these methods often have significant side effects and may not be suitable for long-term care. As an alternative to conventional treatments, injecting stem cells into knee joint cartilage is a promising option for repairing damaged cartilage. In this review, we outline the general procedure for stem cell treatment of knee joint cartilage regeneration, emphasizing the potential of intra-articular stem cell injections as a therapeutic option for osteoarthritis. We examined and summarized patient evaluation and preparation for knee joint stem cell therapy, stem cell harvesting, stem cell preparation, injection procedures for stem cell therapy, post-injection care and monitoring, potential outcomes of stem cell therapy, and considerations and risks associated with stem cell therapy. Overall, stem cell injections for knee joint cartilage damage represent a promising frontier in orthopedic care. They offer potential benefits such as pain and inflammation reduction, promotion of cartilage repair and regeneration, and the possibility of avoiding more invasive treatments such as knee surgery. Ongoing collaboration among researchers, clinicians, and regulatory organizations is crucial for advancing this field and translating scientific discoveries into effective clinical applications.

The Evolving Role of the Oncology Nurse in the United States of America-A Survey Exploring Their Perspective.

The role of the oncology nurse has evolved since the COVID-19 pandemic to continuously meet patient needs, resulting in an increased virtual presence. However, there is little information about whether these roles have continued since the pandemic and how it is affecting nurses. The aim of this study, conducted via an electronic survey questionnaire, was to examine the perspective of oncology nurses in the United States of America regarding how their role has changed, the adaptation to telehealth, challenges, and needs. Over 5 months, 197 respondents from 17 different states completed the survey. They were all registered nurses working in oncology with different roles, such as being nurse practitioners (23%), nurse navigators (20%), infusion nurses (23%), and working in outpatient settings (93%). The findings of the survey highlight the multifaceted responsibilities of nurses in providing care across the cancer care continuum, emphasizing patient-centered care, communication, education, and empowerment, in addition to expected duties such as the administration of anticancer therapy, monitoring of side effects, and symptom management. A total of 82.6% of United States of America oncology nurses feel their workload has increased. The role of nurses in oncology is continuously evolving and the impact of the COVID-19 pandemic, in certain areas such as telehealth, is here to stay. The results of the study allow a better understanding of the emergent roles of oncology nursing. The importance of self-care initiatives and education are emphasized as critical to support nurses in their complex, busy, and emotionally charged work environment and to help retain existing nurses and attract new individuals into the profession. The study ultimately seeks to inform policy and drive professional development in oncology nursing in the United States of America.

Integration of Alternative and Complementary Medicine with Modern Western Medicine for Enhanced Patient Care

The integration of alternative and complementary medicine (CAM) with modern Western medicine offers a promising approach to improving patient care by combining the strengths of both systems. CAM therapies such as Ayurveda, acupuncture, homeopathy, yoga, meditation, and herbal medicine focus on holistic, patient-centred care that emphasizes prevention, lifestyle modification, and natural healing processes. In contrast, modern Western medicine excels in evidence-based diagnosis and treatment of acute conditions through pharmacological, surgical, and technological interventions. However, modern medicine often focuses on symptom management rather than addressing the root causes of disease, particularly in the context of chronic and lifestyle-related conditions. This paper explores the potential for CAM therapies to complement conventional treatments, focusing on their synergistic effects in managing chronic diseases, reducing medication side effects, enhancing mental health, and offering more personalized care. By incorporating CAM approaches, healthcare providers can address both the physical and psychological aspects of health, thereby improving patient outcomes and satisfaction. The mechanisms of action underlying CAM therapies are increasingly understood through scientific research, helping bridge the gap between these two paradigms. This integration represents an evolving model of patient care, where the combined use of CAM and conventional medicine offers a more comprehensive and individualized approach to health. Future research and multidisciplinary collaboration are essential for fully realizing the potential of integrative medicine.

From promise to practice: CAR T and Treg cell therapies in autoimmunity and other immune-mediated diseases.

Autoimmune diseases, characterized by the immune system's attack on the body's own tissues, affect millions of people worldwide. Current treatments, which primarily rely on broad immunosuppression and symptom management, are often associated with significant adverse effects and necessitate lifelong therapy. This review explores the next generation of therapies for immune-mediated diseases, including chimeric antigen receptor (CAR) T cell and regulatory T cell (Treg)-based approaches, which offer the prospect of targeted, durable disease remission. Notably, we highlight the emergence of CD19-targeted CAR T cell therapies, and their ability to drive sustained remission in B cell-mediated autoimmune diseases, suggesting a possible paradigm shift. Further, we discuss the therapeutic potential of Type 1 and FOXP3+ Treg and CAR-Treg cells, which aim to achieve localized immune modulation by targeting their activity to specific tissues or cell types, thereby minimizing the risk of generalized immunosuppression. By examining the latest advances in this rapidly evolving field, we underscore the potential of these innovative cell therapies to address the unmet need for long-term remission and potential tolerance induction in individuals with autoimmune and immune-mediated diseases.