Clinical use of photobiomodulation for the prevention and treatment of oral mucositis: the real-life experience of MASCC/ISOO members

AimTo assess clinical use and patient outcome of photobiomodulation (PBM) for oral mucositis (OM) prevention and treatment among specialized practitioners.MethodsA poll was emailed to the members of the Mucositis Study Group of MASCC/ISOO. The PBM parameters used by the respondents were analyzed using exploratory statistical methods to identify combinations of PBM parameters (patterns) that characterize the variance in the protocols (principal component analysis).ResultsResponses were received from 101 MSG members, with 78 providing analyzable data. Most of the responders were dental practitioners or oral medicine specialists. PBM was used by 59% of the responders for OM or targeted therapy stomatitis. Technical parameters varied widely. Most responders used wavelengths & SIM;650 nm intra-orally. The spot-size and distance from the tissue were the main factors driving the variation. All PBM users noted that PBM relieved pain, either immediately or a delayed effect. High likelihood of pain relief (measured as responder's report of pain relief in 67-100% of patients) was reported by 22% and 19% of PBM users for immediate pain relief and delayed pain relief, respectively. The most common reported barriers to using PBM were financial considerations, time constraints, lack of training or experience and concern about the potential for malignant transformation or increased risk of cancer recurrence.ConclusionsThe use of PBM for OM prevention or treatment is in early phases of adoption in practices, facing some obstacles to implement it. A wide variation in technical parameters was found. Nonetheless, responses indicate that PBM provided pain relief

A systematic review and meta-analysis on the effectiveness of education on medication adherence for patients with hypertension, hyperlipidaemia and diabetes

10.1111/jan.14025JOURNAL OF ADVANCED NURSING75112478-249

A randomized controlled trial of the effectiveness of a self-help psychoeducation programme on outcomes of outpatients with coronary heart disease: study protocol

Aim: To develop and examine the effectiveness of a home-based self-help psychoeducation programme on health-related quality of life, stress level, anxiety and depression symptoms, self-efficacy, cardiac risk factors and health service use of outpatients with coronary heart disease. Background: Hospital-based cardiac rehabilitation programmes have been shown to improve, effectively, the quality of life of patients with coronary heart disease. However, a majority of these patients do not participate in these programmes, while those who do enrol in these programmes fail to complete the programmes. Design: Randomized controlled trial with repeated measures. Methods: This study was approved and received the grant in July 2013. A convenience sample of 128 coronary heart disease outpatients will be recruited from a tertiary hospital in Singapore. Participants are randomly assigned to the 4-week experimental group and will participate in the programme or the control group who will not participate in the programme. The outcome measures include the: 12-item Short Form Health Survey, Perceived Stress Scale, Hospital Anxiety and Depression Scale and General Self-Efficacy Scale. Data will be collected at baseline, then 4 and 16 weeks from baseline. At the end, a process evaluation will be conducted to assess the acceptability, strengths and weaknesses of our programme based on the participants' perspectives. Discussion: Our programme offers coronary heart disease patients an additional option to the existing cardiac rehabilitative services in Singapore hospitals. It aims to help them manage their disease effectively by reducing cardiac risk factors and improve their health-related quality of life and psychological well-being

Effect of a Diabetes Self-Efficacy Enhancing Program on Older Adults With Type 2 Diabetes: A Randomized Controlled Trial

This randomized controlled trial examined the effect of a diabetes self-efficacy enhancing program (DSEEP) on older adults with type 2 diabetes. The 8-week DSEEP consisted of a guidebook on diabetes self-care, a 1-day workshop, and fortnightly follow-up telephone calls. In total, 113 participants (56 in intervention group and 57 in control group) completed the study. Data were collected at baseline and at 8 weeks from the baseline. Outcome measures included self-efficacy, diabetes self-care activities, health-related quality of life, glycated hemoglobin (HbA1c) and unplanned health care service usage. Compared with participants in the control group, those who received DSEEP had significantly higher increase in self-efficacy and diabetes self-care activities, lower HbA1c, and lesser unplanned health service usage. However, there was no significant difference in health-related quality of life between the two groups. The DSEEP increased self-efficacy, which successfully enhanced self-care activities and reduced HbA1c

Systematic review of growth factors and cytokines for the management of oral mucositis in cancer patients and clinical practice guidelines

Purpose: To update the clinical practice guidelines for the use of growth factors and cytokines for the prevention and/or treatment of oral mucositis (OM). Methods: A systematic review was conducted by the Mucositis Study Group of the Multinational Association of Supportive Care in Cancer/International Society of Oral Oncology (MASCC/ISOO). The body of evidence for each intervention, in each cancer treatment setting, was assigned an evidence level. The findings were added to the database used to develop the 2014 MASCC/ISOO clinical practice guidelines. Based on the evidence level, the following guidelines were determined: recommendation, suggestion, and no guideline possible. Results: A total of 15 new papers were identified within the scope of this section and were merged with 51 papers that were reviewed in the previous guidelines update. Of these, 14, 5, 13, 2, and 1 were randomized controlled trials about KGF-1, G-CSF, GM-CSF, EGF, and erythropoietin, respectively. For the remaining agents there were no new RCTs. The previous recommendation for intravenous KGF-1 in patients undergoing autologous hematopoietic stem cell transplantation (HSCT) conditioned with high-dose chemotherapy and TBI-based regimens is confirmed. The previous suggestion against the use of topical GM-CSF for the prevention of OM in the setting of high-dose chemotherapy followed by autologous or allogeneic stem cell transplantation remains unchanged. Conclusions: Of the growth factors and cytokines studied for the management of OM, the evidence supports a recommendation in favor of KGF-1 and a suggestion against GM-CSF in certain clinical settings

Systematic review of anti-inflammatory agents for the management of oral mucositis in cancer patients and clinical practice guidelines

Purpose: The aim of this systematic review was to update the clinical practice guidelines for the use of anti-inflammatory agents in the prevention and/or treatment of oral mucositis. Methods: A systematic review was conducted by the Multinational Association of Supportive Care in Cancer/ International Society of Oral Oncology (MASCC/ISOO) subcommittee on mucositis guideline update. The body of evidence for each intervention, in each cancer treatment setting, was assigned an evidence level. The findings were added to the database used to develop the clinical practice guidelines published in 2014. Based on the evidence level, one of the following three guideline determinations was possible: recommendation, suggestion, and no guidelines. Results: A total of 11 new papers across five interventions were examined. The recommendation for the use of benzydamine mouthwash for the prevention of radiotherapy-induced mucositis remained unchanged. New suggestion for the use of the same for prevention of mucositis associated with chemoradiotherapy was made. No guideline was possible for any other antiinflammatory agents due to inadequate and/or conflicting evidence. Conclusions: Of the anti-inflammatory agents studied for oral mucositis, the evidence supports the use of benzydamine mouthwash in the specific populations listed above. Additional well-designed research is needed on other (class of agents) interventions and in other cancer treatment settings