Effectiveness of music therapy for alleviating pain during haemodialysis access cannulation for patients undergoing haemodialysis: a multi-facility, single-blind, randomised controlled trial

Background: Repeated pain during haemodialysis access cannulations is a serious problem for haemodialysis patients even when prescribed oral or topical analgesics. Although some studies have observed the efficacy of music therapy for improving pain and anxiety, its effectiveness during haemodialysis access cannulations during dialysis is uncertain. The purpose of this study is to investigate the effects of music therapy for pain when cannulating haemodialysis access for haemodialysis patients. Methods: A prospective, multi-facility, single-blind, crossover, randomised controlled trial will be implemented. The intervention includes listening to Mozart, along with a white noise control condition. One hundred twenty haemodialysis patients will be enrolled across five facilities. Patients will be randomly allocated to either an Early-sequence group or a Later-sequence group. The Early-sequence group will receive cannulation while listening to Mozart\u27s Sonata for two pianos in D major (K.448) during the second week (Music period) and white noise during the fourth week (White noise period). The Later-sequence group will receive cannulation along with white noise first, followed by Mozart. All patients will also undergo cannulation during a no-sound period (wearing only headphones) during the first and third week (No-sound period). The music or no-music protocol will begin 8 min prior to the cannulating procedure, and participants will finish listening after starting haemodialysis during each period. The primary outcomes that will be assessed include the Visual Analogue Scale (VAS) score for pain during cannulation, and secondary outcomes are blood pressure, heart rate, VAS anxiety score, State-Trait Anxiety Inventory score, and salivary amylase activity. The operators who are in charge of haemodialysis access cannulation will be blind to the listening condition and VAS report. Discussion: The proposed study has several methodological benefits. First, using white noise is a suitable control condition for addressing the role of sound in pain management. Additionally, using a crossover design with repeated measurements can help control individual differences between participants, which should better distinguish between- and within-participant variability. Overall, music therapy is a safe and inexpensive intervention that does not have the problematic side effects typically associated with pharmacological treatment. If effective, music therapy can be easily implemented for reducing pain and anxiety during cannulation. Trial registration: This trial was prospectively registered to UMIN Clinical Trials Registry on 1 July 2018 (UMIN 000032850)

パルボシクリブ併用内分泌治療が著効した閉経前再発乳癌の１例

　パルボシクリブ併用内分泌療法が著効した閉経前再発乳癌の１例を報告する．８年前に乳房温存手術を受け，残存乳房への放射線治療後に化学内分泌補助療法（シクロフォスファミド＋エピルビシン（CE 90）を４サイクル後に毎週パクリタキセルを４サイクル施行．化学療法終了後からLH-RH アゴニスト２年間とタモキシフェン５年間）を行った．治療継続中も含め定期で外来受診を継続しており，年１回の画像検査（肺，肝，骨を標的）と３か月ごとの腫瘍マーカー測定では再発の兆候はなく経過していた．しかし，補助治療終了後約３年で発熱と肝機能障害をきっかけに多発遠隔再発（肺・骨・肝・子宮体部）を発見した．ホルモン感受性は残存している可能性はあったが，急速な再発であるために，再発後初回治療としてドセタキセルおよびデノスマブの投与を開始した．有効ではあったが投与後約半年でマーカーの再上昇と体動時呼吸困難（在宅酸素療法導入）および疲労・倦怠感の増強が出現した．有害事象と病勢進行のため再発後の二次治療としてパルボシクリブ，フルベストラント，LH-RH アゴニストを導入した．導入後１か月で体動時呼吸困難が消失し，３か月で在宅酸素療法が中止できた．半年後のPET/CT で集積が消失しており画像上は著効と判断できた．有害事象は白血球・好中球減少が出現した以外に認めなかった．再発治療としてパルボシクリブ併用内分泌治療が有用であった．　We have a case of pre-menopausal patient with recurrent breast cancer showing an excellent response to endocrine therapy with palbociclib. Eight years ago, she underwent breast conserving operation followed by adjuvant chemo-endocrine therapy (4 cycles of cyclophosphamide and doxorubicin, 4 cycles of paclitaxel and tamoxifen adding LHRH agonist). The administration of tamoxifen continued for 5 years as an adjuvant therapy. After 3 years of discontinuation of adjuvant medication, fever and liver dysfunction led to find the recurrence of breast cancer in lung, bone, liver and uterus. We chose to treat with chemotherapy as the first line, because the recurrence was rash and multiple. After 6 months of treatment of docetaxel and denosumab, serum decreased tumor markers elevated gradually and dyspnea and general fatigue worsened. She recieved palbociclib, fluvestrant and LH-RH agonist as a second endocrine therapy. Six months after the treatment, PET/CT revealed an excellent effect on each metastatic lesion. Adverse event was only seen in neutropenia to make one-level reduction of dose. Palbociclib and endocrine therapy appeared to be useful as a second-line treatment for recurrent breast patient

ベバシズマブ併用化学療法中に消化管穿孔をきたした再発乳癌の１例

　ベバシズマブはパクリタキセルとの併用でHER2陰性の進行・再発乳癌に対する有効性が示されており，無増悪生存期間を有意に延長させる．しかし，ベバシズマブ特有の有害事象も報告されており，投与の際には注意を要する．今回，再発乳癌に対しベバシズマブを使用し，腸管穿孔を起こした１例を経験した．症例は72歳女性．右乳癌術後５年目に多発リンパ節，肺転移を認め，化学療法で治療中に８次治療としてベバシズマブとパクリタキセル（BP）療法を開始した．１年ほど奏効したが，突然，腹痛を訴え受診した．CT で腹腔内にfree air を認めたため緊急開腹術を施行した．小腸に１か所の穿孔部位を認めた．病理組織検査では，穿孔部に乳癌の転移巣が認められた．乳癌に対するベバシズマブ併用化学療法中の消化管穿孔は報告が少ない．腹膜播種を認める症例やベバシズマブ投与期間の長い患者では，腹部膨満感や腹痛を訴えた際は消化管穿孔を念頭におく必要がある．　Combination therapy with bevacizumab and paclitaxel (BP therapy) has been reported to be effective for the treatment of HER2-negative metastatic breast cancer and to significantly prolong progression-free survival. However, there are specific adverse effects induced by bevacizumab that physicians should pay attention to. We report a recent case of metastatic breast cancer with gastrointestinal perforation during bevacizumab therapy. A 72-year-old female patient had metastases into multiple lymph nodes and lungs five years after surgery for primary breast cancer, and was treated with several chemotherapies. The patient received BP therapy as the eighth treatment regimen. Although the therapy led to stable disease for approximately one year, the patient suddenly developed abdominal pain. Emergency laparotomy was performed because computed tomography revealed free air in the peritoneal cavity. A perforated lesion was found in her small intestine. On pathological examination, breast cancer metastasis was noted around the perforated site. There are few reports of gastrointestinal perforation during bevacizumab therapy for patients with metastatic breast cancer. When a patient has peritoneal dissemination, long-term BP therapy and abdominal pain, physicians should keep in mind the possibility of gastrointestinal perforation during BP therapy. (187 words

Hur oro och ångest kan minskas hos vuxna patienter vid MRT-undersökningar : En litteraturstudie

Bakgrund:  Magnetresonanstomografi (MRT) används inom radiologi och är suverän inom vissa typer av diagnostik. Dock upplever många patienter oro och ångest i samband med MRT-undersökningar, vilket kan leda till avbrutna undersökningar. I röntgensjuksköterskans profession ingår ett ansvar för patienternas trygghet och välbefinnande. Syfte: Litteraturstudiens syfte var att belysa hur oro och ångest kan minskas hos vuxna patienter vid MRT-undersökningar. Metod: Syftet besvarades med en litteraturstudie med resultat från åtta kvantitativa studier. Sökningarna genomfördes i databaserna PubMed, CINAHL och PsycINFO samt genom manuell sökning. Artiklarna kvalitetsgranskades och analyserades. Resultat: Resultatet sorterades till fem kategorier som beskriver Utformning av gantry, Avslappning, Utökad information utöver standardiserad information, Utökad information kombinerat med avslappning och Utökad information kombinerat med avslappning samt introduktion till undersökning och miljö. Konklusion: Utformning av gantry och avslappning samt utökad information, var för sig eller kombinerat, kan minska oro och ångest hos vuxna patienter vid MRT-undersökningar. På så sätt minskas avbrutna undersökningar och kostnadseffektivitet uppnås

Investigation of factors behind foreign accent in the L2 acquisition of Japanese lexical pitch accent by adult English speakers

The productions of adult second language (L2) learners are often detected as having a foreign accent by native speakers of the target language. However, there is no clear answer for what kind of problems contribute to L2 learners’ foreign accent. This thesis aims to investigate potential factors behind foreign accent. We intend to achieve this goal by examining cross-linguistic empirical evidence of the L2 acquisition of Japanese lexical pitch accent by English learners. L2 prosody has been found to significantly influence native speakers’ auditory impression of foreign accent. L2 prosody also allows us to test crosslinguistic differences in the function of the key acoustic correlates of L2 contrasts. In this thesis we examine F0, which signals both lexical pitch accent and phrasal distinctions in Japanese, but which signals only phrasal distinctions, not lexical distinctions, in English. For adult L2 learners to achieve target-like productions, the literature suggests that three abilities are the key factors: 1) learners’ ability to differentiate the acoustic correlate of the target L2 contrasts, 2) ability to articulate the acoustic correlate of the target L2 contrasts and 3) ability to categorize the target L2 contrasts. This thesis evaluates all three of these potential factors. The main contribution of this thesis is to provide a comprehensive view of foreign accent, by investigating possible interactions between the factors and by examining the different abilities of the same learners. Another contribution is to provide empirical evidence for the nature of learners’ problems with foreign accent during L2 acquisition, by testing two groups of English learners of Japanese (experienced and inexperienced) in comparison with Japanese native speakers. The first experiment used intelligibility scores and overall F0 patterns to quantify the degree of foreign accent in the learners’ productions of Japanese lexical pitch accent. The second experiment showed that the learners’ ability to differentiate F0 contours in a nonspeech context was equal to that of the native speakers. The third experiment showed that the learners’ ability to articulate the F0 contours in a non-speech context differed from that of the native speakers. The fourth experiment showed that although learners were able to hear the phonetic differences between the target L2 contrasts, due to poor formation of the target L2 categories and poor lexical assignment ability, the inexperienced learners seem to have greater difficulty than experienced learners both in categorizing boundary items into the target L2 categories and in assigning the L2 categories to lexical items. Overall, the foreign accent of adult L2 learners’ productions is explained through a combination of articulation and categorization factors. Importantly, this cross-sectional study has indicated how learners’ problems with foreign accent change as they gain L2 experience. Whereas experienced learners seem to have problems mainly in the articulation and phonetic realization of the L2 contrasts, the inexperienced learners seem to have mainly problems in phonetic and lexical-phonological representations of the target L2 categories in addition to articulation and phonetic realization. This study offers both theoretical insights for the field of L2 speech acquisition research and also practical insights for the L2 classroom.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

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Sites of blood collection and topical disinfectants associated with contaminated cultures: An ambidirectional cohort study

Abstract Background We aimed to determine whether puncture sites for blood sampling and topical disinfectants are associated with rates of contaminated blood cultures in the emergency department (ED) of a single institution. Methods This single‐center, ambidirectional cohort study of 548 consecutive patients ≥20 years of age was performed in the ED of a university hospital in Japan over a 13‐month period. Pairs of blood samples were collected for aerobic and anaerobic cultures from patients in the ED. Physicians selected puncture sites and topical disinfectants according to their personal preference. Results Potential contamination was identified in 110 of the 548 patients (20.1%). One hundred fourteen (20.8%) patients showed true‐positive results for bacteremia, and 324 (59.1%) patients showed true‐negative results. Multivariate analysis revealed more frequent contamination when puncture sites were disinfected with povidone‐iodine (PVI) than with alcohol/chlorhexidine (ACHX) (adjusted risk difference, 19.1%; 95% confidence interval [CI]), 15.7–22.6; p < 0.001). In terms of blood collection sites, femoral and central venous (CV) catheter with PVI disinfection showed more frequent contamination than venous sites with ACHX (adjusted risk differences: 26.6%, 95% CI 21.3–31.9, p < 0.001 and 41.1%, 95% CI 22.2–59.9, p < 0.001, respectively). Conclusion Rates of contaminated blood cultures were significantly higher when blood was collected from the CV catheter or femoral sites with PVI as the topical disinfectant