Single-session versus two-session placement of chest port and gastrostomy tube in patients with head and neck cancer: Is there any difference in the device-related early infection rates?

Background It is unknown whether placement of a chest port (port) and a gastrostomy tube (G-tube) in a single session increases the risk of the early device infections in patients with head and neck cancer (HNC) undergoing chemoradiation. Purpose To compare the incidence of early (≤30 days) port and G-tube infections placed in a single session compared to two separate sessions in patients with HNC. Material and Methods Between January 2012 and December 2019, 169 patients with HNC undergoing chemoradiation had a port and a G-tube placed in a single session (single-session group), while 25 had both devices placed in two separate sessions (two-session group) within 30 days of each other. The incidence of early device infections was compared between groups. Logistic regression analysis was conducted to determine if the number of sessions was a variable affecting device infections. Results A total of 6 (3%) early port infections and 13 (6.7%) early G-tube infections were identified. The two groups did not significantly differ in the incidence of early port infections (3.0%, 5/169 and 4.0%, 1/25, p = 0.59) nor early G-tube infections (7.1%, 12/169 and 4.0%, 1/25, p = 1.0). The number of sessions for device placement was not a variable affecting overall device infections in logistic regression analyses (odds ratio: 1.24, 95% confidence interval: 0.20–7.82, p = 0.82) after controlling for potential confounding variables. Conclusions The risk of early device infections in single-session placement appeared to be the same as two-session placement in patients with HNC undergoing chemoradiation.

Comparison of two formats of journal club for postgraduate students at two centers in developing critical appraisal skills

Journal club (JC) is an integral part of postgraduate medical education. Although several innovations have been attempted to improve its effectiveness, the influence of the number of sessions remains unexplored. The current study investigated the effect of the number of sessions (one vs. four) of conduction of journal club on critical appraisal skills of postgraduate students at two institutions. A quasi-experimental study was conducted comparing the effectiveness of JC in a one- versus four-session JC format using two objective tests: Critical Appraisal Skills Test (CAST) and Population, Intervention, Comparison, Outcome (PICO) score. The degree of changes (pre-JC vs. post-JC session) after each format exposure, association of prescores to postscores, and correlation between the CAST and PICO scores were discerned. CAST score was higher in the four-session format ( P = 0.03), whereas PICO score increased in the single-session format of JC ( P = 0.03). Also, the change in CAST score was higher in the four-session versus single-session JC format ( P = 0.04). We conclude that a four-session format of JC is more effective in augmenting critical appraisal skills of postgraduate students, whereas a single session is sufficient for improving factual knowledge.

Self-Selected Music for Relational Trauma: Commentary on the Psychotherapy Case of "James"

This commentary discusses Dr. Paul Blimling’s (2019) composite case of James, a patient with a history of severe childhood interpersonal trauma, who responded remarkably well to individual psychotherapy augmented with the targeted use of self-selected music. I describe how music and psychotherapy both have their origins in the shamanistic practices of our hunter-gatherer ancestors, such that combining psychotherapy and music together is a reconciliation of sorts. The Case of James demonstrates how music can be used in psychotherapy with a counter-dependent patient, to help the patient to access sensitive, vulnerable feelings that normally would never be expressed to another person. In this case, the therapist’s keen sensitivity to the patient’s disorganized attachment style created an environment in which the patient eventually felt safe lowering his defenses and expressing his emotions in the treatment—with the help of five songs. Aside from the direct, visceral benefits of the music itself, the process of asking a relationally traumatized patient to select a song has other potential benefits. For example, it supports the patient’s sense of self (which, in the relationally traumatized patient, is likely fragmented), and it may reduce the "hot seat" feeling with a self-conscious patient, by shifting focus from the patient to the song. Songs selected by patients in advance of a session versus songs selected during a session may provide different types of information, and may have different types of benefits. If I were working with a patient such as James, two additional possibilities I would consider are (a) helping the patient to develop practical skills for managing overwhelming emotions, and (b) making the patient’s goals a more prominent focus throughout the treatment.

The Power of Reiki: Feasibility and Efficacy of Reducing Pain in Children With Cancer Undergoing Hematopoietic Stem Cell Transplantation

Purpose: Reiki is a growing complementary therapy in pediatric oncology that needs evidence to become more credible among the health community. A within-subject design experiment was conducted to pilot testing the feasibility and efficacy of Reiki to provide pain relief among pediatric patients undergoing hematopoietic stem cell transplantation (HSCT). Method: Pediatric patients undergoing HSCT during the inpatient phase in the Stem Cell Transplantation Unit were eligible to participate to the pilot study. Short and medium effects were assessed investigating the increase or decrease of patient’s pain during three specific time periods (“delta”) of the day: morning of the Reiki session versus assessment before Reiki session (within subjects control period), assessment before Reiki session versus assessment after Reiki session (within subjects experimental period) and assessment after Reiki session versus morning the day after Reiki session (within subject follow-up period). The long-term effects were verified comparing the pain evolution in the day of the Reiki session with the following rest day. Results: The effect of 88 Reiki therapy sessions in nine patients (Mage = 12; Female = 61%) was analyzed following a short, medium, and long-term perspective. Repeated-measures analysis of variance revealed a significant difference among the three periods ( F = 17,17 p < .0001): A decrease of the pain occurred in the experimental period in short and medium term, while in the follow-up period, the pain level remained stable. Conclusions: This study demonstrates the feasibility of using Reiki therapy in pediatric cancer patients undergoing HSCT. Furthermore, these findings evidence that trained pediatric oncology nurses can insert Reiki into their clinical practice as a valid instrument for diminishing suffering from cancer in childhood.