Review of recent research on hepatitis C therapy for 54th annual meeting of the American association for the study of liver diseases

Background
Postoperative nausea and vomiting (PONV) are common complications following surgery and anaesthesia. Antiemetic drugs are only partially effective in preventing PONV. An alternative approach is to stimulate the PC6 acupoint on the wrist. This is an update of a Cochrane review first published in 2004, updated in 2009 and now in 2015.

Objectives
To determine the effectiveness and safety of PC6 acupoint stimulation with or without antiemetic drug versus sham or antiemetic drug for the prevention of PONV in people undergoing surgery.

Search methods
We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (Cochrane Library, Issue 12, 2014), MEDLINE (January 2008 to December 2014), EMBASE (January 2008 to December 2014), ISI Web of Science (January 2008 to December 2014), World Health Organization Clinical Trials Registry, ClinicalTrials.gov, and reference lists of articles to identify additional studies. We applied no language restrictions.

Selection criteria
All randomized trials of techniques that stimulated the PC6 acupoint compared with sham treatment or drug therapy, or combined PC6 acupoint and drug therapy compared to drug therapy, for the prevention of PONV. Interventions used in these trials included acupuncture, electro-acupuncture, transcutaneous electrical acupoint stimulation, transcutaneous nerve stimulation, laser stimulation, capsicum plaster, acu-stimulation device, and acupressure in people undergoing surgery. Primary outcomes were the incidences of nausea and vomiting after surgery. Secondary outcomes were the need for rescue antiemetic therapy and adverse effects.

Data collection and analysis
Two review authors independently extracted the data and assessed the risk of bias domains for each trial. We used a random-effects model and reported risk ratio (RR) with associated 95% confidence interval (95% CI). We used trial sequential analyses to help provide information on when we had reached firm evidence in cumulative meta-analyses of the primary outcomes, based on a 30% risk ratio reduction in PONV.

Main results
We included 59 trials involving 7667 participants. We rated two trials at low risk of bias in all domains (selection, attrition, reporting, blinding and other). We rated 25 trials at high risk in one or more risk-of-bias domains. Compared with sham treatment, PC6 acupoint stimulation significantly reduced the incidence of nausea (RR 0.68, 95% CI 0.60 to 0.77; 40 trials, 4742 participants), vomiting (RR 0.60, 95% CI 0.51 to 0.71; 45 trials, 5147 participants) and the need for rescue antiemetics (RR 0.64, 95% CI 0.55 to 0.73; 39 trials, 4622 participants). As heterogeneity among trials was substantial and there were study limitations, we rated the quality of evidence as low. Using trial sequential analysis, the required information size and boundary for benefit were reached for both primary outcomes.

PC6 acupoint stimulation was compared with six different types of antiemetic drugs (metoclopramide, cyclizine, prochlorperazine, droperidol. ondansetron and dexamethasone). There was no difference between PC6 acupoint stimulation and antiemetic drugs in the incidence of nausea (RR 0.91, 95% CI 0.75 to 1.10; 14 trials, 1332 participants), vomiting (RR 0.93, 95% CI 0.74 to 1.17; 19 trials, 1708 participants), or the need for rescue antiemetics (RR 0.87, 95% CI 0.65 to 1.16; 9 trials, 895 participants). We rated the quality of evidence as moderate, due to the study limitations. Using trial sequential analyses, the futility boundary was crossed before the required information size was surpassed for both primary outcomes.

Compared to antiemetic drugs, the combination of PC6 acupoint stimulation and antiemetic therapy reduced the incidence of vomiting (RR 0.56, 95% CI 0.35 to 0.91; 9 trials, 687 participants) but not nausea (RR 0.79, 95% CI 0.55 to 1.13; 8 trials, 642 participants). We rated the quality of evidence as very low, due to substantial heterogeneity among trials, study limitations and imprecision. Using trial sequential analysis, none of the boundaries for benefit, harm or futility were crossed for PONV. The need for rescue antiemetic was lower in the combination PC6 acupoint stimulation and antiemetic group than the antiemetic group (RR 0.61, 95% CI 0.44 to 0.86; 5 trials, 419 participants).

The side effects associated with PC6 acupoint stimulation were minor, transient and self-limiting (e.g. skin irritation, blistering, redness and pain) in 14 trials. Publication bias was not apparent in the contour-enhanced funnel plots.

Authors' conclusions
There is low-quality evidence supporting the use of PC6 acupoint stimulation over sham. Compared to the last update in 2009, no further sham comparison trials are needed. We found that there is moderate-quality evidence showing no difference between PC6 acupoint stimulation and antiemetic drugs to prevent PONV. Further PC6 acupoint stimulation versus antiemetic trials are futile in showing a significant difference, which is a new finding in this update. There is inconclusive evidence supporting the use of a combined strategy of PC6 acupoint stimulation and antiemetic drug over drug prophylaxis, and further high-quality trials are needed.

Stimulation of the wrist acupuncture point PC6 for preventing postoperative nausea and vomiting

Pharmacology and Physiology in Anesthetic Practice

The aim of this study was to investigate two different acupuncture approaches in the treatment of orthodontic patients with a gagging reflex (GR). Forty-five patients (mean age 10.1 + or - 2.6 years) had an upper dental alginate impression taken prior to receiving laser stimulation. GR assessment was evaluated by using the Gagging Severity Index (GSI). Fifteen patients in Group A underwent a red-light soft magnetic field laser stimulation of conception vessel 24 (CV 24) for 1 min. Fifteen other patients in Group B undertook a combination of laser stimulation of CV 24 and acupressure pericardium 6 (PC 6). Group C, which consisted of the remaining 15 patients, formed the placebo group. After the laser stimulation and acupressure, a second impression was taken. The Gagging Prevention Index (GPI) was used to evaluate gagging reflex after the laser stimulation and acupressure. Both GSI and GPI were recorded at three stages of the dental impression taking procedure, ie with an empty impression tray, with a loaded tray and the ability to keep the impression in the mouth until set. A significant decrease in GPI values compared to GSI values, was observed at the three stages of the impression taking process and after the laser stimulation in Group A and B (p <0.05). The average improvement between the GSI and GPI scores was 58.9% before and after the laser stimulation in Group B 37.9% in Group A and 11.2% in Group C. Both acupuncture points CV 24 and PC 6 were found to be effective in controlling GR in orthodontic patients.

/pdf/the-role-of-acupuncture-in-the-treatment-of-orthodontic-2mqkavsxi0.pdf

The role of acupuncture in the treatment of orthodontic patients with a gagging reflex: a pilot study.

Postoperative nausea and vomiting (PONV) is one of the most common postoperative complications. Aside from pharmacological interventions, other complementary healing modalities have been introduced to assist patients in decreasing PONV and improving postoperative outcomes. This study examined acupressure as a safe complement to the more traditional approach of using drugs to prevent and/or relieve nausea and vomiting in the Cesarean section (C/S) under spinal anesthesia. In a prospective randomized clinical trial, 152 patients who were candidate for elective C/S under spinal anesthesia were evaluated in two groups (acupressure vs control groups). Subjects in the acupressure group received constant pressure by a specific wrist elastic band (without puncture of the skin) on the Nei-Guan acupuncture point, 30 min prior to spinal anesthesia. The incidence of PONV was assessed during the surgery, at recovery room and at 1st, 2nd and 3rd two hours after the surgery. Significant differences in the incidence of the post-operative nausea and vomiting were found between the acupressure and control groups, with a reduction in the incidence rate of nausea from 35.5% to 13.2%. The amount of vomitus and the degree of discomfort were, respectively, less and lower in the study group. In view of the total absence of side-effects in acupressure, its application is worthy. Our study confirmed the effectiveness of acupressure in preventing post-operative nausea and vomiting, when applied 30 minutes prior to surgery.

/pdf/the-effect-of-acupressure-on-nausea-and-vomiting-after-1te0tcgzly.pdf

The effect of acupressure on nausea and vomiting after cesarean section under spinal anesthesia.

PURPOSE This study was done to investigate correlations between compliance and physiological parameters of hemodialysis patients. METHOD The subjects were 102 patients on hemodialysis at 3 hospitals in B city. Data was collected using Shon(1986)'s questionnaire and measuring physiological parameters (serum urea nitrogen, creatinine, hemoglobin, albumin, potassium, phosphorus, interdialytic weight gain). RESULT Mean scores of compliance with the therapeutic regimen was 4.00+/-0.55 on a 5 point scale. The area of visiting hospitals and taking medicines were shown to have high compliance with therapeutic regimens; on the other hand, the areas concerning diet and symptoms were shown to be low. Interdialytic weight gain and phosphorus were significantly related to the compliance with therapeutic regimens. CONCLUSION Hemodialysis patients' therapeutic compliance was related to the physiological parameters(potassium, phosphorus, interdialytic weight gain). Therefore, these findings give hemodialysis patients useful information for raising their therapeutic compliance.

/pdf/hyeolaegtuseog-hwanjayi-ciryojisi-ihaengjeongdowa-2c3rx50uzg.pdf

혈액투석 환자의 치료지시 이행정도와 생리적 지표와의 관계

Purpose: This study was to identify the effects of Nei-Guan accupressure using a wrist band on postoperative nausea and vomiting after middle ear surgery. Methods: The study design was a nonequivalent control group non-synchronized posttest design. Forty patients were assigned into two groups of 20 patients, the wrist band group and the control group. In the wristband group, acupressure was applied with a wrist band on the P6 point at both wrists from 30 min before to 24 hr after anesthesia. Results: The 1st hypothesis ‘Applied wrist band groups will have a greater reduction in the nausea & vomiting grades by INVR than the control group’ was accepted (t=2.303, p=.028). The 2nd hypothesis ‘The Applied wrist band groups will have a greater reduction in the occurrence of nausea & vomiting than the control group’ was partly accepted. The 3rd hypothesis ‘The applied wrist band group will have a greater reduction in injection of antiemetics for 24 hr. post anesthesia than the control group’ was rejected. Conclusion: Acupressure on the P6 point using a wrist band is effective to alleviate nausea for middle ear surgery patients.

/pdf/effects-of-the-nei-guan-acupressure-by-wrist-band-on-2h2rzivwew.pdf

[Effects of the Nei-Guan acupressure by wrist band on postoperative nausea and vomiting after middle ear surgery].

Purpose: In this single repeated measures study, an examination was done on the effects of dialysate flow rate on dialysis adequacy and fatigue in patients receiving hemodialysis. Methods: This study was a prospective single center study in which repeated measures analysis of variance were used to compare Kt/V urea (Kt/V) and urea reduction ratio (URR) as dialysis adequacy measures and level of fatigue at different dialysate flow rates: twice as fast as the participant’s own blood flow, 500 mL/min, and 700 mL/min. Thirty-seven hemodialysis patients received all three dialysate flow rates using counterbalancing. Results: The Kt/V (M±SD) was 1.40±0.25 at twice the blood flow rate, 1.41±0.23 at 500 mL/min, and 1.46±0.24 at 700 mL/min. The URR (M±SD) was 68.20±5.90 at twice the blood flow rate, 68.67±5.22 at 500 mL/min, and 70.11±5.13 at 700 mL/min. When dialysate flow rate was increased from twice the blood flow rate to 700 mL/min and from 500 mL/min to 700 mL/min, Kt/V and URR showed relative gains. There was no difference in fatigue according to dialysate flow rate. Conclusion: Increasing the dialysate flow rate to 700 mL/min is associated with a significant nicrease in dialysis adequacy. Hemodialysis with a dialysate flow rate of 700 mL/min should be considered in selected patients not achieving adequacy despite extended treatment times and optimized blood flow rate.

https://www.jkan.or.kr/Synapse/Data/PDFData/0006JKAN/jkan-46-642.pdf

The Effect of Dialysate Flow Rate on Dialysis Adequacy and Fatigue in Hemodialysis Patients

Purpose: This study was to test the effects of the positional change on low back pain, discomfort, and bleeding complications during the period of bed rest following transarterial chemoembolization (TACE). Methods: The research design for this study was a non-equivalent control group quasi-experimental design. The participants were 23 patients for the experimental group, and 23 patients for the control group. The experimental group received positional change of taking the semi-Fowler's position and the 30-degree lateral position alternatively during the period of bed rest after TACE for 4 hours at one-hour intervals. The control group maintained the supine position continuously during the period of bed rest after TACE. Results: There were statistically significant differences in low back pain and discomfort between the experimental and the control group after intervention. And no significant difference was found in bleeding complication between two groups. Conclusion: The results of the study suggest that the positional change is an effective nursing intervention to reduce low back pain and discomfort without increasing the risk of bleeding after TACE.

/pdf/the-effects-of-position-change-on-low-back-pain-discomfort-753oogmkm4.pdf

The Effects of Position Change on Low Back Pain, Discomfort, and Bleeding after Transarterial Chemoembolization

PURPOSE This study tries to explore mothers' stress patterns and the related factors influencing mothers' stress over time after giving birth to premature babies. METHOD Eighty four mothers who had given birth to premature babies were selected from Hospitals in B city. Data was collected using a self-reporting questionnaire that the mothers' stress level. RESULT The mothers' stress after giving birth to premature babies gradually diminished and the stress pattern of mothers changed over time. Mother's age, occupation, income level, gestational period of the measures baby, weight at birth, nutrition type, lactation mode, number of complications, and existence or non-existence of an operation were analyzed as the factors that affected the mother's stress. CONCLUSION The stress pattern of mothers giving birth to premature babies changed overtime. Based on the study results, it is considered that the nursing intervention programs should be developed in order to reduce the stress of premature baby's mothers with time elapse.

https://jkan.or.kr/Synapse/Data/PDFData/1006JKAN/jkan-34-1265.pdf

Hye Sook Min

Papers

혈액투석 환자의 치료지시 이행정도와 생리적 지표와의 관계

[Effects of the Nei-Guan acupressure by wrist band on postoperative nausea and vomiting after middle ear surgery].

The Effect of Dialysate Flow Rate on Dialysis Adequacy and Fatigue in Hemodialysis Patients

The Effects of Position Change on Low Back Pain, Discomfort, and Bleeding after Transarterial Chemoembolization

[The change of the mother's stress pattern with time elapse after giving birth to premature babies].