Meeting patient expectations in relation to pain management is an essential component of palliative and end-of-life care. However, previous research has demonstrated that pain is highly prevalent, especially during the four months prior to death. Poorly controlled pain contributes to cognitive failure, depression and an inability to complete daily activities. Unfortunately, pain and symptom management are often inadequate for patients placed in hospice care. The purpose of this study is to evaluate the perspectives of hospice nurses on complementary and alternative therapies to determine if there is an educational need in order to aide in the management of chronic pain in older adults. A survey was developed in order to determine the nursing perceptions of complementary and alternative therapies. A total of 24 participants were recruited. The survey targeted 28 complementary and alternative therapies most commonly used as defined by National Institute for Complementary and Alternative Medicines (NCCAM). Each therapy was ranked on several aspects including perceptions, personal experience, and present knowledge and training. After completing the survey it was found that all participants were either eager or open to use some complementary and alternative therapies in their workplace, in spite of having an educational barrier on how to implement them, and wanted these therapies to become available to patients, families, and staff.

Fibromyalgia is a chronic widespread pain disorder that can also cause fatigue, depression, sleep disturbances, and cognitive symptoms. Because the etiology of fibromyalgia is unknown, it is difficult to treat. Research shows that medication alone is insufficient to treat the symptoms of fibromyalgia and that complementary therapies are required to fully manage this disorder. The purpose of this research was to determine what complementary therapies patients with fibromyalgia were currently using. The sample for the survey was taken from fibromyalgia support groups throughout the state of Florida. A total of 15 people diagnosed with fibromyalgia participated in the survey. The most commonly used complementary therapies included diet and relaxation techniques. The therapies that were rarely or never used were hypnotherapy, Tai Chi, and Chi (Qi) Gong. These findings provide evidence to support client education concerning the use of complementary therapies for individuals with fibromyalgia. Research with larger samples is recommended to provide further evidence of the effectiveness of complementary therapies for this patient population.

The purpose of this study was to analyze the effects of an 8-week judo program on self-competency, physical activity (PA) motivation, and enjoyment of PA in children diagnosed with Autism Spectrum Disorder (ASD). METHODS: The sample included 20 children (ages 8 – 17) with a primary diagnosis of ASD. The participants completed an 8-week judo program that occurred once a week for 45 minutes. Participants were instructed to complete a series of questionnaires that measured athletic self-competency, PA motivation, and PA enjoyment at baseline and at the end of the 8-week judo program. Paired t-tests were conducted to examine differences in psychosocial factors from baseline and post-judo. Additionally, correlational analyses were conducted to examine the association between the psychosocial variables and attendance during the 8-week program. RESULTS: Although increases in psychosocial factors were observed following the cessation of the judo program, these changes were not statistically significant for any of the psychosocial factors following the 8-week program. There was a significant, positive association between PA motivation and judo attendance (r=.43, p=.05), however, neither athletic competency nor PA enjoyment were correlated with judo attendance. CONCLUSION: Although not significant, improvement in psychosocial factors were observed post-judo program. Future studies should consider increasing the duration and frequency of the judo program to potentially elicit greater changes in psychosocial factors related to PA.

Medulloblastoma (MB) is the most common malignant pediatric brain tumor. Out of the four molecular subgroups (WNT, SHH, Group 3 and Group 4), Group 3 patients face the highest incidence of leptomeningeal spread and overall patient survival of less than 50%. Current clinical trials for recurrent MB patients based on genomic profiles of primary, treatment-naïve tumors, provide limited clinical benefit since recurrent metastatic MBs are highly genetically divergent from their primary tumors. The paucity of patient matched primary and recurrent MB samples has contributed to the lack of molecular targets specific to medulloblastoma recurrence, limiting relapsing MB patients to palliation. Our previous in silico analyses revealed enriched expression of many stem cell self-renewal regulatory genes in Group 3 MB. In this work, I have set out to investigate whether by identifying genes contributing to self-renewal of Group 3 MB cells, we can characterize a population of cells responsible for therapy evasion and subsequent tumor relapse. Initially, we have adapted the existing COG (Children’s Oncology Group) protocol for children with newly diagnosed high-risk MB for treatment of immuno-deficient mice intracranially xenografted with human MB cells. Cell populations recovered separately from brains and spines mice during the course of tumor development and therapy were comprehensively profiled for gene expression analysis, stem cell and molecular features to generate a global, comparative profile of MB cells through therapy. Additionally, we have investigated therapeutic potential of small molecules targeting BMI1, a known self-renewal regulating gene. In the setting of recurrent Group 3 MB, pharmacological inhibition of BMI1, led to a remarkable decrease in cell proliferation and self-renewal in vitro as well as reduction of local and spinal metastatic disease in vivo. Finally, by combining the established therapy-adapted patient-derived xenograft mouse model and BMI1 inhibitor, PTC-596, we have demonstrated an additive effect of two modalities and provided the pre-clinical data for the upcoming Phase I trial. Biological investigations into the drivers of MB recurrence will lead to development of new therapeutic options for children who are frequently limited to palliation. Clinically relevant mouse models of MB recurrence can serve as platforms for pre-clinical testing and validation of new treatments aimed to provide therapeutic intervention rather than palliation. / Thesis / Doctor of Philosophy (PhD) / Medulloblastoma is the most common type of brain cancer that affects children. Out of the four main subgroups of medulloblastoma, tumors in Groups 3 and 4 are the most aggressive and are associated with a low overall survival in children diagnosed with this type of brain cancer. These two subtypes of medulloblastoma also account for the largest number of patients in which gold standard therapies fail and no additional therapies are available. Several studies have shown the existence of few cells within the tumor that alone can drive tumor growth. The aggressive behavior of these cells has in part been attributed to dysregulation of genes involved in cell replication and division. Further studies that will focus on understanding the significance of genes that regulate cell growth and replication can help discover a population of cells that is capable of evading therapy and contribute to tumor relapse. The identification and characterization of such population can lead to development of novel treatments for the children affected with aggressive medulloblastoma. In my thesis, I have developed a mouse model that replicates the aggressive therapy given to the medulloblastoma patients in order to study cells capable of escaping the harsh treatment and drive tumor comeback. Next, by profiling the gene expression and functional attributes of those cells, we identified genes that contribute to regulation of cell division and growth. The effects of both increasing and decreasing the activity of those genes were then tested in cells grown in the dish. Subsequently, the most promising results were verified in the established mouse models. The main objective of my thesis was to discover new opportunities in treatments the most aggressive type of brain cancer affecting children, and thus not only improve the quality of treatment but also the overall survival of patients with medulloblastoma.

According to the American Cancer Society (2009) it is estimated that there will be 1.5 million new cases of cancer in the United States in 2009. Pain is a common symptom experienced by cancer patients throughout various stages of the disease process, as well as while undergoing cancer treatment. Research has found that between 30 and 45% of cancer patients report pain upon diagnosis or at some stage throughout the course of the disease, while 75% of patients with advanced cancer report suffering from pain. The pain experienced by cancer patients is often under treated. Unrelieved pain has negative effects on almost every aspect of an individual's life resulting in needless suffering, decreased quality of life, immunosuppression, and additional burdens on family caregivers. The under treatment of pain in cancer patients could be due in part to the fact that cancer pain is not always completely relieved by analgesic medications. Research is beginning to support the integration of complementary, nonpharmacologic, interventions for pain relief along with a traditional analgesic regimen in order to provide optimal management of pain in cancer patients. The purpose of this integrative review of literature is to examine the use and effectiveness of complementary therapies for the management of pain in cancer patients. Findings indicate that the majority of complementary therapies are effective in improving the pain experience among cancer patients. Recommendations for nursing practice, research, and education will be provided.

A música exerce efeitos diversos no nosso organismo como terapêutica complementar. Quando uma mãe tem um filho hospitalizado, sente-se insegura e com medo do futuro, gerando ansiedade. Este estudo objetivou verificar se o canto Gregoriano altera o estado de ansiedade de mães com filhos internados. Pesquisa do tipo descritiva, exploratória, correlacional com análise quantitativa, quase-experimental em uma unidade de internação de especialidades de hospital governamental de grande porte, pediátrico de atenção quaternária. A unidade é para atendimento a convenios empresariais, com 15 leitos ativos. Amostra inicial composta por 71 mães, sendo que 28 concluíram todas as etapas da coleta de dados. A mãe foi convidada, pessoalmente, a participar da pesquisa e após o aceite do convite, assinou o Termo de Consentimento Livre e Esclarecido e preencheu o Inventário de Diagnóstico de Ansiedade Traço. Foram agendados dois encontros no quarto individual do próprio paciente para a realização da audição musical de canto Gregoriano com utilização de equipamento digital e uso de fones de ouvido. Também foram respondidos o formulário de identificação do sujeito da pesquisa contendo dados pessoais, dados relacionados ao filho internado e informações sonoro-musicais e o Inventário de Diagnóstico de Ansiedade Estado antes e após cada audição musical. A primeira audição musical foi com, no mínimo, 48 horas de internação e a segunda audição musical foi agendada 48 horas após a primeira. A pesquisadora permaneceu no quarto nos primeiros e nos últimos 5 minutos da audição musical das mães. Os dados foram armazenados em planilha Excel for Windows Explorer® e analisados em programa SPSS - Statistical Package for the Social Sciences - Versão 18.0. Foram realizadas análises estatísticas descritivas através de: teste de normalidade (Kolmogorov-Smirnov), correlação de Pearson entre os escores da escala de ansiedade; análise de variância (ANOVA ONE WAY) para comparar os escores da escala de ansiedade; teste t de student para comparar as médias entre os escores e as variáveis sócio-demográficas. Adotado o nível de 5% de significância nas análises estatísticas. Na primeira audição musical verificou-se que 25(89,2%) mães tiveram seu estado de ansiedade diminuidos e na segunda audição musical, 25(89,2%) continuaram a ter seu estado de ansiedade diminuído. Apesar de não permitir generalizações devido o número limitado de mães participantes deste estudo, pôde-se concluir que a utilização do canto Gregoriano diminui o estado de ansiedade das mães de crianças hospitalizadas em um hospital pediátrico de atenção quaternária acomodados em quartos individuais. É necessário que se amplie o estudo dos estilos musicais para sua aplicabilidade na assistência de enfermagem com mães de crianças hospitalizadas. / The Music exerts different effects on our body, such as complement therapy. When the mother have hospitalized child feel insecurity and fear of the future, causing anxiety. This research aimed to verify if the Gregorian chant changes the state of anxiety of mothers with hospitalized children. Descriptive research, exploratory, correlational with quantitative analysis, almost-experimental, done in large-sized teaching hospital in units of quaternary care pediatric specialties, with 15 active beds, whose focus of attendance are business and individual agreements. Initial sample composed of 71 mothers, but only 28 mothers completed all stages of the data collection. Mothers were invited personally to participate in the study and after agreeing to sign the Informed Consent to fill the Diagnostic Inventory Trait Anxiety. Two meetings were scheduled in the patient bedroon individual, so they listened the Gregorian chant with the use of Digital Equipment and headphones. They were also answered the identification form the subject of the investigation that contains personal data relating to child boarding and sound-musical information and the Diagnostic Inventory State Anxiety before and after each listening session. The listening session was first with at least 48 hours of hospitalization and the second listening session was scheduled 48 hours after the fisrt. The researher stay in the room at the first and the last five minutes of music listening mothers. The datas were stored in Excel spreadsheet for Windows Explorer ® and analyzed in SPSS - Statistical Package for the Social Sciences - Version 18.0. Descriptive statistical analysis were carried out through: test of normality (Kolmogorov-Smirnov), Pearson correlation between the scores of the anxiety scale, analysis of variance (ANOVA - ONE WAY) to compare the scores of the anxiety scale; test t student to compare means between the scores and socio-demographic variables. Adopted 5% level of significance in statistical analysis. At the first listening session was verified that 25 (89.2%) mothers had decreased their anxiety state and the second listening session, 25 (89.2%) continued their state of anxiety decreased. Despite not allow generalizations due to the limited number of mothers participating in this study, so it was concluded that the use of Gregorian chant decreases anxiety of mothers with children hospitalized in quaternary care pediatric hospital accommodated in rooms individualized. It is necessary to broaden the study of musical styles to applicate in nursing care com mothers of hospitalized children.

The growing interest and use of complementary and alternative approaches by the general public has created pressure on many health care providers to broaden their traditional scope of practice and integrate complementary and alternative therapies into their repertoire. This study examined the knowledge, attitudes, and level of integration of complementary and alternative approaches by Canadian social workers. Due to limited literature on social work use of complementary and alternative approaches, a broad operational definition of Complementary and Alternative Medicine (CAM) was utilized in the study and a wide range of approaches were listed in the questionnaire. This cross-sectional, descriptive, quantitative research study included 311 Canadian social workers. A self-administered, web-based survey was developed for the study to examine social workers’ level of knowledge, use, as well as attitudes toward complementary and alternative medicine. Based on the findings of the study, Canadian social workers demonstrate general familiarity with CAM, however are less likely to be trained in the approaches. Despite lack of appropriate training, a significant number of social workers integrate complementary and alternative approaches into their practice. Overall, Canadian social workers hold a positive attitude toward complementary and alternative medicine. They express interest in broadening their knowledge in CAM as well as are open to integrating some approaches into their practice. Implications of the findings and further research suggestion are offered at the conclusion of the thesis. There are several implications from this study, most importantly the need for clear guidelines around integration of those approaches into social work practice and inclusion of complementary and alternative methods into social work educational curriculum. There exists number of external and internal threats to validity of the study. The limitations of the study include lack of participation from a number of Canadian provincial social work regulatory bodies. Also the use of web based, English only survey, and may have deterred some social workers. Self-selection process may have attracted those with extreme opinions about the topic. The descriptive nature of the study did not require manipulation of the variables, the analysis was bi-variate, and, therefore could not account for confounding factors.

The growing interest and use of complementary and alternative approaches by the general public has created pressure on many health care providers to broaden their traditional scope of practice and integrate complementary and alternative therapies into their repertoire. This study examined the knowledge, attitudes, and level of integration of complementary and alternative approaches by Canadian social workers. Due to limited literature on social work use of complementary and alternative approaches, a broad operational definition of Complementary and Alternative Medicine (CAM) was utilized in the study and a wide range of approaches were listed in the questionnaire. This cross-sectional, descriptive, quantitative research study included 311 Canadian social workers. A self-administered, web-based survey was developed for the study to examine social workers’ level of knowledge, use, as well as attitudes toward complementary and alternative medicine. Based on the findings of the study, Canadian social workers demonstrate general familiarity with CAM, however are less likely to be trained in the approaches. Despite lack of appropriate training, a significant number of social workers integrate complementary and alternative approaches into their practice. Overall, Canadian social workers hold a positive attitude toward complementary and alternative medicine. They express interest in broadening their knowledge in CAM as well as are open to integrating some approaches into their practice. Implications of the findings and further research suggestion are offered at the conclusion of the thesis. There are several implications from this study, most importantly the need for clear guidelines around integration of those approaches into social work practice and inclusion of complementary and alternative methods into social work educational curriculum. There exists number of external and internal threats to validity of the study. The limitations of the study include lack of participation from a number of Canadian provincial social work regulatory bodies. Also the use of web based, English only survey, and may have deterred some social workers. Self-selection process may have attracted those with extreme opinions about the topic. The descriptive nature of the study did not require manipulation of the variables, the analysis was bi-variate, and, therefore could not account for confounding factors.

Thesis (M.S.W.)--Smith College School for Social Work, Northampton, Mass., 2008. / Typescript. Includes bibliographical references (leaves 55-59).

A música exerce efeitos diversos no nosso organismo como terapêutica complementar. Quando uma mãe tem um filho hospitalizado, sente-se insegura e com medo do futuro, gerando ansiedade. Este estudo objetivou verificar se o canto Gregoriano altera o estado de ansiedade de mães com filhos internados. Pesquisa do tipo descritiva, exploratória, correlacional com análise quantitativa, quase-experimental em uma unidade de internação de especialidades de hospital governamental de grande porte, pediátrico de atenção quaternária. A unidade é para atendimento a convenios empresariais, com 15 leitos ativos. Amostra inicial composta por 71 mães, sendo que 28 concluíram todas as etapas da coleta de dados. A mãe foi convidada, pessoalmente, a participar da pesquisa e após o aceite do convite, assinou o Termo de Consentimento Livre e Esclarecido e preencheu o Inventário de Diagnóstico de Ansiedade Traço. Foram agendados dois encontros no quarto individual do próprio paciente para a realização da audição musical de canto Gregoriano com utilização de equipamento digital e uso de fones de ouvido. Também foram respondidos o formulário de identificação do sujeito da pesquisa contendo dados pessoais, dados relacionados ao filho internado e informações sonoro-musicais e o Inventário de Diagnóstico de Ansiedade Estado antes e após cada audição musical. A primeira audição musical foi com, no mínimo, 48 horas de internação e a segunda audição musical foi agendada 48 horas após a primeira. A pesquisadora permaneceu no quarto nos primeiros e nos últimos 5 minutos da audição musical das mães. Os dados foram armazenados em planilha Excel for Windows Explorer® e analisados em programa SPSS - Statistical Package for the Social Sciences - Versão 18.0. Foram realizadas análises estatísticas descritivas através de: teste de normalidade (Kolmogorov-Smirnov), correlação de Pearson entre os escores da escala de ansiedade; análise de variância (ANOVA ONE WAY) para comparar os escores da escala de ansiedade; teste t de student para comparar as médias entre os escores e as variáveis sócio-demográficas. Adotado o nível de 5% de significância nas análises estatísticas. Na primeira audição musical verificou-se que 25(89,2%) mães tiveram seu estado de ansiedade diminuidos e na segunda audição musical, 25(89,2%) continuaram a ter seu estado de ansiedade diminuído. Apesar de não permitir generalizações devido o número limitado de mães participantes deste estudo, pôde-se concluir que a utilização do canto Gregoriano diminui o estado de ansiedade das mães de crianças hospitalizadas em um hospital pediátrico de atenção quaternária acomodados em quartos individuais. É necessário que se amplie o estudo dos estilos musicais para sua aplicabilidade na assistência de enfermagem com mães de crianças hospitalizadas. / The Music exerts different effects on our body, such as complement therapy. When the mother have hospitalized child feel insecurity and fear of the future, causing anxiety. This research aimed to verify if the Gregorian chant changes the state of anxiety of mothers with hospitalized children. Descriptive research, exploratory, correlational with quantitative analysis, almost-experimental, done in large-sized teaching hospital in units of quaternary care pediatric specialties, with 15 active beds, whose focus of attendance are business and individual agreements. Initial sample composed of 71 mothers, but only 28 mothers completed all stages of the data collection. Mothers were invited personally to participate in the study and after agreeing to sign the Informed Consent to fill the Diagnostic Inventory Trait Anxiety. Two meetings were scheduled in the patient bedroon individual, so they listened the Gregorian chant with the use of Digital Equipment and headphones. They were also answered the identification form the subject of the investigation that contains personal data relating to child boarding and sound-musical information and the Diagnostic Inventory State Anxiety before and after each listening session. The listening session was first with at least 48 hours of hospitalization and the second listening session was scheduled 48 hours after the fisrt. The researher stay in the room at the first and the last five minutes of music listening mothers. The datas were stored in Excel spreadsheet for Windows Explorer ® and analyzed in SPSS - Statistical Package for the Social Sciences - Version 18.0. Descriptive statistical analysis were carried out through: test of normality (Kolmogorov-Smirnov), Pearson correlation between the scores of the anxiety scale, analysis of variance (ANOVA - ONE WAY) to compare the scores of the anxiety scale; test t student to compare means between the scores and socio-demographic variables. Adopted 5% level of significance in statistical analysis. At the first listening session was verified that 25 (89.2%) mothers had decreased their anxiety state and the second listening session, 25 (89.2%) continued their state of anxiety decreased. Despite not allow generalizations due to the limited number of mothers participating in this study, so it was concluded that the use of Gregorian chant decreases anxiety of mothers with children hospitalized in quaternary care pediatric hospital accommodated in rooms individualized. It is necessary to broaden the study of musical styles to applicate in nursing care com mothers of hospitalized children.