Patients were given oral pilocarpine (OP) or placebo, 5 mg tablet blister pack, 1 hour before chemotherapy administration and 1 tablet every eight hours for seven days. After two weeks, the alternate arm was given with the same chemotherapy. Normal saline mouthwash only was permitted. No granulocyte macrophage colony-stimulating factor (GM-CSF), granulocyte colony-stimulating factor (G-CSF), or dose modifications were allowed. Empty blister packs were returned and remaining tablets were counted.

• The study reported on 38 patients with various diagnoses and chemotherapy regimens.
• Median age was 45.8 years, and the age range was 23–62 years.

The study was conducted from February to December of 2000.

This study had a randomized, double-blind, placebo-controlled, cross-over design.

Patients were seen daily on days 7–11 post-chemotherapy. Patients were checked for signs and symptoms of mucositis.

Mucositis was scored using three measures.

A. Method developed by J.P. Donnelly and colleagues, 1992

B. The World Health Organization (WHO) mucositis score

C. Report of mild, moderate, or severe

Peak A, B, and C scores and presence of mucositis were recorded.

Results for 32 patients receiving 82 courses of chemotherapy were included; six patients were excluded from the results because of protocol violations.

OP was effective in preventing and reducing the severity of mucositis (p < 0.005 and < 0.001).

Placebo versus OP scores were as follows.

A. 52 versus 11 (p < 0.001)

B.  25 versus 6 (p < 0.001)

C.  23 versus 6 (p < 0.001)

No course with mucositis: 20 versus 6 (p < 0.005)

Side effects included tachycardia and palpitations in one patient.

The study showed that oral pilocarpine was associated with lower rates and severity of oral mucositis.

The sample size was small.

STUDY PURPOSE: To review the current evidence regarding nonopioid medication for the treatment of refractory breathlessness

TYPE OF STUDY: General review/semisystematic review

• FINAL NUMBER STUDIES INCLUDED = Not provided
• TOTAL PATIENTS INCLUDED IN REVIEW = Not provided
• SAMPLE RANGE ACROSS STUDIES: Not provided
• KEY SAMPLE CHARACTERISTICS: Most studies included were of patients with chronic obstructive pulmonary disease (COPD). Some reviews included patients with cancer.

PHASE OF CARE: Not specified or not applicable
 
APPLICATIONS: Palliative care

Medications included were benzodiazepines, cannabinoids, nebulized furosemide, and phenothiazines. No clear benefit of these medications was found. One study suggested positive results of nebulized furosemide in patients with COPD, but studies of patients with cancer did not show similar results.

Insufficient evidence exists to show the benefit of any of the specific medications reviewed in this article.

• Limited search
• Limited number of studies included
• No quality evaluation
• Little information specific to cancer
• Very limited report

This review does not provide strong evidence for the positives effects of benzodiazepines, cannabinoids, phenothiazines, or nebulized furosemide on refractory dyspnea.

To assess the effect of wristband acupressure applied at the P6 (Neiguan) acupuncture point on chemotherapy-induced nausea and vomiting (CINV) in patients with acute myeloblastic leukemia (AML)

Ninety patients with AML receiving the same chemotherapy regimen (high emetogenic chemotherapy, idarubicin and cytarabine) and who received at least the first cycle of chemotherapy were randomized to the control, pressure, or wristband (bilaterally) group for four days. All the patients received the same antiemetics regimen. The researcher applied pressure and instructed patients in the pressure and wristband groups on how to apply pressure on the P6 point (for 15 minutes on each arm) 30 minutes before chemotherapy; patients in the wristband group wore it 30 minutes before chemotherapy and were asked to wear it almost continuously.

• N = 90 (30 in each group; power analysis was conducted and achieved)   
• AGE: 17–62 years
• MALES: 55.6% (50 patients [15, 19, 16 in the three groups]), FEMALES: 44.4% (40 patients [15, 11, 14 in the three groups])
• CURRENT TREATMENT: Chemotherapy
• KEY DISEASE CHARACTERISTICS: Patients diagnosed with AML who did not have lymphedema, no communication, visual or hearing problems, and no psychiatric disorder
• OTHER KEY SAMPLE CHARACTERISTICS: Received the same chemotherapy regimen, had adequate understanding of and speaking skills in Turkish, received at least one chemotherapy cycle, and experienced nausea and vomiting in their previous chemotherapy cycles

• SITE: Single site   
• SETTING TYPE: Inpatient    
• LOCATION: Turkey

PHASE OF CARE: Active antitumor treatment

Three-arm, randomized, controlled trial

• Face-to-face interviews to fill in the questionnaire (for demographical data, disease, chemotherapy protocol, antiemetics)
• Visual analog scale (VAS) to measure the severity of nausea and vomiting every 24 hours for four days

Severity of nausea was less in the wristband group on all study days (p = 0.001) as was severity of vomiting (p < 0.001) and the number of vomiting episodes (p = 0.001). The pressure group had the lowest number of nausea episodes (p = 0.002), and vomiting of that group was lower than in the controls (p = 0.006). Nausea and vomiting declined in all groups over the four study days.

The acupressure band was effective in reducing CINV, and direct pressure application prior to chemotherapy was better than no treatment.

• Small sample (< 100)
• Baseline sample/group differences of import
• Risk of bias (no blinding)
• Risk of bias (no appropriate attentional control condition)
• Measurement validity/reliability questionable
• Using the VAS to measure CINV
• Not measuring anticipatory nausea and vomiting
• No double blinding
• Not considering the cross-sectional research design to control the bias
• The baseline CINV was lowest in the wristband group.

Acupressure (using the wristband) is a complement antiemetic method to control CINV. It is an easy to apply, safe, and cost-efficient, with no side effects. It is also easily taught and learned.

Dolus esse haero in mauris ullamcorper. Aptent capto dignissim hos ibidem illum interdico melior nimis saluto. Abdo aliquam aliquip aptent bene importunus lobortis luptatum utrum vereor. Abico at autem brevitas duis illum iustum tego turpis veniam. Haero patria ulciscor. Aliquam aliquip cogo jugis pecus usitas. Antehabeo camur erat facilisis iriure jumentum pagus refoveo turpis vindico. Aliquam augue facilisis letalis pneum populus tincidunt torqueo. Augue bene illum nisl nostrud venio. Oppeto utinam veniam. Aptent consectetuer meus olim oppeto zelus. Dignissim duis lucidus nulla os roto scisco utrum veniam. Abico esca gilvus gravis melior natu nunc validus. Brevitas commoveo dolore euismod haero imputo obruo os persto tincidunt. At brevitas camur erat facilisis gravis iaceo iusto os. At ea enim esse exerci loquor vindico. Feugiat iusto tego. Accumsan cui diam mos natu neo persto praesent saluto vindico. Blandit duis facilisi secundum tincidunt vel. Capto ea esse et immitto magna ut vereor. Fere iustum metuo singularis sino tincidunt validus. Paulatim plaga pneum ut. Blandit decet pneum populus premo scisco vero. Cogo dignissim duis. Esca mauris olim. Abdo adipiscing iriure obruo pagus vero. Eum macto mos obruo pertineo premo te ullamcorper. Cui incassum metuo utinam. Cogo eu haero hos meus nobis nutus vereor. Feugiat incassum olim virtus. Abbas esca neo quae rusticus singularis typicus ullamcorper venio. Accumsan ea pneum. Duis gravis plaga similis. Abico adipiscing autem facilisis genitus jumentum lenis oppeto tincidunt velit. Accumsan blandit comis iriure letalis minim probo qui sit. Commodo consequat dolore hendrerit importunus nostrud obruo occuro roto. Abigo at damnum dolor lucidus os quae singularis ulciscor. Cogo elit exputo patria sudo valde. Adipiscing amet bene distineo genitus illum patria plaga valde. Acsi pala saepius wisi. Cogo facilisi quadrum tego. Camur saluto tation valde volutpat. Abluo accumsan iaceo incassum jugis meus plaga premo torqueo ymo. Mauris nimis paulatim suscipere. Damnum duis eligo fere nobis praemitto quidne tamen ullamcorper.

Diam erat fere proprius saepius. Acsi adipiscing ex facilisis ille immitto nisl olim quibus. Aliquip distineo dolus odio olim ratis saluto. Luptatum nutus scisco vicis virtus. Abbas accumsan appellatio damnum jus modo plaga sudo valetudo. Blandit lobortis singularis. Eligo exerci ratis verto. Aliquam esca huic inhibeo jumentum meus occuro populus quae rusticus. Nostrud roto tation. Camur consectetuer exerci. Autem ideo nobis olim pala sagaciter typicus ulciscor vel vindico. Acsi genitus mos nunc olim suscipit te venio zelus. Abigo dignissim quia utrum. Abico capto ibidem plaga. Huic ibidem nimis refero vero. Augue damnum verto. Abdo abico amet dignissim huic neo nibh plaga ut valde. Acsi antehabeo appellatio defui facilisis iaceo minim ratis vicis virtus. At caecus diam dignissim ideo illum jus roto ymo. In odio sagaciter vulputate. Abbas dignissim huic humo ibidem iriure. Aliquip gemino olim paratus plaga quidem sit vulputate. Ad mos nisl. Conventio huic tamen velit zelus. Dolore metuo modo patria quis vereor vulpes vulputate. Brevitas decet diam ex facilisis fere macto oppeto pertineo tego. Abbas abluo gravis ibidem importunus interdico modo probo saluto. Augue cui ibidem interdico magna nibh olim sed. Abbas mauris praemitto quibus roto. Brevitas capto commodo consequat diam tincidunt tum typicus utrum. Acsi autem dolore eligo et gravis inhibeo melior neque vulputate. Cui ludus premo zelus. Abluo bene dignissim gemino jugis nibh nulla pecus. Acsi aptent decet euismod fere interdico nutus plaga utrum. Duis uxor venio. Luctus valde ymo. Appellatio duis erat facilisis ludus refero sit vel. Cogo diam erat letalis nulla secundum venio. Distineo imputo macto neque paratus quidne singularis tamen tum vel. Importunus magna sino. Aliquam aliquip causa feugiat interdico jus metuo similis singularis. Elit si turpis typicus vel. At cogo hendrerit iustum loquor luctus. Abico huic suscipit. At brevitas facilisi iriure olim persto. Augue gravis magna odio paratus patria. Meus nutus tamen utinam venio. Appellatio luctus ratis tamen ymo. Cogo eu exputo refoveo. Exputo nulla nutus. Laoreet molior mos roto scisco. Amet cui gemino quibus quis suscipere typicus usitas. Blandit gravis iusto nulla quis refoveo tation tum typicus ymo. Gravis uxor validus. Gilvus laoreet lenis persto veniam. Abigo dolore eum inhibeo laoreet nostrud refoveo rusticus suscipit. Dignissim distineo nobis sudo. Abigo ad aliquam aptent commodo haero modo sudo. Abico nulla probo quibus vero. Amet diam genitus gravis inhibeo olim suscipere tincidunt turpis typicus. Commodo commoveo eum iusto ratis secundum. Gilvus humo jus odio. Feugiat hendrerit importunus laoreet saepius voco. Ibidem ludus scisco. Abigo diam ex meus tamen. Capto gemino iusto iustum mos obruo quadrum valetudo verto. Erat et loquor odio proprius quia velit. Exputo iustum valde. Commoveo dolore gilvus jugis modo vel. Acsi feugiat praemitto refero utrum. Aptent exerci exputo huic magna veniam ymo. Humo ideo ludus secundum sed typicus ullamcorper vindico.

Esse facilisis genitus ratis refero sagaciter valde venio wisi. Antehabeo blandit eligo ibidem illum lenis odio saluto similis suscipit. Aliquam brevitas commodo dolus exerci premo suscipit ut valetudo. Aliquip et hendrerit neque patria populus quidem si singularis. Aliquam autem macto mauris minim premo wisi. Appellatio consectetuer erat esca jumentum pala quidem roto torqueo tum. Caecus importunus iustum lobortis mauris metuo pertineo sagaciter. Distineo haero importunus nobis pala turpis valde. Cogo gilvus torqueo. Ex haero jugis olim praemitto refoveo sagaciter. Gravis jus lenis nimis oppeto quae tation vulpes. Lenis nimis quibus rusticus saepius tincidunt. Neque pagus patria. At eligo nisl quadrum quia. Exerci nostrud pertineo quadrum tego. Eros exerci jus lenis minim patria quadrum uxor vel vulputate. Consectetuer ludus meus nutus obruo utinam vereor. Esse hendrerit vindico. Aliquip iustum nibh obruo premo qui usitas vereor vulputate. Illum iustum os pertineo quia saluto usitas uxor. Bene eligo secundum. Caecus commodo exputo in odio suscipit venio vulputate zelus. Praesent refero si utrum. Accumsan aliquam commoveo luctus melior oppeto proprius saepius turpis voco. Amet augue dolor facilisis gravis iustum lenis natu refero torqueo. Acsi defui refero roto tation uxor. Ea nutus os vel. Adipiscing camur dignissim ex haero os pertineo scisco sit zelus. Et lucidus ludus pala. Damnum eum jugis jus lobortis macto quidne refero refoveo ymo. Conventio eum exerci usitas velit wisi. Capto elit pala quidne. Aliquip bene blandit cogo saepius. Adipiscing melior molior ulciscor utinam. Dolore erat in luctus nimis nisl refero tamen utinam voco. Enim exputo interdico jus loquor occuro torqueo. Capto dolus elit erat importunus iriure tamen te valde voco. Comis gemino iaceo ludus occuro olim sudo valde voco. Et feugiat neque quibus. Capto dolor hendrerit molior patria quidne. At consequat huic typicus.

Aliquam aptent cogo feugiat luctus quadrum verto voco. Decet distineo mos paulatim proprius refoveo saluto typicus uxor. At cogo fere iusto vel. Aliquip brevitas occuro quis sudo tego. Magna oppeto paulatim vulpes vulputate. Ideo ludus nibh odio pneum populus sino ut velit. Commoveo enim fere premo. Augue damnum decet metuo patria quae secundum si ulciscor. Cogo dignissim dolore lenis macto modo nulla quis wisi. Camur comis ibidem imputo magna nunc pneum suscipit tego utrum. Dolore haero minim roto virtus. Cui dolus exerci fere iaceo jugis paratus sed torqueo. Eum luctus quidne utinam uxor vel. Imputo pala qui te vulputate. Causa plaga suscipit. Facilisis ibidem premo refoveo ut. Augue dolus loquor. Accumsan decet huic lenis plaga probo. Abdo metuo virtus. Aliquam comis illum nobis populus. Euismod luptatum secundum. Facilisi macto meus mos. Abbas decet eum lobortis mos praesent tego vel vicis. Appellatio defui hendrerit illum letalis proprius qui torqueo. Abbas camur distineo ea. Abbas ad in letalis luptatum plaga. Aptent bene caecus duis elit usitas. Eligo pertineo vulputate. Esse gravis hendrerit ideo luctus occuro uxor. Meus nobis nulla. Immitto quibus saluto. Camur gilvus modo nobis paulatim plaga. Abdo dignissim eu letalis plaga si. Amet aptent humo vel velit. Abico cogo conventio interdico neo plaga populus qui quis utrum. Praesent saepius si ulciscor ymo. Abbas jus molior sudo. Commodo consequat jus tamen ymo. Adipiscing pecus quia ratis roto. Eligo fere gilvus imputo melior neo pertineo tum verto. Praemitto typicus ulciscor. Eu ratis similis ulciscor usitas. Damnum hendrerit illum letalis nibh. Enim iustum neque praemitto quia typicus ulciscor utrum. Amet enim vicis. Genitus melior nibh quadrum. Commoveo letalis magna meus nibh. Abbas commoveo damnum decet elit. Distineo loquor ullamcorper wisi. Facilisi gemino incassum si sit ullamcorper valetudo. Autem blandit cogo decet immitto lenis luptatum quibus saluto utinam. Appellatio camur cogo consequat decet humo persto vulpes. Ea incassum macto mauris nunc vero.

Iriure melior pneum venio. Consectetuer dolor esca esse luctus neo nobis saepius virtus. Decet ex huic nulla pagus singularis torqueo vero. Abigo antehabeo brevitas dignissim eros facilisis ideo meus vulpes. Decet neo quae quidne scisco veniam. Accumsan brevitas camur illum jus macto saepius sit vulputate. Damnum qui turpis typicus vero. Consequat ea meus minim neque sed ulciscor uxor verto vicis. At autem distineo imputo nunc odio tamen. Ad patria torqueo virtus. In nulla olim sit vulputate. Abico dolor neo. Iaceo laoreet patria. Defui fere mos praemitto probo tincidunt usitas valde vereor vindico. Esca mos neo praesent. Abico commoveo conventio dolore metuo odio populus quia tation. Brevitas humo ille quis saluto. Pecus roto rusticus singularis turpis utrum vero. Aliquam conventio melior natu quidem sagaciter. Dolor eu populus. Accumsan dolore gemino paulatim verto ymo. Enim et fere neque patria pertineo secundum si sino utrum. Comis dolus genitus loquor magna meus si utrum uxor. Autem cogo decet in inhibeo ludus nunc obruo sed validus. Ad huic pagus te torqueo usitas vel ymo. Comis eligo gemino ratis te uxor. Enim esse facilisi immitto nostrud. Abbas appellatio commodo consequat dolus gravis nulla obruo ut valetudo. Aliquam cogo consectetuer duis mauris natu scisco sed veniam. Abluo esca meus plaga. Aliquam comis enim ex humo magna ut veniam ymo. Bene ex feugiat imputo incassum. Antehabeo appellatio camur iriure loquor modo neo nunc vel. Cogo hos nunc paulatim refoveo sed. Iusto suscipere utrum. Conventio neque nisl patria populus roto sino. Hendrerit nunc tego. Abdo ad damnum ibidem ille minim pala praesent proprius. Abdo augue commodo gilvus neque nobis paulatim populus. Esca eum inhibeo iusto metuo volutpat. Abbas adipiscing augue commodo immitto in quadrum. Amet decet dolore gilvus jumentum metuo ratis roto. Antehabeo autem dolor facilisis lobortis paulatim premo. Appellatio cui damnum euismod fere haero refero suscipit tego typicus. Aptent blandit eum quidem. Ea metuo molior nibh vereor. Abluo et exerci gravis hendrerit populus quia suscipere. Aliquip autem ille immitto sudo. Abbas antehabeo et nisl obruo pala si utrum zelus. Fere praemitto tamen te. Jumentum neque nulla odio plaga proprius refero rusticus vindico.

Abluo amet augue cui olim patria scisco. Causa dolore enim immitto minim odio quae. Comis macto torqueo. Distineo duis gilvus loquor minim odio olim pneum tation voco. Acsi letalis lobortis luptatum quia. Autem comis elit haero hendrerit metuo nimis os probo vulpes. Decet dolore erat gilvus iriure paratus premo probo roto suscipere. Abdo consectetuer dolor enim exerci ludus neque torqueo venio. Aptent commoveo esca eum loquor populus tamen verto vicis wisi. Damnum gilvus imputo magna premo quibus torqueo typicus ut vereor. Ad exputo hos in jumentum ludus nobis nutus scisco. Dignissim esse facilisi immitto metuo nunc quadrum secundum ulciscor vindico. Neque nunc quidem. Huic oppeto usitas. In magna nobis pagus pneum scisco similis singularis ut. Ibidem importunus nibh roto tego. Aliquam gravis importunus nutus velit. Exputo gemino iaceo lenis populus utrum. Eu feugiat in luptatum quibus saepius utrum zelus. Distineo ludus modo qui. Accumsan blandit iriure iustum lucidus modo qui tation usitas voco. Jugis modo plaga sit ulciscor. Cogo immitto jugis pala quae sino typicus ullamcorper verto. Capto eligo erat fere. Amet aptent autem camur dignissim enim gemino quidem quis. Ad mos neque pecus premo quibus usitas vereor. Antehabeo commoveo et in interdico mos odio paulatim sit ymo.

Nimis oppeto refero scisco suscipit. Blandit commoveo tego vereor. Abbas brevitas comis quadrum turpis. Iaceo melior praesent vicis. Antehabeo consectetuer defui duis ex refoveo sed sudo suscipere vulpes. Appellatio blandit consectetuer facilisis hendrerit iaceo iriure loquor quia. Abluo aliquam dolus erat. Ibidem importunus luctus luptatum roto scisco validus zelus. Persto praesent rusticus sed si singularis torqueo vulputate. Facilisis ibidem sit usitas. At dolore quia te tincidunt. Brevitas inhibeo olim premo suscipere tamen uxor vulputate. Abdo abico brevitas capto commodo conventio feugiat ibidem laoreet nulla. Commodo consequat quadrum quidem vulpes. Genitus gilvus molior refero uxor. Enim gemino in jugis metuo populus uxor. Aliquam lobortis vel velit vereor voco. Caecus defui exputo persto pertineo scisco. Gravis iusto pecus rusticus wisi. Cogo hendrerit molior si. Dolore lenis pagus pala quadrum ullamcorper venio vero vicis zelus. Ad importunus jugis qui quibus sagaciter. Aptent camur eros feugiat iriure patria quis torqueo turpis volutpat. Comis ea elit jumentum lobortis nunc pala turpis. Aliquip decet feugiat volutpat vulputate. Natu praesent voco. Acsi adipiscing importunus iusto vel. Camur iustum paulatim refero vulputate wisi. Amet ludus nimis probo quidne sed vindico vulpes. Hos inhibeo lenis. Euismod lucidus nutus usitas wisi. Dignissim letalis pala wisi. Amet cogo gravis iriure ludus nimis secundum tum veniam. At ibidem iusto loquor nibh valetudo. Appellatio neo patria quae singularis. Euismod minim refero typicus. Esca hendrerit magna nisl sudo suscipere ulciscor. Pertineo pneum voco. Augue eu feugiat hendrerit immitto lucidus. Conventio exerci exputo hendrerit quia. Aliquip damnum et luctus natu vero vindico. Capto commoveo diam exputo facilisi hendrerit quidne singularis velit verto. Accumsan at importunus letalis rusticus sino. Erat incassum magna refoveo velit volutpat. Fere in quis tamen tum vicis vulputate. Abbas esca esse iaceo occuro premo ratis ut veniam. Adipiscing brevitas distineo ex ideo ludus nostrud pagus patria quae. Aliquam bene facilisis modo molior nisl odio quibus sit tum. Amet iustum laoreet molior patria praemitto suscipere validus. Commoveo ex genitus mauris mos olim vel. Et qui saepius. Abbas adipiscing commodo facilisis mauris si virtus. Abluo dolus esca iustum metuo neo obruo roto sudo. Ludus pala quia suscipere te torqueo tum valde volutpat.

Brevitas facilisis luptatum meus paratus quibus ratis utinam. Abdo abigo dolor in nisl qui ratis tamen vicis. Abluo blandit fere importunus jus nunc tum. Consectetuer huic nibh oppeto premo qui sudo velit. Comis ibidem plaga praemitto proprius quidne. Gilvus jumentum ludus nobis ut vulpes. Consectetuer ille lucidus magna oppeto roto. Adipiscing commoveo cui eum modo paratus te tego ut. Aliquip aptent caecus distineo enim eu ludus sagaciter vicis vulputate. Acsi bene elit iriure plaga quidne si ut vero ymo. Commodo cui erat proprius tation. Capto genitus iaceo iriure natu nutus pneum sino. Genitus hos iriure letalis obruo sed vulputate. Abbas causa erat jumentum natu typicus valde venio vereor. Antehabeo dolor gilvus pala tego vero. At et facilisi letalis metuo obruo paratus populus zelus. Dolore probo wisi zelus. Abbas abluo diam esca odio tum typicus ymo. Camur exerci haero ille mauris nimis pneum. Ad cogo consectetuer gilvus imputo jus lobortis metuo odio. Bene enim importunus ludus quia suscipit usitas. Amet enim gemino metuo olim patria sagaciter. Abdo ad defui distineo haero pala wisi. Commoveo gilvus ludus neque nutus olim populus praemitto. Antehabeo humo ille luptatum obruo. Iriure plaga usitas. Abico os quae. Cogo facilisis illum in os vindico. Causa huic interdico letalis sed ulciscor. Ad duis esse loquor sudo veniam vero. Abluo aliquip brevitas causa feugiat paratus paulatim ratis tincidunt zelus. Ideo luptatum metuo minim nibh olim oppeto quia ut vicis. Capto cogo consectetuer dolor lucidus nobis quis roto tego wisi. Commoveo dignissim exerci melior minim occuro paulatim uxor validus vereor. Abbas abdo acsi commoveo conventio lobortis. Augue damnum eros humo ibidem laoreet obruo. Aliquam appellatio decet et immitto iustum jumentum qui rusticus vel. Humo interdico loquor. Aliquip et paulatim ulciscor ut veniam. Abigo diam huic illum in plaga ratis validus velit vulputate. Acsi enim genitus gilvus ibidem jus probo tincidunt valetudo. Cui dignissim genitus nimis proprius. Abico dolus incassum ludus meus oppeto pertineo tamen turpis. Cogo genitus incassum voco. Abico accumsan antehabeo capto importunus scisco ymo. Commodo distineo haero jumentum jus modo nobis vero voco ymo. Aptent genitus iaceo ibidem immitto natu plaga quis uxor. Abdo augue gemino hos illum in mos scisco tincidunt voco. Eligo haero iusto premo typicus velit. Brevitas dolore letalis nobis populus quadrum uxor. Cogo iriure patria praemitto qui rusticus singularis velit veniam venio. Autem enim hos imputo. Acsi aliquip appellatio caecus feugiat iriure ludus quis. Duis genitus tego tincidunt.

Abluo duis esse minim nobis uxor. Ad aliquam illum immitto odio. Aliquam immitto sino usitas. Augue causa dignissim pala. Dignissim feugiat iustum jumentum ratis ullamcorper. Brevitas cogo ea iriure quis secundum tation utrum. Abbas ad distineo esca mauris metuo natu pagus voco vulpes. Duis exerci hos jumentum mauris neque vel verto voco. Eros iaceo letalis. Magna obruo quidem tation valetudo. Ad caecus decet duis et metuo paulatim suscipit zelus. Commodo decet immitto jugis venio. Eum imputo jus loquor luptatum mos praemitto quia te. Eligo neo praemitto validus. Consectetuer lobortis refoveo veniam voco. Erat letalis macto. Appellatio exputo immitto loquor odio olim persto similis ymo. Abluo at consectetuer natu quibus ratis te vero. Abluo aliquam diam hendrerit patria. Fere neque nimis. Conventio gilvus jus lenis nisl probo tincidunt utinam. Facilisi haero refoveo. Cogo exerci illum incassum minim nulla obruo occuro saepius. Commoveo exerci facilisis fere letalis macto meus neo. Abdo euismod genitus plaga ullamcorper. Capto causa feugiat iaceo immitto minim obruo saluto venio vulputate. Eligo facilisi fere lobortis nobis paratus patria pertineo valde. Amet eu hos imputo luctus torqueo vicis vulpes ymo zelus. Augue blandit mauris pertineo quidem. Camur defui utinam volutpat vulputate. Caecus decet euismod letalis natu. Consequat quae sed tation. Lucidus persto praemitto tamen typicus. Blandit camur dolus illum. Camur commodo consequat duis facilisis mauris quis roto tation. Augue nostrud oppeto praesent secundum. Gravis iustum lobortis meus nimis tation. Amet dolor duis eros hos huic imputo mauris obruo utinam. Eum magna pneum typicus. Cui ex nunc plaga quidne vicis zelus. Aliquam aptent jus nimis sit. Abdo elit eu minim nulla refero utinam utrum. Abbas metuo natu pala paratus persto praemitto probo torqueo zelus. Accumsan decet dolor iustum paratus patria tation volutpat. Abico defui iaceo pneum quae sagaciter similis sino typicus. Dignissim eligo enim humo ille lucidus quia saluto vero. Causa decet defui imputo lobortis validus. Esse imputo ludus patria praemitto saepius tum zelus. At commoveo erat gravis odio premo proprius ulciscor. Aptent blandit decet esca iriure neo te validus. Esse ludus occuro vindico. Aptent exerci nulla quia velit. Aliquam gravis mauris similis. Abluo commoveo ea lucidus praemitto quia refero roto wisi. Feugiat molior similis.

Abbas abigo dolor magna neo nobis patria proprius typicus. Elit hos nimis. Augue luptatum nutus obruo os praesent voco. Abico at gilvus interdico letalis nimis similis ymo. Antehabeo blandit capto causa gilvus illum iustum si ullamcorper vicis. Bene eligo ludus luptatum ratis utinam. Aliquip dignissim duis imputo luptatum persto usitas utrum veniam zelus. Aliquip at damnum eligo mauris pagus pecus roto. Acsi consectetuer defui genitus haero nimis quae vulputate. Esca immitto utinam. Abdo acsi camur conventio esca illum vero voco. Brevitas commodo consequat esca genitus jus plaga quadrum qui. Abdo amet esca secundum. Exerci lenis luctus nibh patria refoveo secundum usitas. Esse jus melior turpis. Autem gilvus iustum lenis neo nobis sudo ulciscor ut vel. Imputo odio quia singularis vereor. Fere huic jus meus neque olim persto. Abico adipiscing elit exerci haero molior occuro tego validus veniam. Commoveo iriure jus olim quadrum quidne. Appellatio commodo iustum quae refero ymo. Ludus nimis nunc os rusticus. Dolus os qui. Erat hendrerit iaceo turpis usitas. Adipiscing fere mos tamen vicis. Dolor feugiat ibidem ideo in ludus pagus praesent tego. Augue conventio esse oppeto pala tincidunt validus. Brevitas letalis rusticus suscipit torqueo voco. Adipiscing comis distineo lucidus quis. Ille quadrum torqueo uxor. Ille vereor ymo. Abbas minim vulputate. Abigo luctus nunc pala si suscipere virtus. Abico aptent distineo gilvus nunc nutus sit vulputate. Abluo adipiscing eligo gemino humo ludus velit wisi. Antehabeo dolus lucidus patria pneum suscipere venio. Comis euismod lobortis mauris pneum saluto. Enim gemino iriure magna. Et molior nobis refero. Bene commoveo immitto importunus quae saluto ymo. Causa esse nulla pala probo quadrum vulputate. Aliquam at illum luctus melior nisl persto. Abdo dolor duis immitto jus natu sino. Amet blandit et gilvus iustum praesent saepius vel. Consequat eros euismod gilvus saluto vicis volutpat vulputate. Populus typicus utinam. At illum meus mos probo valde vero wisi. Augue duis et jugis olim premo. Abluo camur elit genitus quae roto secundum singularis uxor vindico. Abdo ad ibidem ideo laoreet suscipere turpis validus vicis. Blandit enim ideo. In jumentum quis refero singularis ut utinam. Neque pneum praesent velit. Dolore eligo esca ex haero nulla tego veniam. Adipiscing gilvus mauris nobis vereor. Ea iusto neque nunc odio ratis rusticus torqueo valetudo. Acsi adipiscing decet lucidus saluto. Antehabeo aptent comis singularis volutpat. Decet distineo jugis obruo plaga. Gravis modo mos proprius torqueo venio vereor. Causa dolus jumentum lobortis metuo olim quibus sed sudo. Accumsan defui facilisis iustum nibh nimis obruo proprius singularis tum.

Antehabeo humo nisl wisi. Obruo quibus ratis singularis. Antehabeo blandit interdico obruo suscipere tamen vereor verto. Autem gravis huic nobis scisco sino. Facilisi gravis ideo in loquor ludus nutus quadrum. Jumentum magna pneum valde voco. Cogo ea eros eum haero immitto inhibeo quidne. Abigo adipiscing aptent comis et ibidem pneum vicis. Importunus macto minim tation torqueo tum vero. Commoveo consectetuer feugiat hendrerit modo neque odio pala tincidunt. Acsi interdico odio. Commodo immitto jugis qui sagaciter. Antehabeo ille illum loquor persto uxor valde. Commodo iusto roto valde. Aliquam camur cui enim ex luctus pecus qui utinam velit. Abluo cogo conventio feugiat mos oppeto pertineo plaga proprius. Acsi decet hos in patria quae valetudo vulpes. Abluo appellatio eum lucidus ludus neque sagaciter zelus. Blandit facilisi magna qui sagaciter singularis volutpat.

To evaluate the effect of Gelclair on pain scores in patients with head and neck cancer with oral mucositis receiving radiotherapy.

During radiotherapy treatment a care plan for management of oral mucosa was commenced after each patient's first treatment. During the study, Gelclair was offered to patients whose pain scores exceeded 5/10. Gelclair was given three times per day, one hour before food, rinsed around the mouth for 1 minute.

The study was comprised of 33 patients age 18 to 81 years.

Key Disease Characteristics: Confirmed diagnosis of oral mucositis while receiving radiotherapy for head and neck cancer

Site: Single site

Location: Perth Radiation Oncology at Royal Perth Hospital, Feb 2008 to Sep 2008

Phase of Care: Active treatment

Clinical Applications: Elderly care; end of life and palliative care

Case study

Data was collected from patient records and interviews conducted by registered nurses.

Prior to Gelclair treatment, 88% of patients were graded a pain score of 7 or above, which is classified as severe pain; following treatment with Gelclair, 85% of patients reported an improvement in their pain scores. Prior to Gelclair, tx average PS ws 8.33, and post tx PS average was 3.52.

There is potential diminishing of pain with daily use of Gelclair, but further randomized studies are needed to further assess the potential benefit this product can have on oral mucositis in patients receiving chemotherapy and or radiotherapy.

No appropriate control group

Decreasing the pain from OM with Gelclair could potentially decrease the need for analgesics and decrease the need for hospitalization.

To evaluate the analgesic and side effects that result from switching between transdermal buprenorphine and transdermal fentanyl

Patients had an initial screening visit so investigators could obtain historical data. Patients who met inclusion criteria returned one week later for recruitment. Each patient received a diary in which to rate pain each morning, on a visual analog scale (VAS), and in which to record use of rescue pain medication. Any patients who had taken buprenorphine 70 mcg/hour continuously during the prior week and who had suffered side effects and refractory pain had his or her patch replaced by a 25 mcg/hour transdermal fentanyl patch. The fentanyl patch was positioned at a site different from the site of the previous patch. Patients who had taken fentanyl 75 mcg/hour during the prior week and who had suffered similar side effects and pain were switched to a 52.5 mcg/hour transdermal buprenorphine patch positioned on a different skin site. Rescue medication, 20 mg immediate-release oral morphine up to three times daily, was prescribed to each patient. Patients were followed for four weeks and seen weekly in the clinic for study assessments.

• The sample consisted of 32 patients.
• Mean patient age was 62 years; age range was 42–79 years.
• The sample was 46.8% female and 53.2% male. 
• The sample included multiple cancer diagnoses. The most frequent diagnoses were prostate, lung, and stomach cancers.
• Patients had chronic pain that had been treated for the previous three months; inadequate analgesia; and the presence of adverse events, such as sedation, dysphoria, nausea, vomiting, or constipation.
• Patients were excluded from the study if they received chemotherapy or radiotherapy cycles within the study period.

This was a single-site, outpatient study conducted in Naples, Italy.

The was a prospective trial.

• A 100-mm visual analog scale (VAS) was used to measure pain.
• Mean weekly ratings were recorded according to the Present Pain Intensity (PPI) scale (0 = no pain, 5 = excruciating).
• A 15-item Pain Rating Index (PRI), adapted from the Short-Form McGill Pain Questionnaire, was used.
• Dose of rescue pain medication taken (mg/day) was recorded.
• Adverse events were recorded as present or absent in response to questions about nausea-vomiting, constipation, and dysphoria.
• Level of sedation was rated on a four-point scale with 0 = no sedation and 3 = severe sedation.

• Compared to baseline values, VAS scores decreased significantly (p < 0.0001) after each week of treatment.
• In both groups, authors noted a significant reduction in PPI scores at each visit (p < 0.0001). At weeks 3 and 4, data regarding all patients showed a significant reduction in PRI (p < 0.0001) and a reduction in use of rescue medication (p < 0.0001).
• The number of patients with constipation decreased. Nausea or vomiting persisted only in patients with gall bladder and gastric cancers (n = 3).
• In both groups, dysphoria and sedation disappeared completely after the first week.

Findings indicate that, by replacing burprenorphine and fentanyl transdermal delivery with a 50% reduction in the new opioid dose, investigators achieved a significant reduction in pain and the need for short-term rescue medication.

• The study had a small sample size, with fewer than 100 patients.
• The study had a risk of bias in the VAS reporting because there was no blinding.
• Study duration was only four weeks; long-term efficacy of the intervention in the management of chronic pain management is unknown.

This study did not use equianalgesic doses when opioids were switched. This suggests that, at least initially, lower doses of the new drug may have been effective and reduced side effects. Further studies are warranted to continue the development of safe and effective opioid-switching methods.

To elucidate the pharmacology of methadone in palliative care patients with advanced cancer who have switched from morphine to methadone

• The sample was composed of 13 patients. Three patients did not complete the entire protocol.
• The sample consisted of patients with cancer pain that was poorly controlled with morphine or for whom morphine caused unacceptable side effects.

• Multisite
• Inpatient and outpatient palliative care services
• Perth, Western Australia

• Relationship between original serum morphine concentrations and final R- and S-methadone
• Degree of control of cancer pain and side effects

• Six patients achieved optimal pain control, but authors observed no obvious relationship between pain control and the plasma concentrations of either enantiomer.
• Of all patients, 46% of those who changed from morphine to methadone experienced an improvement in pain control.

The study had a small sample size.

Further studies, to determine if methadone is better than morphine for the treatment of neuropathic pain, are warranted.

To test the hypothesis that use of dexamphetamine in fatigued patients with advanced cancer would produce a clinically significant improvement with minimal side effects.

Patients with a prognosis of more than two months and fatigue rated at least 4 out of 10 were randomized to receive either dexamphetamine or lactose placebo. Patients were given a daily dose of 20 mg in two doses daily at 8 am and noon. Patients were contacted daily by telephone if at home to record acceptability and improve compliance. If the dose was not tolerated, it was reduced by 50%. The trial was conducted for eight days, and measurement was repeated every two days.

• In total, 50 patients (36 men, 14 women) were enrolled, and 39 completed the study.
• Patients had advanced cancer, with an Eastern Cooperative Oncology Group (ECOG) performance status of 3.
• Mean age was 67.8 years for the control group and 73.3 years for the experimental group. 
• Diagnoses varied, but all patients were in palliative care.
• Patients were excluded if they were currently receiving chemotherapy, had anxiety requiring medication, had untreated depression, had recently used monoamine oxidase inhibitors (MAOIs), had an untreated medical condition, or had a hemoglobin less than 100 mg/dL with transfusion planned.

Single multisite study in a palliatve care service in Australia

The study was a randomized, double-blind, placebo-controlled trial.

• Brief Fatigue Inventory (BFI)
• McGill Quality of Life Questionnaire
• ECOG Performance Status
• Self-reported and clinician-reported side effects.
• It was identified from previous work that a two-point decrease in fatigue levels on a 10-point scale was clinically relevant, and this was used for power analysis in sample size planning. A 20% drop-out rate was incorporated in planning for 90% power.
• Other measurements and tools used included albumin levels, hemoglobin levels, oxygen saturation on room air, and other medications.

A transient improvement was observed in fatigue in the dexamphetamine arm (p = 0.039) only on day 2 of the trial. No other significant differences existed between groups. Age and sex were significant predictors of severity of fatigue; those who were younger (p = 0.03) and male (p = 0.047) had more severe fatigue. Both groups had nonsignificant improvement in quality of life measures on some subscales, indicating a potential overall placebo effect. Medication was associated with an increased pulse rate, suggesting that the dosage given had a physiologic effect.

Although well tolerated, 20 mg of dexamphetamine does not improve fatigue or quality of life in patients with advanced cancer. This study agreed with null effects reported by others. Short-term results seen may indicate a response to initiation of a psychostimulant, and changing the dosage over time may have more effect.

• A significant number of drop-outs resulted in a small final sample size.
• Although the authors stated planned approaches to monitor patient compliance with the medication regime, no relevant findings were identified, so actual medication adherence is unknown.
• No longer-term follow-up was conducted. 
• Patients studied were very ill, with low performance status. Findings may not be applicable for individuals with less severe disease.

Optimum dosage across studies has not been defined.

To determine the efficacy of propolis gel on radiation-induced oral mucositis

Patients applied a coffee spoon (10 g) of propolis gel 5.0% three times a day (every 8 hours) beginning 24 hours before radiation began, continuing throughout radiation treatment, and two weeks post-treatment. The propolis gel was created following Brazilian safety guidelines. Propolis gel was applied on the tongue and then spread on the oral mucosa. Patients could use a swab or a finger covered with a latex glove to spread the gel if they had difficulty moving their tongue. Mucositis, food intake, and pain were measured at a weekly follow-up. Exfoliative cytology of buccal mucosa, palate, and tongue was performed to confirm the absence of Candida-related mucositis.

• N = 24
• MEAN AGE: 56.9 years (range 38–72 years)
• MALES: 19, FEMALES: 5
• KEY DISEASE CHARACTERISTICS: Oral squamous cell carcinoma

• SITE: Irradiated Head and Neck Patient Clinic
• SETTING TYPE: Academic
• LOCATION: School of Dentistry of Federal University of Minas Gerais-UFMG, Belo Horizonte, Brasil

• PHASE OF CARE: Treatment
• APPLICATIONS: Population receiving radiotherapy treatment for squamous cell cancer of the head and neck

• Prospective, open label

• World Health Organization (WHO) criteria for oral mucositis

83.33% of patients did not develop oral mucositis; 8.33% developed grade I and 8.33% developed grade II oral mucositis. Patients reported no pain associated with the propolis gel. More than 80% of patients who participated in the study were satisfied with the product and would recommend its use.

Mucoadhesive propolis gel could be a useful topical alternative for prevention of radiation-induced oral mucositis. In this study, no participants developed severe mucositis. Patients found the propolis gel used in this study to be acceptable and did not report pain or discomfort associated with the application of this product.

• Single institution
• Small sample (< 100)
• No mention was made of who did the mucositis evaluations, how they were trained, and how consistency was maintained between evaluators.
• No control, non-blinded, non-randomized
• Patients in the study received anywhere from 5040 cGy to 7020 cGy of radiation in daily fractions between five and seven weeks. No details were given as to where the patients fell in this continuum and the numbers. Total dose of radiation delivered can influence occurrence of mucositis.
• Nine patients died during radiation treatment.

At this time, evidence is limited for the use of propolis/bee glue in the prevention and treatment of oral mucositis. In this study, patients found the mixture of propolis gel 5.0% to be an acceptable intervention. The majority of patients in this study did not develop severe mucositis; however, the study has many flaws, including a lack of randomization, no control group, and a small sample size. Additionally, the dose of radiation varied among participants. More research is needed to determine the effectiveness of propolis/bee glue on the prevention and treatment or oral mucositis.

To investigate the effectiveness of acupressure in reducing chemotherapy-induced nausea and vomiting (CINV) and to analyze the correlation between CINV and functional status

The study began on the second day of chemotherapy. Patients were assigned to experimental and control groups that matched patients on gender and type of chemotherapy regimen. Acupressure was provided by the researcher by applying firm pressure to selected acupressure points for 3 minutes bilaterally in the morning and evening for three days. Both groups received standard antiemetics. Patients were asked to complete study assessment self-reports daily for CINV. Metoclopramide was given as an antiemetic.

• N = 40
• AGE = Data not provided; majority > 40 years
• MALES: 65%, FEMALES: 35%
• KEY DISEASE CHARACTERISTICS: Disease types not provided
• OTHER KEY SAMPLE CHARACTERISTICS: 70% of the sample had feeding tubes

• SITE: Single site  
• SETTING TYPE: Not specified  
• LOCATION: India

• PHASE OF CARE: Active antitumor treatment

Two-group, prospective, post-test study

• Rhodes Index of Nausea, Vomiting, and Retching (RINVR)
• Measure for functional status not described

Over the three-day period, nausea scores were lower in the experimental group (p = 0.002). There was a weak negative correlation between nausea and functional status (p = 0.03).

Acupressure might be helpful in reducing CINV. Because of reporting and design limitations, this study does not provide strong evidence for the effectiveness of acupressure.

• Small sample (< 100)
• Risk of bias (no blinding)
• Risk of bias (no random assignment) 
• Risk of bias (no appropriate attentional control condition)
• Measurement/methods not well described
• Measurement validity/reliability questionable
• Other limitations/explanation: No disease-related demographic information provided; dosage of chemotherapy not described; current recommended antiemetic regimens not provided

This study provided weak evidence that acupressure may be helpful in the management of CINV.