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Background: Acupuncture is an effective complementary therapy for nausea and vomiting during pregnancy (NVP). Nevertheless, the utilization of acupuncture for NVP has been minimally explored in current scholarly research, with a paucity of systematic randomized clinical trials (RCTs) in it. We aim to evaluate the effects of acupuncture on NVP after assisted reproductive techniques (ART) and explore the metabolism-related mechanism of the efficacy. Methods: This single-blind, randomized, controlled trial will randomize 68 patients with NVP after ART to a traditional acupuncture (tACP) or a sham acupuncture (sACP) group. The tACP group will receive tACP thrice a week for 2 weeks with a day interval between sessions, while the sACP group will undergo the same number of nonpenetrative acupuncture at non-acupoints for the same period. Pregnancy-specific quantification of emesis will be used to evaluate symptom severity. Routine blood and urine tests, liver and kidney function tests, human chorionic gonadotropin, nuchal translucency thickness, and embryonic development measured using ultrasound will be used to evaluate safety during pregnancy. Non-targeted metabolomic analysis will be performed to explore the association between metabolic changes and clinical symptoms. Discussion: This study will elucidate the effects and safety of acupuncture in treating NVP in women undergoing ART. The results of this study will contribute to optimizing acupuncture therapies by combining the body and auricular points and exploring the underlying therapeutic mechanism using a metabolomics approach. Trial registration: Chinese Clinical Trial Registry, ChiCTR2300075259. [ABSTRACT FROM AUTHOR]

Cyclical vomiting syndrome (CVS) was described over 100 years ago, but it is often underdiagnosed and undertreated, even after a diagnosis is made. It is relatively common, affecting almost 2% of school-age children in some studies. Although it is traditionally seen as a childhood disease related to migraine, CVS does occur in adults. The main characteristic of CVS is the stereotypical recurrent nature of episodes of intense nausea and vomiting lasting from few hours to few days and followed by a complete resolution of symptoms. The diagnosis is predominantly a clinical one and there are internationally accepted criteria for diagnosis. The management of acute attacks of CVS aims to relieve symptoms, reduce the duration of attacks and prevent dehydration and hospital admission. Management also includes appropriate counselling on healthy lifestyle, provision of individual management plans and preventive medications. The aim of management is to reduce the number of attacks and improve quality of life. About half the children with CVS start to have migraine with or without aura in late adolescence and around 40% continue with CVS into early adult life. This article is aimed at healthcare professionals looking after children with CVS and describes the clinical presentation, the criteria required for diagnosis and outlines the different treatment options. [ABSTRACT FROM AUTHOR]

Simple Summary: Acupuncture is becoming a popular complementary treatment in pediatric cancer care for managing symptoms like nausea and vomiting that result from cancer treatments. This review aims to evaluate how effective and safe acupuncture and similar techniques are for children with cancer. By analyzing data from multiple studies, the authors found that acupuncture may help reduce nausea and vomiting in young cancer patients. However, there is not enough evidence to make conclusions about its effects on number of vomiting episodes, need for anti-nausea medication, or fatigue. More high-quality research is needed to confirm these benefits and ensure the safety of acupuncture for children undergoing cancer treatment. Background/Objectives: Oncology acupuncture is emerging as a complementary treatment in pediatric cancer care centers. It is valued for its potential to manage symptoms associated with cancer and treatment toxicities without increasing polypharmacy. The aim of this review is to evaluate the efficacy and safety of acupuncture and related techniques in alleviating symptoms of cancer treatment in pediatric oncology patients. Methods: A comprehensive search was conducted across nine databases, including PubMed, Cochrane Library, and CNKI, up to June 2023. Inclusion criteria focused on randomized and quasi-randomized controlled trials involving pediatric oncology patients undergoing needle acupuncture or related techniques. Study selection and data extraction were independently performed by pairs of authors. Results were analyzed narratively, and meta-analysis was performed when possible. Results: Results suggest that acupuncture may help manage symptoms such as nausea and vomiting in pediatric oncology patients. However, the quality of evidence was generally low, and further research is required to substantiate these findings. Conclusions: Acupuncture shows promising results as a complementary treatment for reducing nausea and vomiting in pediatric oncology. However, current evidence is insufficient to draw conclusions for other outcomes, such as the number of vomiting episodes, reduction in antiemetic medication use, or fatigue. High-quality, rigorously designed studies are necessary to better understand the clinical relevance and safety of acupuncture in this vulnerable population. [ABSTRACT FROM AUTHOR]

Aim: Postoperative sore throat (POST) is a commonly encountered and significant complication following anesthesia, which can adversely affect the quality of a patient's recovery. Many factors contribute to the development of POST. Controlled hypotension (CH) is a surgical technique used to reduce blood flow, improve visibility, and shorten procedure time by safely lowering blood pressure. In this study, we aimed to investigate the effects of CH on POST, coughing, hoarseness, and vomiting in patients undergoing surgery in a supine position with a fixed endotracheal cuff pressure. Material and Method: A total of 124 patients, aged between 18 and 65 years, classified as American Society of Anesthesiologists (ASA) class I-II and scheduled for elective surgical procedures, were included in the study. The patients were divided into two groups: Group N (n=65), consisting of normotensive individuals, and Group H (n=59), which included patients subjected to CH. In both groups, the endotracheal cuff pressure was manually set to 25 cmH2O using a cuff pressure manometer. CH was achieved in Group H by administering glyceryl trinitrate (nitroglycerin) infusion, maintaining the mean arterial pressure (MAP) within the range of 55-65 mmHg. Patients were assessed for POST, coughing, hoarseness, and vomiting at postoperative 15 minutes, 2, 6, 12, and 24 hours. Results: Demographic data, smoking status, ASA scores, surgical and anesthesia durations were similar between the groups. Statistically significant differences were observed between the groups in the numeric rate scores (NRS) for throat pain at 15 minutes and 2 hours, as well as hoarseness scores at 2 and 6 hours. The groups were similar regarding vomiting rates and cough scores. Conclusion: In this study investigating the impact of CH on sore throat, we observed an increased incidence of POST and hoarseness in patients subjected to CH. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Clinical Nursing in Practice is the property of Journal of Clinical Nursing in Practice (Editorial Board, Shanghai Jiao Tong University Press) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Purpose: Chemotherapy-induced nausea and vomiting (CINV) is a common adverse events in cancer patients and can negatively affect their quality of life (QoL). This study aimed to evaluate the clinical efficacy of an electric massage chair (EMC) for the treatment of CINV. Methods: A randomized phase II cross-over trial was conducted on solid cancer patients who received moderate (MEC) to high emetogenic chemotherapy (HEC). The participants were randomly assigned to receive their first chemotherapy either on a standard bed (Group A) or in an EMC (Group B) during the infusion. The patients were then crossed over to the next cycle. CINV and QoL questionnaires were collected from the participants. Results: A total of 59 patients completed the trial protocol and were included in the analysis, with 29 and 30 patients in Groups A and B, respectively. The mean INVR (Index of Nausea, Vomiting, and Retching) score in the 2nd day of the first cycle was higher in Group B (3.63 ± 5.35) than Group A (2.76 ± 4.78), but the difference was not statistically significant (p = 0.5367). The complete response rate showed little difference between the groups. Among the high-emetic risk subgroups, patients who received HEC (p = 0.04595), younger patients (p = 0.0108), and non-colorectal cancer patients (p = 0.0495) presented significantly lower CINV scores when EMC was applied. Conclusion: Overall, there was no significant difference in INVR scores between standard care and EMC. Applying EMC at the first chemotherapy infusion may help preserve QoL and reduce CINV in high-risk patients. Trial registration: KCT0008200, 17/02/2023, Retrospectively registered. [ABSTRACT FROM AUTHOR]

Background: Children with life-threatening and life-limiting conditions can experience high levels of suffering due to multiple distressing symptoms that result in poor quality of life and increase risk of long-term distress in their family members. High quality symptom treatment is needed for all these children and their families, even more so at the end-of-life. In this paper, we provide evidence-based recommendations for symptom treatment in paediatric palliative patients to optimize care. Methods: A multidisciplinary panel of 56 experts in paediatric palliative care and nine (bereaved) parents was established to develop recommendations on symptom treatment in paediatric palliative care including anxiety and depression, delirium, dyspnoea, haematological symptoms, coughing, skin complaints, nausea and vomiting, neurological symptoms, pain, death rattle, fatigue, paediatric palliative sedation and forgoing hydration and nutrition. Recommendations were based on evidence from a systematic literature search, additional literature sources (such as guidelines), clinical expertise, and patient and family values. We used the GRADE methodology for appraisal of evidence. Parents were included in the guideline panel to ensure the representation of patient and family values. Results: We included a total of 18 studies that reported on the effects of specific (non) pharmacological interventions to treat symptoms in paediatric palliative care. A few of these interventions showed significant improvement in symptom relief. This evidence could only (partly) answer eight out of 27 clinical questions. We included 29 guidelines and two textbooks as additional literature to deal with lack of evidence. In total, we formulated 221 recommendations on symptom treatment in paediatric palliative care based on evidence, additional literature, clinical expertise, and patient and family values. Conclusion: Even though available evidence on symptom-related paediatric palliative care interventions has increased, there still is a paucity of evidence in paediatric palliative care. We urge for international multidisciplinary multi-institutional collaboration to perform high-quality research and contribute to the optimization of symptom relief in palliative care for all children worldwide. [ABSTRACT FROM AUTHOR]

Nausea and vomiting are distressing symptoms experienced by many patients receiving palliative care for serious illness. Common pharmacologic management strategies include 5-HT3 receptor antagonists, antipsychotics, antihistamines, and antimuscarinic agents; however, these agents incur risks of adverse effects. One of the most worrisome risks of commonly used antiemetics is prolonging the QT interval and the associated risk of torsades de pointes. To avoid the dangers of pharmacologic treatment of nausea and vomiting, previous studies in emergency medicine and postoperative settings suggest that inhaled isopropyl alcohol is an inexpensive, safe, and effective nonpharmacologic intervention. This case report highlights the successful use of inhaled isopropyl alcohol for managing nausea and vomiting in a patient with heart failure receiving palliative care. [ABSTRACT FROM AUTHOR]

Auricular acupuncture (AA) has been used to manage chemotherapy-induced nausea and vomiting (CINV). However, the application of the technique varies widely among the clinical trials that test its effectiveness. The aim of the present study was to develop and clinically validate an AA protocol for the management of CINV in cancer patients. This study was carried out in two stages: (1) development of the AA protocol for the management of CINV and (2) clinical validation of the protocol. The content validity of the protocol was determined by a panel of specialists, with an agreement rate ranging from 85.7% to 100%. In the clinical validation, when administered to cancer patients, the protocol developed has been shown to reduce the incidence, frequency, severity, and length of nausea and vomiting following chemotherapy, as well as the severity of nausea and anticipatory nausea following chemotherapy. This protocol needs to be tested in future studies, including a pilot study with a sham group and a randomized clinical trial, in order to further evaluate its feasibility, acceptability, safety, and clinical usefulness for the management of CINV. [ABSTRACT FROM AUTHOR]

Dihydrolipoamide dehydrogenase (DLD) deficiency is a rare disease of genetic origin due to the malfunctioning of a shared subunit of three mitochondrial multi-enzyme complexes. Phenotypes of this disease are a set of clinical manifestations ranging from neonatal disorders to myopathy or recurrent episodes of liver failures, and vomiting for which no adequate or definitive treatment is currently available. This study described a case involving a 16-year-old boy who had experienced recurrent vomiting of unknown cause from age two. Normal value ranges for the basic metabolic panel were reported in previous years. The patient was admitted with Wernicke's encephalopathy after the last vomiting attack, also indicating metabolites of organic acids compatible with DLD deficiency. Whole exome sequencing identified a known pathogenic mutation in the DLD gene, leading to a diagnosis of DLD deficiency. Our patient was treated with a high dose of thiamine supplementation and continued treatment, has not experienced any vomiting attacks or related problems in the last two years and has adequately responded to the treatment prescribed. Normal urine organic acid levels in patients with recurrent vomiting cannot roll out DLD deficiency. However, although thiamine deficiency typically induces Wernicke's encephalopathy, it can also be implicated in pyruvate dehydrogenase complex (PDHc) deficiency, and high-dose thiamine therapy (with doses up to 30 mg/kg) is recommended for deficient patients. [ABSTRACT FROM AUTHOR]

Aim: This study aims to assess the effectiveness of ATHP-HC on the severity of nausea and vomiting, relaxation state, brainwaves, and quality of life in women with Nausea and Vomiting in Pregnancy (NVP). Methods: A quasi-experimental study was conducted on 62 pregnant women randomly allocated into intervention and control groups using a pre-post-test. Researchers provided ATHP-HC to the intervention group and Cirebon Gamelan audio therapy to the control group. The research instruments included PUQE-24-hour scoring, measurement of vital signs, brainwaves using NeuroSky MindWave Mobile II, and WHOQOL-BREF. The data collected were processed with SPSS version 24.0 and analyzed using the statistical formula paired t-test. Results: The results of the study showed that there were significant differences between nausea and vomiting scores (p = 0.000), relaxation levels (p = 0.003 in the intervention group and p = 0.000 in the control group), and quality of life (p = 0.000), before and after the treatment in the intervention group and the control group. There was a significant difference in the state of relaxation after the intervention in the two groups of respondents (p = 0.001). There was no significant difference in the proportion of increased meditation in the two groups of respondents (p = 0.707). Conclusion: As relaxation and meditation music, ATHP-HC can be a complementary therapy for pregnant women to overcome NVP. [ABSTRACT FROM AUTHOR]

BACKGROUND: Despite advances in antiemetic regimens, uncontrolled chemotherapy-induced nausea and vomiting (CINV) remains a problem for patients receiving oncology treatment, leading to decreased quality of life and worse treatment outcomes. OBJECTIVES: The purpose of this pilot project was to use follow-up telephone calls to identify barriers related to successful management and prevention of CINV on a single-center outpatient chemotherapy infusion unit. METHODS: A mixed-methods descriptive design was used for this project. Quantitative data were used to assess barriers to management and prevention of CINV. Secondary multiple regression analysis was used to determine whether barriers could predict CINV. Qualitative data were used to analyze common barriers and themes. FINDINGS: Of the patients called (N = 132), 50% identified a barrier to managing and treating CINV, with the most common barrier being knowledge gaps related to proper use of antiemetics. [ABSTRACT FROM AUTHOR]

Aims Studies conducted in the field of non-pharmacological interventions to control acute and delayed nausea and vomiting caused by chemotherapy have reported contradictory results. The present study aimed to compare the effect of ice massage and C-band on acute and delayed nausea and vomiting caused by chemotherapy in cancer patients. Materials & Methods In the present clinical trial study, 105 patients referred to the chemotherapy department of Shahid Rajaei Hospital, Yasuj, Iran in 2018, were selected by convenience sampling and randomly assigned to three groups: Ice massage, C-band, and control. Acute nausea and vomiting was assessed through the Morrow Assessment of Nausea and Emesis, and delayed nausea and vomiting were assessed using the MASCC tool at 6, 12, 18, and 24 hours after chemotherapy, before and after the interventions. The collected data were analyzed using SPSS 22 software. Findings Before intervention, there was no significant difference in terms of the presence/ absence, as well as the intensity of acute and delayed nausea and vomiting in the three groups at 6, 12, 18, and 24 hours after chemotherapy (p>0.05). Also, after the interventions, there was no significant difference in the presence/absence and intensity of acute and delayed nausea in the patients in the ice massage, C-band, and control groups at 6, 12, 18, and 24 hours after chemotherapy (p>0.05). Conclusion Ice massage and C-bandage do not improve nausea and vomiting in chemotherapy patients. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Clinical Nursing in Practice is the property of Journal of Clinical Nursing in Practice (Editorial Board, Shanghai Jiao Tong University Press) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Bowel obstruction is commonly a pre-terminal event in women with advanced ovarian cancer. Management of symptoms will often be the focus rather than surgical intervention. Determining the patient's end-of-life wishes is paramount − because the prognosis for these patients can be short, advanced care planning is key. This case study will explore the management of nausea and vomiting associated with malignant bowel obstruction and demonstrate how a patient's psychological and social wellbeing is as important as managing the physical symptoms. It will discuss how skilled and effective communication is vital early in the disease trajectory in ensuring the patient's needs are met. Additionally, by undertaking a thorough holistic needs assessment, all aspects of end-of-life care can be discussed with the patient and family, which may enable the achievement of a preferred place of care and a peaceful, dignified death. Multidisciplinary working and co-ordination of care may allow for quick interventions, meeting individual needs and symptoms being managed more effectively. [ABSTRACT FROM AUTHOR]

Background: Complementary and integrative medicine may be effective for postoperative outcomes. This study aimed to determine the effect of lemon inhalation aromatherapy on pain, nausea, and vomiting and neurovascular assessment in patients for lower extremity fracture surgery. Methods: This is a randomized clinical trial study. Ninety patients who had undergone lower extremity fracture surgery were randomly assigned to the intervention (lemon aromatherapy) and control groups. Lemon aromatherapy was started in the morning of the surgery and extended at two-hour intervals until the end of the surgery, in the recovery room, and 16 h after surgery. Numerical pain and nausea and vomiting scales, the Rhodes Index of Nausea, Vomiting, and Retching, and the WACHS Neurovascular Observation Chart were used to assess the outcomes before and after the intervention (in the recovery room and 4, 8, 12, and 16 h post-surgery). The data were analyzed using the Wilcoxon test, ANCOVA, and Repeated Measure ANCOVA. Results: A significant difference was observed between the groups in terms of the intensity of pain (P < 0.001) and nausea and vomiting (P = 0.001) during the study period. Moreover, a significant difference was found between groups as to the frequency and severity of nausea, vomiting, and retching. The amount and duration of postoperative vomiting and nausea were significantly lower in the intervention group compared to the control group. In addition, lemon inhalation aromatherapy decreased the frequency of anti-emetic drug administration in the recovery room (P = 0.04) and 16 h post-surgery (P = 0.03). Conclusions: This study indicated that aromatherapy reduced pain intensity, postoperative nausea, vomiting, and retching, as well as the incidence of anti-emetic drug administration. Therefore, using lemon inhalation aromatherapy to relieve pain and reduce nausea and vomiting is suggested for lower extremity fracture patients who have undergone surgery. Trial registration: This study was registered in the Iranian Registry of Clinical Trail (Number = 57,331, IRCT20130616013690N10, approved 24/07/2021) (https://www.irct.ir/trial/57331). [ABSTRACT FROM AUTHOR]

This randomized controlled clinical trial aimed to examine the effect of spirituality-based palliative care on pain, nausea, vomiting, and the quality of life in 80 Iranian colon cancer inpatients from January to June 2020 in southern Iran. Patients were randomly assigned to an intervention group and a control group. The intervention group took part in four 120-min sessions while the control group received standard care. Pain, nausea, vomiting, and quality of life were assessed before the intervention and one month after the intervention. Data were analyzed using paired t-test and independent t-test. Between-groups differences analysis showed a significant difference in the quality of life scores, pain score, as well as nausea and vomiting scores following the one-month intervention. In conclusion, this group spirituality-based palliative care intervention might be beneficial in improving quality of life and reducing symptoms. [ABSTRACT FROM AUTHOR]

To assess the effects of auriculotherapy for the management of CINV in cancer patients. This is a systematic review of randomized controlled trials (RCTs). We searched MEDLINE via PubMed, AMED, Biblio Auriculo, Embase, CINAHL, CENTRAL, BVS, MTCI Américas, Web of Science, Scopus, PEDro, CNKI, CBMdisc, and CSJD-VIP databases up to September 2021 with no language restrictions. We included 25 studies with a total of 2,167 randomized participants. The results of the included studies suggest positive effects of auriculotherapy for the control of CINV, however 92% studies presented a high risk of bias overall. In the included studies, the most used auricular acupoints in the studies were the stomach (CO4) (n = 24, 96%), shenmen (TF4) (n = 23, 92%), sympathetic nerve (AH6a) (n = 15, 60%), spleen (CO13) (n = 14, 56%), liver (CO12) (n = 11, 44%), subcortex (AT4) (n = 10, 40%), and cardia (CO3) (n = 9, 36%). It was not possible to assess the effectiveness of auriculotherapy for the management of CINV due to the great heterogeneity of the studies regarding the form of evaluating the outcome, the application of auriculotherapy, and the high risk of bias. It is suggested that robust clinical trials be conducted and reported according to the STRICTA guidelines. [ABSTRACT FROM AUTHOR]

Copyright of Forum Zaburzen Metabolicznych is the property of VM Medica-VM Group (Via Medica) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Anaesthesiologie & Intensivmedizin is the property of DGAI e.V. - Deutsche Gesellschaft fur Anasthesiologie und Intensivmedizin e.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Pregnant patients often seek natural remedies when they experience pregnancy-induced nausea and vomiting (PINV). Scant evidence exists to quantify the beneficial effects of essential oil inhalation as a remedy for PINV, yet is identified as a common integrative and complementary medicine treatment, particularly during the first trimester. The purpose of this trial was to evaluate the effects of aromatic essential oils on nausea, vomiting, and quality of life during the first 13 weeks of pregnancy. Methods: This was a 4-arm randomized, blinded, placebo controlled clinical trial to evaluate the potential of grapefruit, ginger, and peppermint essential oils on nausea, vomiting, and overall quality of life. Citrus paradisi is cold pressed from the citrus rind, Zingiber officinale is extracted from the root of the herb, and Mentha x piperita is extracted from the leaves of the plant. The essential oils were diluted in avocado oil for skin application. The placebo consisted of avocado oil. Participants were recruited through the research practice's database and completed the intervention in their own homes to mimic real world scenarios. Seventy-four pregnant women within their first trimester were randomized into four groups, including the placebo group. Results: Outcomes were measured using the Quantification of Emesis 24-hour scale (PUQE-24), a validated measurement of nausea, vomiting, and quality of life during pregnancy. All groups improved on all measures progressively during the trial. When placebo and intervention groups were compared, there was no significant difference between groups on sleep and nausea outcomes. Ginger essential oil was found to reduce retching and the use of aromatherapy in general improved well-being. [ABSTRACT FROM AUTHOR]

Context: Palliative care aims to improve the quality of life in patients with incurable illness. Medicinal cannabis (MC) has been used in the palliative care setting to address multiple symptoms in patients.Objectives: To evaluate the full scope of available literature investigating the effects and potential harms of MC on symptom management and quality of life in palliative care.Methods: PubMed, Embase, The Cochrane Library and clinicaltrials.gov were searched for eligible articles, published between 1960 and September 9, 2021. Quality of the evidence was assessed in accordance with Grading of Recommendations, Assessment, Development and Evaluations. Risk of bias was assessed using the RoB 2 tool for randomised controlled trials and the Risk of Bias in Non-randomized Studies-of Interventions (ROBINS-I) tool for non-randomized trials.Results: Fifty-two studies (20 randomised; 32 non-randomised) with 4786 participants diagnosed with cancer (n = 4491), dementia (n = 43), AIDS (n = 235), spasticity (n = 16), NORSE syndrome (n = 1) were included. The quality of evidence was 'very low' or 'low' for all studies, and low for only two randomised controlled trials. Positive treatment effects (statistical significance with P < 0.05) were seen for some MC products in pain, nausea and vomiting, appetite, sleep, fatigue, chemosensory perception and paraneoplastic night sweats in patients with cancer, appetite and agitation in patients with dementia and appetite, nausea and vomiting in patients with AIDS. Meta-analysis was unable to be performed due to the wide range of cannabis products used and the heterogeneity of the study outcomes.Conclusion: While positive treatment effects have been reported for some MC products in the palliative care setting, further high quality evidence is needed to support recommendations for its use in clinical practice. [ABSTRACT FROM AUTHOR]

Objective: We aimed to evaluate the effectiveness and safety of preoperative electroacupuncture (EA) on the incidence of postoperative nausea and vomiting (PONV), and severity of postoperative pain, in gynecological patients undergoing laparoscopic surgery. The effects of EA administered at different preoperative time points were compared. Methods: A total of 413 patients undergoing elective laparoscopic gynecological surgery were randomly allocated into 4 groups receiving EA the day before surgery (Group Pre, n = 103), 30 min before (Group 30, n = 104) or both (Group Comb, n = 103), or usual care alone (Group Usual, n = 103). All acupuncture groups had usual care. The incidence of PONV and pain at 24 h were primary outcomes. Secondary outcomes included the severity of postoperative nausea, vomiting and pain, requirement for antiemetic medication and quality of recovery (QoR)-15 scores after surgery. Results: There were significant differences between the four groups in nausea and vomiting incidence (0–24 h), postoperative antiemetic use (0–48 h), and postoperative pain (0–6 h), with the EA groups recording the lowest levels. Regarding primary outcomes, incidence of nausea and vomiting at 6-24 h was 28/11/18/11% (p = 0.003) 23/5/8/9% (p < 0.001), respectively, for Groups Usual/Pre/30/Comb. Accordingly, EA reduced the incidence of nausea and vomiting at 6-24 h by 61/34/60% and 79/65/61% for Groups Pre/30/Comb, respectively. Regarding secondary outcomes, incidence of nausea and vomiting at 0-6 h was 20/9/11/7% (p = 0.013) and 17/7/9/6% (p = 0.021), respectively, for Groups Usual/Pre/30/Comb. Rescue antiemetics at 0–6 h were required by 18/4/11/4% (p = 0.001) in Groups Usual/Pre/30/Comb. The mean numerical rating scale (NRS) pain score (0–10) at 0–6 h was significantly different between groups (2.45/1.89/2.01/1.97 for Groups Usual/Pre/30/Comb, p = 0.024). There were no significant differences between the three EA-treated groups. Conclusion: In gynecological patients undergoing laparoscopic surgery and treated with multimodal antiemetic methods, one session of preoperative EA may be a safe adjunctive treatment for PONV prophylaxis. Optimal timing of EA requires further verification. Trial registration number: ChiCTR-INR-16010035 (Chinese Clinical Trial Registry). [ABSTRACT FROM AUTHOR]

Background: Cyclic Vomiting Syndrome (CVS) is a rare functional gastrointestinal disorder, which has a considerable burden on quality of life of both children and their family. Aim of the study was to evaluate the diagnostic modalities and therapeutic approach to CVS among Italian tertiary care centers and the differences according to subspecialties, as well as to explore whether potential predictive factors associated with either a poor outcome or a response to a specific treatment. Methods: Cross-sectional multicenter web-based survey involving members of the Italian Society of Pediatric Gastroenterology, Hepatology and Nutrition (SIGENP) and Italian Society of Pediatric Neurology (SINP). Results: A total of 67 responses were received and analyzed. Most of the respondent units cared for less than 20 patients. More than half of the patients were referred after 3 to 5 episodes, and a quarter after 5 attacks. We report different diagnostic approaches among Italian clinicians, which was particularly evident when comparing gastroenterologists and neurologists. Moreover, our survey demonstrated a predilection of certain drugs during emetic phase according to specific clinic, which reflects the cultural background of physicians. Conclusion: In conclusion, our survey highlights poor consensus amongst clinicians in our country in the diagnosis and the management of children with CVS, raising the need for a national consensus guideline in order to standardize the practice. [ABSTRACT FROM AUTHOR]

Objective: To describe the local experience of adult patients presenting with cannabinoid hyperemesis syndrome (CHS) to an urban ED in the outer northern suburbs of Melbourne. Methods: Retrospective chart review of adult patients presenting to the ED with a documented history of CHS or equivalent terminology from January 2015 to January 2021. Age, sex, cannabis use, clinical features, pathology results, imaging and symptomatic management were examined as well as outcomes regarding disposition, representation, morbidity and mortality. Results: One hundred and forty‐two adult presentations were included. Sixty‐seven were unique presentations and 29 were patients who represented during the study period. Most represented within 3 months (37.8%) and most represented at least twice. Males were overrepresented (68.7%). Patients were young (median age 31 years, interquartile range 23–35 years) and all had a history of regular cannabis use (usually daily). Cyclical nausea and/or vomiting was the most common clinical feature compared to others in previously reported diagnostic criteria. Patients typically had elevated white cell counts with associated neutrophilia (75.8%) and mild hypokalaemia (57.9%). Lipase was not elevated, and C‐reactive protein was typically less than 50 mmol/L (98.2%). Imaging was not commonly performed but largely normal. Treatment was supportive with anti‐emetic use, intravenous fluids and analgesia. There were no deaths or admissions to intensive care. Conclusions: Cyclical nausea and vomiting was the most common feature observed in this cohort compared to other clinical features reported in prior studies. Serum lipase was normal and C‐reactive protein only mildly elevated. Prospective studies are required to further assess these findings. A retrospective case series summarising a local hospital experience of presentations due to Cannabinoid Hyperemesis Syndrome. The article explores clinical features, investigations findings, management and disposition outcomes. [ABSTRACT FROM AUTHOR]

Nausea and vomiting have psychological negative effects on some pregnant women during gestation. Different strategies have been used for the treatment of nausea and vomiting during pregnancy, such as acupressure and psychological interventions. This study was conducted to evaluate the effects of psychological counseling and acupressure based on couple therapy procedures on vomiting and nausea in pregnant women in Iran. Two hundred and eight women were divided into four groups (n=52): 1) they did not any intervention (control group), 2) they received the psychological intervention, 3) they received acupressure intervention, and 4) they received a combination of psychological + acupressure interventions. To investigate the effects of interventions on nausea and vomiting, the Rhodes index of nausea, vomiting and retching were used. The counseling period has lasted for 4 weeks. The pressure intervention on the site was conducted in clockwise form for 1 min and anticlockwise form for another 1 min. Groups did not have a significant difference for abortion and income (p>0.05). The effects of counseling, and acupressure interventions on severity and period of vomiting and nausea were not significant (p>0.05), but the intervention based on counseling and acupressure decreased severity of vomiting and nausea (p<0.05). The intervention based on counseling and acupressure could not reduce nausea and vomiting during the gestation, but the intervention based on a combination of both decreased nausea and vomiting. It can be suggested to apply an intervention based on a combination of counseling and acupressure in short-time period for decreasing nausea and vomiting in women during pregnancy. [ABSTRACT FROM AUTHOR]

Simple Summary: Palliative care aims to improve the quality of life for patients with serious illnesses by improving symptoms. Many patients with advanced diseases suffer from nausea and vomiting. In addition to evidenced-based treatments, patients with advanced diseases often seek for complementary and integrative therapies. Aromatherapy is commonly used to alleviate the various symptoms of palliative care patients and is well accepted by both patients and their caregivers. We retrospectively evaluated the efficacy of using lemon oil pads against nausea and vomiting in our palliative care unit and found a positive effect against nausea and vomiting in this patient group. Aromatherapy is regularly used in the University Hospital Krems's palliative care unit. In a retrospective analysis, we investigated whether there were improvements in nausea and vomiting in patients with advanced cancers over a time span of 24 months. Data collection used the medical records of patients who were institutionally approved to receive routine aroma applications for alleviating nausea and vomiting. The efficacy of using lemon oil pads was tested with one-dimensional chi-squared tests. Sixty-six patients received 222 applications of lemon oil on cotton pads; no data were available for 17 applications. The adequate relief of nausea and vomiting was reported for 149 (73%) applications, whereas no symptom control was seen for 56 (27%) applications. For the 56 applications without symptom control, first- and second-line rescue medications were successful in 53 and 3 cases, respectively. The use of aromatherapy with lemon oil pads against nausea and vomiting was feasible for 73% of all applications. All patients who did not benefit from aromatherapy had effective symptom control with a rescue medication. Large randomized prospective trials are necessary to evaluate the benefit of the use of lemon oil pads against nausea and vomiting in patients with advanced cancer. [ABSTRACT FROM AUTHOR]

Objective: To investigate the influencing factors of transcatheter arterial chemoembolization (TACE) on patients with hepatocellular carcinoma (HCC) for tumor response (complete and partial response, CR + PR).Methods: This research conducted a retrospective study of the hospital charts of patients treated with TACE successfully renewed from October 2014 to December 2015 at Sun Yat-sen University Cancer Center (Guangzhou, China). Univariate analysis (Chi-square test and repeated-measures ANOVA) selected nine influential tumor response factors from 22 core factors. The nine variables were included in a forward multiple logistic regression model predicting patients treated with TACE to achieve tumor response. Overall survival was calculated using the Kaplan-Meier method.Results: Data of 277 of 282 patients were included in the analysis. Nine variables were analyzed by univariate analysis and independently associated with tumor response (tumor capsule integrity, nausea and vomiting, microwave ablation, liver dysfunction, the absolute value of lymphocyte (LYM), alpha-fetoprotein, and gamma-glutamyl transpeptidase (GGT). By multivariate analysis, GGT (odds ratio [OR] =0.996), liver dysfunction (OR = 0.395), combined with microwave ablation (OR = 0.503), and tumor capsule integrity (OR = 1.894) were the significant predictors of the tumor response group compared with the standard deviation group (P < 0.05).Conclusions: This study suggests that TACE combined with ablation on patients with complete tumor capsules may have a better prognosis in tumor response and OS; additionally, liver dysfunction and nausea and vomiting were the independent predictors of tumor response. [ABSTRACT FROM AUTHOR]

Cannabinoid hyperemesis syndrome is a condition characterized by cyclic severe nausea, vomiting, and abdominal pain associated with frequent, long-term marijuana use. The condition resolves with cessation of cannabis but may be temporarily relieved by bathing in hot water. Topical capsaicin cream may also alleviate symptoms, perhaps through antiemetic effects produced by activation of TRPV1 receptors, similar to that of hot water bathing. This review summarizes the epidemiology, clinical presentation, diagnosis, pathophysiology, and management of cannabinoid hyperemesis syndrome, focusing on treatment with topical capsaicin. [ABSTRACT FROM AUTHOR]

We conducted an online survey of 249 Australian women who currently or previously experienced severe nausea and vomiting of pregnancy (NVP) or hyperemesis gravidarum (HG) and examined their experiences in being denied medications during pregnancy. One in four women reported being denied medications for NVP/HG, which most commonly involved doxylamine and encounters with community pharmacists. Women's experiences reflected that lack of awareness of guidelines and unfavourable risk‐benefit assessments appeared to be key barriers to facilitating medication access. Approaches towards identifying and effectively addressing barriers to the provision of effective treatments for severe NVP and HG are urgently needed. [ABSTRACT FROM AUTHOR]

The article focuses on a Canadian Paediatric Surveillance Program study aiming to understand the potential risks associated with virtual care for children. It discusses two cases that highlight adverse events possibly related to virtual care and emphasizes the need to assess the burden and nature of these events.

Objectives/Background: Cyclic vomiting syndrome (CVS) is a disabling disorder of gut–brain interaction manifested by stereotypical and severe episodes of nausea and vomiting. Prevalence data indicate that CVS affects 1–2% of children and there has been a recent dramatic rise in diagnosed adults. Methods: This narrative review summarizes relevant literature pertaining to pediatric and adult CVS and provides a guide to management based on extensive clinical experience. Results: More timely diagnosis is facilitated by an expert consensus diagnostic approach and limited testing. Some diagnostic tests of exclusion remain essential. These include an upper gastrointestinal (GI) contrast study to exclude intestinal malrotation and basic laboratory screening. An abdominal ultrasound is recommended to exclude renal hydronephrosis in children and biliary disease in adults. Exclusion of metabolic/genetic conditions is warranted in those with specific warning signs, presentation in infants/toddler age, and in those with refractory disease. In the absence of chronic GI symptoms, referral to a GI specialist for upper endoscopy is generally not necessary in children but recommended in adults. A large subset termed migraine‐equivalent CVS display strong clinical and genetic features of migraine. A unifying pathophysiologic core concept involves neuronal hyperexcitability and aberrant central modulation of autonomic signals. This is coupled with multiple susceptibility factors including mitochondrial dysfunction/cellular energy deficits, a hyper‐responsive hypothalamic–pituitary–adrenal axis and many comorbidities that increase vulnerability to triggering events. CVS episodes are frequently triggered by stressors and intercurrent illnesses. Lifestyle and non‐pharmacological interventions thus play a pivotal role in successful management. Pharmacological therapies are categorized into abortive, supportive/rescue, and prophylactic treatments. The majority respond particularly well to migraine‐focused treatment strategies. Conclusion: Despite improved characterization and understanding, CVS remains classified as a functional disorder of brain–gut interaction that is often disjointly managed by generalists and subspecialists. Early recognition, evaluation, and management will facilitate care and improve outcomes. Further research into its natural history with common progression to migraine headaches, neuroendocrine mechanisms, and the pathophysiologic relation to migraine diathesis is much needed. [ABSTRACT FROM AUTHOR]

Background: Although nausea and vomiting of pregnancy (NVP) is common, the secular and demographic trends of NVP and its treatments are not well‐studied. Objectives: To describe the prevalence and patterns of first‐trimester NVP and selected treatments among controls in the National Birth Defects Prevention Study (NBDPS). Methods: National Birth Defects Prevention Study is a population‐based case–control study of birth defects in the United States (1997‐2011). We collected self‐reported data about NVP and use of commonly reported pharmacological and herbal/natural treatments (ondansetron, promethazine, pyridoxine, metoclopramide, doxylamine succinate, ginger, phosphorated carbohydrate solution, and prochlorperazine) from mothers of non‐malformed control infants. We estimated the prevalence of NVP and selected treatments and examined secular and demographic trends (education, race/ethnicity, and maternal age) for such use, adjusting for study centre. Results: Among 10 540 mothers of controls, 7393 women (70.1%) reported first‐trimester NVP, and 12.2% of those used one or more of the commonly reported treatments. Specific treatment use varied after adjustment for study centre (ondansetron: 3.4%; promethazine: 4.2%; pyridoxine: 3.2%; metoclopramide: 0.7%; doxylamine succinate: 1.7%; ginger: 1.0%; phosphorated carbohydrate solution: 0.4%; and prochlorperazine: 0.3%). Treatment use increased for each agent over the study period. Women with more years of education reported more NVP and treatment use. White (72%), Hispanic (71%), and other race (73%) women reported more NVP than Black women (67%); White women used selected NVP treatments most frequently, and Black women used them more than Hispanic women. Though women aged 25‐34 years reported more NVP (72%) than younger (69%) or older (67%) women, the frequency of medication use was similar among women aged 25‐34 and ≥35, and lower among women aged <25 years. Conclusions: National Birth Defects Prevention Study controls reported NVP at frequencies similar to those previously reported. Of note, we observed an increase in use of selected treatments over time, and variations in NVP and treatments by study site and demographic factors. [ABSTRACT FROM AUTHOR]

Cyclical vomiting syndrome (CVS) was described over 100 years ago, but it is often underdiagnosed and undertreated, even after a diagnosis is made. It is relatively common, affecting almost 2% of school-age children in some studies. Although it is traditionally seen as a childhood disease related to migraine, CVS does occur in adults. The main characteristic of CVS is the stereotypical recurrent nature of episodes of intense nausea and vomiting lasting from few hours to few days and followed by a complete resolution of symptoms. The diagnosis is predominantly a clinical one and there are internationally accepted criteria for diagnosis. The management of acute attacks of CVS aims to relieve symptoms, reduce the duration of attacks and prevent dehydration and hospital admission. Management also includes appropriate counselling on healthy lifestyle, provision of individual management plans and preventive medications. The aim of management is to reduce the number of attacks and improve quality of life. About half the children with CVS start to have migraine with or without aura in late adolescence and around 40% continue with CVS into early adult life. This article is aimed at healthcare professionals looking after children with CVS and describes the clinical presentation, the criteria required for diagnosis and outlines the different treatment options. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to determine whether repeated oral cryotherapy was effective in reducing nausea, vomiting, oral mucositis, and oral pain in patients with breast cancer receiving chemotherapy during the 1st, 2nd, and 3rd rounds of chemotherapy for the first time. Methods: A nonequivalent control group non-synchronized design was used. The experimental group (n=21) received oral cryotherapy that applied a 2x2x2 cm ice cube in the mouth for 30 minutes at each chemotherapy. Both experimental group and control group (n=20) received oral care educations. Nausea, vomiting, oral mucositis and oral pain were measured on 5 days, 14 days, and 21 days after each chemotherapy. Data were collected from July 2019 to April 2020 at a university hospital in Korea, and analyzed using the SPSS WIN 25.0 software package. Results: There was a significant difference between the experimental and control groups in the nausea·vomiting score, oral mucositis grade, and oral pain score. Oral cryotherapy was confirmed to be effective in delaying nausea and vomiting. It has been shown that stomatitis and oral pain are related. Conclusion: For breast cancer patients receiving chemotherapy, it is recommended to apply oral cryotherapy as a nursing intervention to reduce nausea, vomiting, oral mucositis, and oral pain. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of the study was to identify the comparison with the different methods of acupressure treatment in breast cancer patients undergoing chemotherapy. Methods: This study was a single group pretest-posttest design. Thirty patients age 30- 65 scheduled for chemotherapy were included. The data were collected through self- reported questionnaires on nausea, vomiting, and anorexia and analyzed using descriptive statistics and the Wilcoxon signed ranked test. Results: The relieving effect of nausea and vomiting (Z=-2.54, p=.011) was significant in P6 acupressure by wrist bands. Conclusion: Patients undergoing chemotherapy have relieving effects on nausea and vomiting after P6 acupressure by wrist band. This study demonstrates the stimulation of the P6 acupressure by wrist band for reducing nausea and vomiting for breast cancer patients undergoing chemotherapy. [ABSTRACT FROM AUTHOR]

Objective: Reports of disordered eating are increasing in mainland China; however, little is known regarding Chinese psychotherapists' conceptualizations of disordered eating symptomatology. This study explores Chinese psychotherapists' conceptualizations of binge eating (BE)/vomiting symptoms and treatment considerations. Method: In‐depth, semi‐structured interviews were conducted with mainland Chinese psychotherapists (N = 41) in Mandarin. Participants were given a hypothetical case and provided their conceptualization of the patient's BE/vomiting etiology and treatment recommendations. Etiological conceptualizations were coded using directed content analysis, and treatment recommendations were grouped by intervention strategy. Results: Participants described psychosocial risk factors for BE/vomiting including intrapersonal characteristics and the childhood family environment, but rarely discussed genetic and neurobiological factors. Few participants reported that they would prioritize the BE/vomiting symptoms in treatment and their specific treatment recommendations varied widely. Discussion: Most research on BE/vomiting behaviors in the literature is based on Western samples with little attention to mainland Chinese populations. Participants in this study provided conceptualizations of risk factors and treatment recommendations that could generally find evidence in the existing Western literature, even if some theories are no longer supported by updated Western research and the participants focused primarily on psychosocial risks as opposed to genetic/neurobiological factors. It will be important for future research to ascertain mainland Chinese therapists' understanding of these additional types of risk. These findings also suggest a disconnect between clinical findings on neurobiological risks and Chinese therapists' knowledge and/or perceived clinical utility of these risks. Implications for treatment and research dissemination to diverse global communities are discussed. [ABSTRACT FROM AUTHOR]

Background and purpose: Cannabinoid hyperemesis syndrome (CHS) was first described in the literature in 2004. The pathophysiology of CHS remains largely unknown. The syndrome is becoming more prevalent in inpatient settings and emergency departments as the legal usage of cannabis proliferates, although it is often not recognized when encountered. While symptoms of CHS are becoming better defined, early recognition and comprehensive treatment plans with reproducible outcomes remain elusive. Symptoms can be further complicated by the presence of chronic conditions or comorbidities. The purpose of this article is to consolidate findings from the literature, identify commonalities in clinical characteristics and pathogenesis, and highlight diagnostic and treatment approaches. Methods: Data collection methods include a review of the literature on CHS published in the past 10 years. Case study data were gathered from a patient interview and chart review. Conclusions and implications for practice: Through better recognition of CHS, nurse practitioners and other providers can promptly and accurately diagnosis the condition and improve treatment plans for these patients. [ABSTRACT FROM AUTHOR]

PURPOSE: Patient-reported outcome measures (PROMs) that assess how patients feel and function have potential for evaluating quality of care. Stakeholder recommendations for PRO-based performance measures (PMs) were elicited, and feasibility testing was conducted at six cancer centers. METHODS: Interviews were conducted with 124 stakeholders to determine priority symptoms and risk adjustment variables for PRO-PMs and perceived acceptability. Stakeholders included patients and advocates, caregivers, clinicians, administrators, and thought leaders. Feasibility testing was conducted in six cancer centers. Patients completed PROMs at home 5-15 days into a chemotherapy cycle. Feasibility was operationalized as ≥ 75% completed PROMs and ≥ 75% patient acceptability. RESULTS: Stakeholder priority PRO-PMs for systemic therapy were GI symptoms (diarrhea, constipation, nausea, vomiting), depression/anxiety, pain, insomnia, fatigue, dyspnea, physical function, and neuropathy. Recommended risk adjusters included demographics, insurance type, cancer type, comorbidities, emetic risk, and difficulty paying bills. In feasibility testing, 653 patients enrolled (approximately 110 per site), and 607 (93%) completed PROMs, which indicated high feasibility for home collection. The majority of patients (470 of 607; 77%) completed PROMs without a reminder call, and 137 (23%) of 607 completed them after a reminder call. Most patients (72%) completed PROMs through web, 17% paper, or 2% interactive voice response (automated call that verbally asked patient questions). For acceptability, > 95% of patients found PROM items to be easy to understand and complete. CONCLUSION: Clinicians, patients, and other stakeholders agree that PMs that are based on how patients feel and function would be an important addition to quality measurement. This study also shows that PRO-PMs can be feasibly captured at home during systemic therapy and are acceptable to patients. PRO-PMs may add value to the portfolio of PMs as oncology transitions from fee-for-service payment models to performance-based care that emphasizes outcome measures. [ABSTRACT FROM AUTHOR]

There is substantial interest in the role of ginger as an adjuvant therapy for chemotherapy-induced nausea and vomiting (CINV). However, available evidence lacks robust methodology. To assess the effect of adjuvant ginger compared with placebo on chemotherapy-induced nausea-related quality of life (QoL) and CINV-related outcomes. A parallel, double-blind, placebo-controlled randomized trial with 1:1 allocation was conducted. One hundred three chemotherapy-naïve adults scheduled to receive moderately to highly emetogenic chemotherapy at two hospitals in Australia were enrolled and analyzed. Four standardized ginger capsules (totaling 84 mg/day active gingerols/shogaols), or placebo, were administered commencing the day of chemotherapy and continuing for 5 days for chemotherapy cycles 1 through 3. The primary outcome was chemotherapy-induced nausea-related QoL. Secondary outcomes were vomiting- and CINV-related QoL; anticipatory, acute, and delayed nausea and vomiting; fatigue; nutritional status; depression and anxiety; health-related QoL; and adverse events. Intention-to-treat analysis was performed. Mixed analysis of variance with repeated measures determined differences between groups. The null hypothesis was no difference between groups. After applying a Bonferroni multiple testing correction, evidence against the null hypothesis was considered at P = 0.003. One hundred three participants (ginger: n = 52; placebo: n = 51) were enrolled and analyzed. There was clinically relevant evidence against the null hypothesis, favoring ginger, in change scores for nausea-related QoL (F [df] = 9.34[1,101]; P = 0.003; partial η2 = 0.09), overall CINV-related QoL (F [df] = 12.26[1,101]; P < 0.001; partial η2 = 0.11), delayed nausea severity (F [df] = 9.46[1,101]; P = 0.003; partial η2 = 0.09), and fatigue (F [df] = 10.11[1,101]; P = 0.002; partial η2 = 0.09). There was a clinically meaningful lower incidence of delayed nausea and vomiting in the ginger group at Cycle 2 (53% vs 75%; P = 0.020 and 4% vs 27%; P = 0.001, respectively) and Cycle 3 (49% vs 79%; P = 0.002 and 2% vs 23%; P = 0.001, respectively). There was a clinically meaningful lower incidence of malnutrition in the ginger group at Cycle 3 (18% vs. 41%; P = 0.032) and in change scores for Patient-Generated Subjective Global Assessment (F [df)] = 4.32[1,100]; P = 0.040; partial η2 = 0.04). Change scores between groups favored ginger for vomiting-related QoL and number of vomiting episodes; however, findings were not clinically meaningful. There was no effect of ginger on anticipatory or acute CINV, health-related QoL, anxiety, or depression. No serious adverse events were reported. Ginger supplementation was a safe adjuvant to antiemetic medications for CINV that enhanced QoL during chemotherapy treatment. Future trials are needed to examine dose-dependent responses to verify optimal dosing regimens. [ABSTRACT FROM AUTHOR]

There is an emerging subset of patients who present to the emergency department (ED) with cannabinoid hyperemesis syndrome (CHS). Cannabinoid hyperemesis syndrome is a relatively new clinical condition and despite a long documented marijuana use in humans, little is known about the pathophysiology of this emerging problem. The focus of this article is to present a patient who presented with CHS. The clinical presentation, diagnostics, and treatment for this patient will be discussed. The nurse practitioner can anticipate high utilization of patients presenting to the ED with CHS. Nurse practitioners need to provide early recognition and careful management of patients who present with this condition. [ABSTRACT FROM AUTHOR]

Purpose: The predominant neurotransmitters and receptors for acute and delayed chemotherapy-induced nausea and vomiting (CINV) are represented in the current paradigm, which reflects successful control of emesis. However, control of nausea (N) lags behind management of vomiting (V). This review aims to re-examine and incorporate new information about the mechanisms of V and N.Methods: The initial literature search focused on CINV. Keywords in articles led to subsequent discovery of publications focused on N&V in other medical and scientific fields (e.g., gastroenterology, neurology, cannabinoid science, neuropharmacology, and motion sickness). Using keywords to identify other sources continued until no further recent, meaningful publications were found.Results: More than 86% of references were from recent non-oncology journals and books, suggesting there are many areas for cross-fertilization research into mechanisms and management of N&V-particularly of N, which involves overlapping and dissimilar CNS areas from V. Information from cited articles was incorporated into visual representation of N&V, which is certainly not exhaustive but supports highly complex processes in the stomach and gut, the vagus nerve and spinal cord neurons, the nucleus tractus solitarii, and the anterior insular cortex and anterior cingulate cortex with input from the amygdala.Conclusions: These data support the idea that mechanisms for N, whatever the cause, must be highly similar. Continued research into nausea, including patient-reported evaluation and outcomes, is important; interventions for nausea could be considered adjuvants to current standard of care antiemetics and be individualized, depending on patient-reported efficacy and adverse effects and preferences. [ABSTRACT FROM AUTHOR]

Purpose: Head-to-head comparison of reliability, validity and responsiveness of four patient-reported outcome measures (PROMS) suitable for assessing health-related quality of life (HRQOL) in palliative care settings: EORTC QLQ-C15-PAL, FACT-G7, FACIT-Pal and short-form FACIT-Pal-14.Methods: Secondary analysis of two phase III randomised trials: ketamine for chronic cancer pain, octreotide for vomiting in inoperable malignant bowel obstruction. Sub-groups were defined by Australia-modified Karnofsky performance status (AKPS) and participants' global impression of change (GIC). Two aspects of reliability were assessed: internal consistency (Cronbach alpha, α); test-retest reliability (intra-class correlation coefficient (ICC)) of patients with stable AKPS and those who self-reported 'no change' on GIC. Construct validity was assessed via pre-determined hypotheses about sensitivity of PROM scores to AKPS groups and responsiveness of PROM change scores to GIC groups using analysis of variance.Results: FACIT-Pal had better internal consistency (α ranged 0.59-0.80, 15/18 ≥ 0.70) than QLQ-C15-PAL (0.51-0.85, 4/8 ≥ 0.70) and FACT-G7 (0.54-0.64, 0/2 ≥ 0.70). FACIT scales had better test-retest reliability (FACIT-Pal 11/27 ICCs ≥ 0.70, FACT-G7 2/3 ICCs ≥ 0.70) than QLQ-C15-PAL (2/30 ICCs ≥ 0.70, 18/30 ≤ 0.5). Four scales demonstrated sensitivity to AKPS: QLQ-PAL-15 Physical Functioning and Global QOL, FACT-G Functional Wellbeing and FACIT-Pal Trial Outcome Index (TOI). Nine scales demonstrated responsiveness: three in the ketamine trial population (QLQ-C15-PAL Pain, FACIT-Pal-14, FACT-G7), six in the octreotide trial population (QLQ-C15-PAL Fatigue; FACIT-Pal PalCare, TOI, Total; FACT-G Physical Wellbeing and Total).Conclusions: No PROM was clearly superior, confirming that choosing the best PROM requires careful consideration of the research goals, patient population and the domains of HRQOL targeted by the intervention being investigated. [ABSTRACT FROM AUTHOR]

Objective: Cyclic vomiting syndrome (CVS) is difficult to diagnose, thus there is often a delay in diagnosis or a misdiagnosis. In the absence of an adequate understanding of the pathophysiology of the syndrome, it is under-recognised and treatment is difficult. The present case series aimed to assess and manage three adolescents with CVS. Method: The Children's Apperception Test was administered on the three Asian adolescents who were referred for the management of CVS to the Department of Clinical Psychology at a tertiary care hospital in New Delhi, India. A treatment module was developed to treat CVS in these adolescents. Results: A strong link was found between the psychological stressors and their physical manifestations in the episodes of vomiting. Therapeutic management with a focus on behavioural modification, adaptive coping skills, and a healthy therapeutic relationship was found to be efficacious in gradually remitting this condition. Conclusions: Thus, the focus of treatment in cases of CVS should be to understand the psychological underpinning and help the adolescents to incorporate healthy coping strategies. [ABSTRACT FROM AUTHOR]

The article discusses the Postoperative vomiting in children which is a frequent and important cause of morbidity in children. Topics discussed include identifying children at risk of postoperative vomiting (POV); Provide effective prophylaxis and treatment of POV in children; and regional anaesthesia is beneficial either in isolation or in combination with general anaesthesia.

Cannabinoid hyperemesis syndrome (CHS) is characterized by severe cyclical nausea, vomiting, and abdominal pain relieved by compulsive hot water bathing in the setting of chronic cannabinoid use. This article reviews the characteristics, proposed pathophysiology, treatment modalities, and role of nurses caring for patients with CHS. [ABSTRACT FROM AUTHOR]

Background: Nausea and vomiting of pregnancy (NVP) is the most prevalent medical condition associated with pregnancy. The Royal College of Obstetricians and Gynaecologists published its first guidelines for management of NVP in 2016, although many current treatments are off label, with only one recently licensed treatment for NVP in the UK.Aim: To identify the current practices for NVP management across the patient pathway, and estimate the economic burden to NHS services.Design and Setting: This was an observational, retrospective research study conducted in the Newcastle Gateshead Clinical Commissioning Group (CCG) health economy area in England.Method: Data were collected from GP practices, local hospital datasets, ambulance services (April 2013-March 2016), and the Hospital Episode Statistics dataset (2006-2016).Results: Eight GP practices participated in the study. In all, 15.2% of the total pregnant population presented with NVP. Treatment varied significantly between GP practices, and 33.6% of women re-presented to their GP. There was an annual increase in women admitted to hospital for NVP symptoms, with increasing length of stay per admission. Almost half (44.6%) of the calls to 999/111 from women experiencing NVP symptoms resulted in an ambulance dispatch. The annual cost of NVP to this health economy was estimated to be £199 804, which crudely extrapolates to £25 758 731 at UK level. Due to underestimations of costs, the impact to the UK NHS could be up to £62 373 961.Conclusion: There is considerable variation in current management practices for NVP outside of recently published guidelines, and this may result in substantial resource use and avoidable financial impact to the NHS. [ABSTRACT FROM AUTHOR]

Background: Reaching an optimal nutritional intake is challenging in critically ill infants. One possible way to minimise nutritional deficits is the use of protein and energy‐enriched (PE)‐formulas. We aimed to describe weight achievement and gastrointestinal symptoms in infants admitted to the paediatric intensive care unit (PICU) while receiving PE‐formula for a prolonged period. Methods: Records from infants admitted to a multidisciplinary PICU and using PE‐formula were analysed retrospectively. Infants were eligible if they received PE‐formula daily for at least 2 weeks. Weight achievement was determined as the difference between weight‐for‐age (WFA) Z‐scores at the start and end of PE‐formula use. Gastrointestinal symptoms, including gastric residual volume, constipation and vomiting, were evaluated as tolerance parameters. Results: Seventy infants with a median [interquartile range (IQR)] age of 76 (30–182) days were eligible. The PICU duration was 50 (35–83) days during which they received PE‐formula for 30 (21–54) days. Predominant admission diagnoses were post‐cardiac surgery, respiratory and cardiac diagnosis. A significant mean (SD) WFA Z‐score increase of 0.48 (1.10) (P < 0.001) and a median (IQR) weight gain of 5.80 (3.28–9.04) g kg−1 day−1 was observed. Multivariate regression showed that a lower WFA Z‐score at start was associated with a higher WFA Z‐score increase during PE‐formula use (β −0.35 (95% confidence interval =  −0.50 to −0.19); P < 0.001). The maximum 24‐h gastric residual volume was 8.1 mL (IQR = 2.2–14.3) for each 1 kg in bodyweight. Three (4%) infants were treated for diarrhoea and three infants were treated for vomiting. Conclusions: The majority of infants with a prolonged PICU stay showed weight improvement when using PE‐formula. PE‐formula was well tolerated because gastrointestinal symptoms only occurred in few infants. [ABSTRACT FROM AUTHOR]