Low-level laser therapy prevents severe oral mucositis in patients submitted to hematopoietic stem cell transplantation: a randomized clinical trial

Purpose

The purpose of this study is to evaluate the effectiveness of low-level laser therapy for the prevention of oral mucositis in patients undergoing hematopoietic stem cell transplantation.

Methods

This is a randomized, parallel, superiority trial including 35 patients divided into the following: laser (n?=?17) and sham (n?=?18). The variables assessed were oral mucositis (grade 2 of the World Health Organization oral toxicity scale), severe oral mucositis (grade 3 or 4), and pain (according to a visual analogue scale). In the laser group, a InGaAlP laser, wavelength of 650 nm, power 100 mW, energy per point of 2 J, time 20 s by point, extremity fiber optic 0.028 cm², and energy density 70 J/cm², was used, applied the first day of conditioning until D + 5, while the sham group received simulated laser over the same period.

Results

No statistically significant difference was found in the incidence of oral mucositis (p?=?0.146). Severe mucositis was found in 40 % of the patients (14/35), 3 in the intervention group (17.65 %) and 11 in the sham group (61.11 %) (p?=?0.015). The cumulative probability of survival with respect to the development of severe oral mucositis was >0.6 for the intervention group and 0 for the control group (p?=?0.0397). On the day on which pain was considered the worst, patients in the sham group were more likely to classify their pain as severe compared to those in the laser group (p?=?0.041).

Conclusion

Low-level laser therapy proved effective for the prevention of severe oral mucositis and intense oral pain in patients submitted to hematopoietic stem cell transplantation.

     

The influence of maternal loss on young women's experience of identity development in emerging adulthood

A qualitative approach was used to study the influence of adolescent maternal loss on identity development in 6 young women. In-depth, semi-structured interviews were audiotaped, transcribed, and analyzed for recurrent themes. Three metathemes emerged from the narratives: Loss of Mother Impacts Identity, Relatedness on the Path of Identity Development, and Integration of Loss into Emergent Identity. Findings indicate that the experience of maternal loss influenced aspects of the women's identity development and initiated a need to seek new connections and redefine aspects of self in order to integrate the loss. Practical implications of these findings are presented for clinicians who work with bereaved young women.     

Achalasia: A review of therapeutic options and outcomes

Advances in achalasia has led to the development of new therapeutic options. This review will focus on methodology and outcomes of two established techniques; pneumatic dilation and surgical myotomy; and one new technique, LES injection of botulinum A toxin.