Low molecular weight heparin for treatment of acute myocardial infarction (FAMI): Fragmin (dalteparin sodium) in acute myocardial infarction

The benefit of using subcutaneous low molecular weight heparin for the treatment of acute myocardial infarction is not known. The aim of this study was to determine the efficacy of a low molecular weight heparin (dalteparin sodium) for the treatment of acute myocardial infarction in patients not treated with thrombolytic therapy. Twenty-nine cardiological centres from leading hospitals in India participated in this prospective, multicentre, double-blind, placebo-controlled study in two phases which included 1128 patients with acute myocardial infarction. In the acute phase (between day 1 and 3 of admission) all the patients received a weight-adjusted dose of subcutaneous dalteparin (120 IU/kg twice daily). In the second, double-blind phase of acute myocardial infarction, patients were randomised to receive a fixed dose of dalteparin (7,500 IU) or an identical placebo injection for 30 days. A composite primary endpoint of death, reinfarction, recurrence of angina and emergency revascularisation was used. All the 1128 patients with acute myocardial infarction were included in the trial. In the acute phase, the composite primary endpoint was observed in 58 (5.1%) patients. Of 1037 paients who were randomly assigned to receive a fixed dose of dalteparin (n=519) or placebo (n=518), the composite primary event rate was 6.7 percent and 7.0 percent, respectively (RR 0.97; 95% CI 0.62-1.52; p=0.90). To conclude, treatment with dalteparin administered subcutaneously in a weight-adjusted dose of 120 IU/kg twice daily resulted in a lower than expected mortality during the acute phase of myocardial infarction. A lower fixed once daily dose of 7,500 IU during the chronic phase did not confer additional protection.     

Expectations of hospitalized cancer and cardiac patients regarding the medical and psychotherapeutic benefits of music therapy

Cancer and cardiac patients were surveyed to determine if their expectations regarding the potential medical and psychotherapeutic benefits of music therapy and the relative effectiveness of different musical activities and styles would vary according to diagnostic group, and musical background. A total of 182 patients participated, 55 with various forms of cancer, and 127 with various cardiac conditions. The mean age was 59.8 years. The results showed that their expectations varied in certain benefit areas, music activities, and musical styles, according to: whether the patient had cancer or a cardiac condition, whether the patient had received music therapy previously, and whether the patient had studied music previously. Implications are drawn for introducing music therapy to cancer and cardiac patients.     

Parturitional Injury of the Head and Neck

Parturitional injuries refer to injuries sustained during and secondary to fetal delivery. The skull, brain, and head and neck regions are frequently involved. Accurate differentiation and classification of the various injuries is essential for treatment, prognosis, and parental counseling. In this review, we discuss the various “bumps and lumps” that maybe encountered along the neonatal skull as well as the most frequent calvarial and intracranial parturitional injuries. In addition, a short discussion of the most common head and neck, facial, and spinal lesions is included. Various mimickers and risk factors are also presented.     

A comparison of cardiac and cancer inpatients on the MARI Card Test

The MARI^® Card Test is a projective preference test developed by art therapist, Joan Kellogg, based on her extensive study of mandalas (circle drawings). As used in this study, the test involved selecting the most and least preferred mandalas from a set of archetypal designs, called the Great Round. The test was administered to 195 patients, 132 hospitalized for cardiac disease and 63 hospitalized for cancer. The purpose was to identify similarities and differences in the design and color choices of the two groups, and to interpret the choices. Based on mandala theory, the projective evidence indicated that both cardiac and cancer patients are trying to preserve what they have achieved in life, and both are fearful of falling apart. Along with a strong will to survive, there is a preoccupation with death, feelings of depression, dependence, and anger, and a general avoidance of deep existential or spiritual issues. The will to survive is accompanied by a strong tendency to find creative ways of dealing with the illness and its treatment. With this comes a need to understand things—their lives, their own identities, their illnesses, and their best treatment options. Differences between the groups were found in specific fears (death, falling apart, spread of cancer); however, these differences may be due to age and length of illness as well as diagnosis. The caveats of projective tests are examined, and implications are drawn for arts therapists.     

Music and healing in cancer care: A survey of supportive care providers

This paper explores the role of music activity and music therapy in health care drawing on a survey of UK cancer care providers offering music interventions and music therapy. The survey examined the extent and type of music provision and explored providers’ views about the role and contribution of music and music therapy in healing. As well as music, the survey organisations offered a range of supportive therapies including complementary and alternative therapies (CAM) and creative therapies such as art therapy. The results provide insight into the way in which music and creative therapies are viewed by those responsible for care provision in this sector. The data point towards some of the challenges facing music therapists in the changing world of cancer care. These include responding to changes arising from developments in treatment and the organisation of care as well as increased collaboration with a diverse range of supportive care practitioners. These include providers of music and arts for health activity as well as complementary and alternative therapy practitioners who are increasingly involved in cancer care provision. We discuss the implications of these changes for the development of music therapy in cancer care.     

Predictive Factors in the Quality of Life of Cancer Inpatients

ABSTRACT

The purpose of the study was to determine whether sense of coherence (SOC), and demographic variables (age, gender, race, education, length of illness) predict quality of life (QOL) in cancer inpatients. SOC is the extent to which one finds life comprehensible, manageable, and meaningful. Participants were 49 inpatients (66% female) with various forms of cancer, mostly African American (71%), with a mean age of 54.5 years. The mean QOLS of cancer inpatients (84.6) was lower than a healthy population (90.0), however, their mean item scores indicated that they are “mostly satisfied” with most areas of QOL except for active forms of past-time and health. The mean SOC score (133.8) was also lower than other groups; however without appropriate norms, it cannot be concluded that cancer inpatients have a weak SOC. Multiple regressions showed that SOC was a significant predictor of QOL, and that the demographic variables were not predictive of QOL, except when combined with SOC. All findings may be limited by demographics of the sample (race, gender, age, severity of illness), and the inability of cross-sectional investigations to determine causality.