BACKGROUND:: Physical stress and mental stress are increasingly common phenomenas in our rapidly changing and stressful modern society. Research has found meditation to produce positive and demonstrable stress reduction effects on brain and immune functions. This study is grounded in traditional Chinese philosophical mores that teach a process summarized by the keynote activities of "calm, still, quiet, consider, and get" and the potential of this process to reduce stress in adolescents. PURPOSE:: The purpose of this study was to examine the effects of meditation on the physical and mental health of junior college students. METHODS:: This research employed a quasi-experimental design. Participants included 242 freshmen from a junior college in Taiwan selected using a convenience sampling technique. Participants were then randomly separated into experimental (n = 119) and control (n = 123) groups. The project duration was 18 weeks, during which the experimental group received 2 hours of meditation treatment per week, for a total of 36 hours. Both groups completed pretest and posttest Life Adaptation Scale forms, which included questionnaires addressing information on physical and mental distress and positive and negative coping strategies. Data were analyzed using analysis of covariance. RESULTS:: Findings showed that the effect of the experiment treatment was significant when student physical and mental distress pretest scores were controlled. Physical and mental symptoms in the experimental group were lower than those in the control group. CONCLUSIONS:: Meditation can help students to adapt to life stressors. This study also provides support for traditional Chinese wisdom, which promotes meditation as one way to improve health.

Abstract Objective: The primary goal of the study was to assess the efficacy of mindfulness-based meditation therapy on anxiety, depression, and spiritual well-being of Japanese patients undergoing anticancer treatment. A secondary goal was to assess the relationships among anxiety, depression, spiritual well-being, growth, appreciation, pain, and symptoms. Methods: The subjects were 28 patients who were receiving anticancer treatment. The subjects participated in two sessions of mindfulness-based meditation therapy, including breathing, yoga movement and meditation. Each patient was taught the program in the first session, then exercised at home with a CD, and subsequently met the interviewer in a second session after 2 weeks. Primary physicians recruited the patients and interviews were conducted individually by nurses or psychologists with training in the program. Patients completed preintervention and postintervention questionnaires on anxiety and depression (Hospital Anxiety and Depression Scale [HADS]), spiritual well-being (Functional Assessment of Chronic Illness Therapy-Spiritual [FACIT-Sp]), and appreciation, growth, pain, and symptoms. Results: HADS scores significantly decreased from 12 +/- 5.3 to 8.6 +/- 6.3 (p = 0.004) after the intervention, and FACIT-Sp increased from 32 +/- 6.5 to 33 +/- 6.9 (p = 0.69), but the change was not significant. There were significant associations between FACIT-Sp and HADS (r =-0.78, p = 000), FACIT-Sp and growth (r =-0.35, p = 0.04), FACIT-Sp and pain (r =-0.41, p = 0.02), and growth and appreciation (r = 0.45, p = 0.009). Conclusions: Mindfulness-based meditation therapy may be effective for anxiety and depression in Japanese cancer patients, and spiritual well-being is related to anxiety and depression, growth, and pain. The negative correlation of spirituality with growth differs from the results of previous studies and the mechanism of this effect needs to be investigated further.

Objective: Although the efficacy of meditation interventions has been examined among adult samples, meditation treatment effects among youth are relatively unknown. We systematically reviewed empirical studies for the health-related effects of sitting-meditative practices implemented among youth aged 6 to 18 years in school, clinic, and community settings. Methods: A systematic review of electronic databases (PubMed, Ovid, Web of Science, Cochrane Reviews Database, Google Scholar) was conducted from 1982 to 2008, obtaining a sample of 16 empirical studies related to sitting-meditation interventions among youth. Results: Meditation modalities included mindfulness meditation, transcendental meditation, mindfulness-based stress reduction, and mindfulness-based cognitive therapy. Study samples primarily consisted of youth with preexisting conditions such as high-normal blood pressure, attention-deficit/hyperactivity disorder, and learning disabilities. Studies that examined physiologic outcomes were composed almost entirely of African American/black participants. Median effect sizes were slightly smaller than those obtained from adult samples and ranged from 0.16 to 0.29 for physiologic outcomes and 0.27 to 0.70 for psychosocial/behavioral outcomes. Conclusions: Sitting meditation seems to be an effective intervention in the treatment of physiologic, psychosocial, and behavioral conditions among youth. Because of current limitations, carefully constructed research is needed to advance our understanding of sitting meditation and its future use as an effective treatment modality among younger populations.

BACKGROUND: The importance of mind-body oriented therapies in oncology has increased in recent years. Eurythmy therapy (EYT, Greek: eurythmy=harmonious rhythm) is a mind-body oriented therapy used in Anthroposophic Medicine. EYT can lead to long-term alleviation of chronic disease symptoms and improve patient quality of life. Yet, little is known about underlying physiological mechanisms. OBJECTIVE: This study aims to compare the effects of EYT and conventional ergometer training (CET) on heart rate variability (HRV). DESIGN: In a cross-over design, 20 healthy subjects performed two different EYT exercises and two sessions of CET. ECGs were recorded throughout these procedures. HRV was quantified by the extent of very low (VLF), low (LF) and high frequency (HF) oscillations of heart rate. RESULTS: VLF and LF oscillations increased during one EYT exercises when compared to rest after EYT ('B exercise', VLF: 7.65 vs. 6.57 log ms(2); LF: 8.06 vs. 6.15 log ms(2)) whereas during the other EYT exercise only LF increased ('L exercise', LF: 7.19 vs. 6.25 log ms(2)). HF was not affected. During CET VLF, LF and HF decreased compared to rest (VLF: 5.4 log ms(2), LF: 4.5 log ms(2), HF: 3.2 log ms(2)). During rest after both EYT exercises LF/HF decreased when compared to rest after CET (0.4 and 0.5 vs. 1.4). CONCLUSION: At comparable workloads, EYT stimulated HRV whereas CET attenuated HRV. The decrease of LF/HF during rest after EYT indicates an improved relaxation. These results suggest that patients may benefit from EYT in terms of HRV improvement.

Objective: This meta-analysis was conducted to investigate the effects of mindfulness-based stress reduction (MBSR) on the mental and physical health status of various cancer patients.Methods: Ten studies (randomized-controlled trials and observational studies) were found to be eligible for meta-analysis. Individual study results were categorized into mental and physical variables and Cohen's effect size d was computed for each category.Results: MBSR may indeed be helpful for the mental health of cancer patients (Cohen's effect size d=0.48); however, more research is needed to show convincing evidence of the effect on physical health (Cohen's effect size d=0.18).Conclusion: The results suggest that MBSR may improve cancer patients' psychosocial adjustment to their disease. Copyright (c) 2008 John Wiley & Sons, Ltd.

To improve the effectiveness of teaching professionalism, the authors propose introducing mindfulness practice into the dental curriculum. The qualities cultivated through mindfulness meditation practice closely resemble the global attitudes of professionalism. Professionalism and mindfulness are broad overlapping constructs with a common prosocial aim: letting go of selfish, short-sighted rewards and promoting the long-term common good. Both constructs also aim for the highest quality of life for practitioners and patients alike. Based on a selective review of the medical literature, we suggest that mindfulness practice should help improve attentiveness, self-awareness, acceptance, wisdom, and self-care in dentistry. We briefly review the role of mindfulness in higher education, as well as current attempts at Dalhousie University to integrate mindfulness into the dental and dental hygiene curricula.

Mind-body medicine, grounded in a respectful, therapeutic partnership, should be a central element in the care of every person diagnosed with cancer. This article reviews some of the physiologic foundations of mind-body medicine, the introduction of mind-body approaches to cancer care in the 1970s, the specific mind-body approaches that have been used, and the evidence that supports their use. The importance of group support for enhancing the effectiveness of these approaches is discussed. Guidelines are offered for integrating mind-body approaches and perspectives in the care of people who have cancer.

The hematopoietic stem cell transplant (HSCT) experience is emotionally and physically stressful for cancer patients who undergo this procedure. Mindfulness-based interventions have been studied in patients with various diagnoses, including cancer, although minimal work has applied this intervention to hospitalized patients. Use of mindfulness meditation has potential to provide HSCT patients with coping skills to deal with unpleasant symptoms and an uncertain future. This exploratory study examined feasibility, physiological arousal, and psychological and physical symptoms in HSCT patients participating in a mindfulness meditation intervention that begins before and continues throughout hospitalization and involves one-on-one guided sessions and daily practice using a 17-minute meditation CD. Of the 20 participants, 78.9% completed the intervention. Statistically significant decreases in heart and respiratory rates and improvements in symptoms immediately before and after each session were found. These findings demonstrate feasibility and preliminary support of a mindfulness meditation intervention with symptomatic, hospitalized cancer patients.

BACKGROUND: Although several studies have reported positive effects of mindfulness-based stress reduction (MBSR) intervention on psychological well-being, it is not known whether these effects are attributable to a change in mindfulness. PURPOSE: The aim of this study is to compare the effects of MBSR to a waiting-list control condition in a randomized controlled trial while examining potentially mediating effects of mindfulness. METHODS: Forty women and 20 men from the community with symptoms of distress (mean age 43.6 years, SD = 10.1) were randomized into a group receiving MBSR or a waiting-list control group. Before and after the intervention period, questionnaires were completed on psychological well-being, quality of life, and mindfulness. RESULTS: Repeated measures multiple analysis of variance (MANCOVAs) showed that, compared with the control group, the intervention resulted in significantly stronger reductions of perceived stress (p = 0.016) and vital exhaustion (p = 0.001) and stronger elevations of positive affect (p = 0.006), quality of life (p =.009), as well as mindfulness (p = 0.001). When mindfulness was included as a covariate in the MANCOVA, the group effects on perceived stress and quality of life were reduced to nonsignificance. CONCLUSION: Increased mindfulness may, at least partially, mediate the positive effects of mindfulness-based stress reduction intervention.

Even when the procedures are successful, patients experience considerable physical, psychological and psychosocial stress before, during and after hematopoietic stem cell transplantation (HSCT). Physical exercise therapy constitutes a potentially promising intervention to reduce such stress within the framework of HSCT because of its multidimensional effectiveness. Up to May 2007, fifteen published studies have examined physical exercise interventions in the context of HSCT, with no study reporting any unexpected or negative effects. The most common intervention involved isolated aerobic exercise programs and occurred during or after the transplantation process; strength training programs and combined intervention strategies are being examined more rarely. Significant benefits from the exercise interventions have been predominantly reported for physical performance, quality of life and fatigue status of the patients. Several other benefits like a faster recurrence of immune cells or reduced severity of therapy-related side effects can be estimated. Future research is needed for the purpose of evidence-based medicine/therapy to provide more rigorous examinations of these interventions, to address existing methodological problems and to identify further effect levels of physical exercise therapy in the context of HSCT.Bone Marrow Transplantation advance online publication, 19 November 2007; doi:10.1038/sj.bmt.1705917.

A 34-year-old woman carrying a BRCA1 gene and a significant family history was diagnosed with T1c, N1 breast cancer. The tumor was estrogen receptor, progesterone receptor, and HER-2/Neu negative.The patient received dose-dense chemotherapy with Adriamycin and Cytoxan followed by Taxol, and left breast irradiation. Later, a bilateral S-GAP flap reconstruction with right prophylactic mastectomy and left mastectomy were performed. During her treatment, the patient had an integrative medicine consultation and was seen by a team of health care providers specializing in integrative therapies, including integrative nutrition, therapeutic massage, acupuncture, and yoga. Each modality contributed unique benefit in her care that led to a satisfactory outcome for the patient.A detailed discussion regarding her care from each modality is presented.The case elucidates the need for integrative approaches for cancer patients in a conventional medical setting.

Abstract In trying to improve clinician communication skills, we have often heard clinicians at every level admonished to "use silence," as if refraining from talking will improve dialogue. Yet we have also noticed that this "just do it," behavior-focused "use" of silence creates a new, different problem: the clinician looks uncomfortable using silence, and worse, generates a palpable atmosphere of unease that feels burdensome to both the patient and clinician. We think that clinicians are largely responsible for the effect of silence in a clinical encounter, and in this article we discuss what makes silence enriching-enabling a kind of communication between clinician and patient that fosters healing. We describe a typology of silences, and describe a type of compassionate silence, derived from contemplative practice, along with the mental qualities that make this type of silence possible.

The hematopoietic stem cell transplant (HSCT) experience is emotionally and physically stressful for cancer patients who undergo this procedure. Mindfulness-based interventions have been studied in patients with various diagnoses, including cancer, although minimal work has applied this intervention to hospitalized patients. Use of mindfulness meditation has potential to provide HSCT patients with coping skills to deal with unpleasant symptoms and an uncertain future. This exploratory study examined feasibility, physiological arousal, and psychological and physical symptoms in HSCT patients participating in a mindfulness meditation intervention that begins before and continues throughout hospitalization and involves one-on-one guided sessions and daily practice using a 17-minute meditation CD. Of the 20 participants, 78.9% completed the intervention. Statistically significant decreases in heart and respiratory rates and improvements in symptoms immediately before and after each session were found. These findings demonstrate feasibility and preliminary support of a mindfulness meditation intervention with symptomatic, hospitalized cancer patients.

Children with cancer are using complementary and alternative medicine (CAM) to relieve symptoms, reduce side effects of treatment, and cope with the emotional aspects of having a life-threatening illness. Parental decisions about using CAM should be based on studies of efficacy and safety. Unfortunately, little evidence of efficacy is available for the majority of CAM therapies. This article discusses the methodological challenges to conducting CAM research in children and the evidence needed to support integrative medicine in pediatric oncology.

Pediatric oncology nurses provide care for children across a continuum from the point of diagnostic evaluation through treatments and cure or a peaceful, dignified death. Nurses provide this care in a wide variety of settings such as the home, hospital, clinics, schools, camps, and residential facilities. Mind-body therapies are being used more frequently in the care of children receiving treatment for cancer. Matching the right therapy with the right patient is an important component of care.

As nurses, we have the unique privilege of witnessing and nurturing the healing process of the whole person--mind, body, and spirit. Teaching mindfulness meditation is a nursing intervention that can foster healing. The consistent practice of mindfulness meditation has been shown to decrease the subjective experience of pain and stress in a variety of research settings. Formal and informal daily practice fosters development of a profound inner calmness and nonreactivity of the mind, allowing individuals to face, and even embrace, all aspects of daily life, regardless of circumstances. By emphasizing being, not doing, mindfulness meditation provides a way through suffering for patients, families, and staff. This practice allows individuals to become compassionate witnesses to their own experiences, to avoid making premature decisions, and to be open to new possibilities, transformation, and healing.

PURPOSE: An integrative literature review was undertaken to examine the research on psycho-spiritual well-being in terminally ill people, specifically patients with advanced cancer. METHOD: A comprehensive search of MEDLINE, CINAHL, CancerLit and PsycINFO using relevant keywords produced 43 primary research studies that investigated psycho-spiritual well-being in patients with advanced cancer. Each report was read, critiqued and systematically assessed for purpose statement or research questions, study design, sample size, characteristics of the subjects, measurement of independent and dependent variables, sample attrition, method of data analysis and results. Major themes and findings were identified for each of the studies. FINDINGS: Psycho-spiritual well-being is an area of interest to researchers all over the world. Retrieved studies had been conducted in 14 countries by researchers in a variety of disciplines, including nursing, medicine, psychology and theology. Six major themes repeatedly emerged as essential components of psycho-spiritual well-being: self-awareness, coping and adjusting effectively with stress, relationships and connectedness with others, sense of faith, sense of empowerment and confidence, and living with meaning and hope. CONCLUSION: Patients with an enhanced sense of psycho-spiritual well-being are able to cope more effectively with the process of terminal illness and find meaning in the experience. Prognostic awareness, family and social support, autonomy, hope and meaning in life all contribute to positive psycho-spiritual well-being. Emotional distress, anxiety, helplessness, hopelessness and fear of death all detract from psycho-spiritual well-being. The research indicated that health professionals can play an important role in enhancing psycho-spiritual well-being, but further research is needed to understand specific interventions that are effective and contribute to positive patient outcomes.

Dehydration in terminally ill patients has been found to be beneficial and to improve the quality of an individual's last few days of life. As the population continues to age, more individuals are cared for in long-term care (LTC) facilities, where they tend to spend their final days. Previous studies have examined the perceptions and attitudes of hospice nurses, acute care nurses, physicians, and caregivers; however, no such studies have evaluated LTC nurses. It is necessary to know LTC nurses' perceptions and attitudes so they can be offered the education needed to provide the best quality care for terminally ill patients. The purpose of this study was to describe how nurses working with elderly individuals in LTC perceived terminal dehydration (TD). Long-term care nurses (N = 64) were surveyed using a modified version of an established 10-item instrument. Significant findings included a positive correlation between age and positive perception of TD--as nurse age increaSed, a more positive view of TD was expressed. Also, the number of deaths witnessed was positively associated with the belief that TD was beneficial. In general, responses to the individual survey items were quite varied, representing inconsistencies in attitudes and care of dying LTC patients. The results of this descriptive study indicate the debate concerning the benefits of TD continues and remains an important topic for the LTC nurse.

Objective: The aim of this paper is to present and critically appraise the evidence for the use of mindfulness-based interventions in cancer care.Methods: Systematic review methods were used. A thorough search of relevant major and specialised electronic databases was made and unpublished and ongoing work was also identified. Both qualitative and quantitative studies were eligible for inclusion. Information about aims, design, participant sample, measures, findings and intervention details were extracted from each study.Results: Thirteen research papers and four conference abstracts published since 2007 were identified which met the criteria, reporting five different types of mindfulness intervention. The 13 papers composed of three randomised control trials, two non-randomised control trials, five pre and post-test designs and two qualitative studies. Studies report significant improvements in anxiety, depression, stress, sexual difficulties, physiological arousal and immune function or subjective benefits across all interventions. Methodological limitations were identified. Diversity in study designs and interventions makes comparisons between studies difficult. Some mindfulness interventions may have a place in acute treatment and palliative care.Conclusion: Mindfulness approaches are a promising intervention in cancer care, potentially across the cancer trajectory. Further qualitative research and research into different styles of mindfulness delivery are recommended. Copyright (c) 2010 John Wiley & Sons, Ltd.

OBJECTIVES: Over the last few years several offers in- and outpatient creative therapy interventions for cancer patients have been developed, implemented and researched. This article describes the content, concept and structure of art therapy interventions based on painting or drawing as well as some further methodical procedures and research results of art therapy in the field of psycho-oncology. METHODS: We searched electronic databases for papers published between 1987 and March 2009 on painting or drawing based art therapy interventions in oncology. The papers were selected using the inclusion criteria detailed below. RESULTS: Of 56 retrieved manuscripts, 17 papers reporting 12 research projects were included. The art therapy interventions differ from each other considerably in their content and structure. The variance in the study design of the papers was also high. More females than males participated in the interventions. The papers dealt with a variety of questions. A total of seven quantitative papers focused on mental health. A decrease in anxiety and depression was noted in six of these. Three papers documented an increase in quality of life. Moreover, four qualitative papers indicated positive effects on personal growth, coping, the development of new form of self-expression, and social interaction. Three papers with qualitative methods investigated participants' mechanisms for coping with their disease. CONCLUSION: Published papers show that art therapy benefits cancer patients in various ways including improving their mental health. Nevertheless, more studies with an evidence-based design are necessary for reaching further conclusions on efficacy of art therapy. This research should include a focus on gender differences, and controlling possible influencing factors.

There has been much discussion regarding the need to empower older adults to make informed health decisions and to test interventions targeting empowerment to promote health among older adults. It has been suggested that an empowerment approach may nurture an older adult's participation in health care decisions and promote positive health outcomes. The purpose of this article is to report the findings of a critical review of published empowerment intervention studies with community-dwelling older adults. A descriptive literature review was conducted to examine how empowerment is conceptualized across interventions, the guiding theoretical frameworks, the outcomes measured, as well as the health outcomes of these interventions. Based on the findings from this review, recommendations for future empowerment intervention research with older adults as well as implications for practice are proposed.

Aims. To review evidence on the role of oncology nurses in the provision of information to cancer patients and to delineate evidence-based implications for clinical practice and research. Background. Provision of information is central for the empowerment of patients to participate in their care. There is not enough evidence regarding the nursing role in the information delivery process in cancer patients. Design. Descriptive literature review. Methods. From January 1990-2008, databases searched included Medline, CINAHL, PubMed, CancerLit and the Cochrane Library. Original research articles addressing the role of nurses in information delivery were included. We explored evidence on:(1) the effectiveness of nurses as information providers,(2) the way patients evaluate nurses' input to information delivery,(3) the extent to which nurses contribute to information delivery to cancer patients and (4) the types of information provided by nurses. Results. The most important findings were:(1) nurses' role as information providers for cancer patients is prominent, especially after the initiation of treatment,(2) specialist nurses are very effective in providing information,(3) no clear evidence exists on how nurses compare with other health-care professionals as information providers and (4) some evidence exists that patients may prefer nurses as information providers at specific times in their treatment and especially in regards to symptom management. Conclusion. Well-designed studies provide some evidence that nurses are effective as information providers to cancer patients. Specifically, oncology nurses are able to provide information of both high quality and of appropriate quantity and to assist individuals to interpret information provided by others. Relevance to clinical practice. Oncology nurses should be specifically educated and prepared to offer explicit, practical and timely information and they should be trained in interpersonal communication skills, which will increase their ability to comprehend patient information needs.

ABSTRACT: In the previous issue of Arthritis Research and Therapy, Brionez and colleagues show that helplessness, depression, and passive coping account for significant variability in self-reported functional limitations in patients with ankylosing spondylitis, beyond the effect of age, inflammation and radiographic damage. Since the perspective of the patients in the experience of health is increasingly important, insight into the type of psychological variables, the pathways by which they influence health and the approaches for how to deal with these variables are challenging.

Objectives: Emotional burden on oncology care workers is considerable. These workers develop confidential relationship with the patient through interpersonal communication, which entails managing their own emotions as well as the emotions displayed by their patients, and it involves a great deal of emotion work. The objectives in our study were to assess the prevalence of burnout and emotional dissonance and to investigate the interrelationship among burnout, emotion work and coping in oncology care.Method: A cross-sectional survey with anonymous questionnaires was conducted among oncology health care workers (N = 48) and non-oncology health care workers (N = 151).Results: The comparison revealed differences primarily in emotion work and coping. Emotional dissonance as stress factor was more prevalent among oncology health care workers. Caregivers dealing with cancer patients felt that they have to display negative emotions less frequently, yet at the same time they frequently have to show understanding and express sympathy to the patient. When certain coping strategies were examined, we found that humour as potential resource in coping is used less frequently among oncology health care workers.Conclusion: In order to devise effective interventions to oncology personnel, we need to focus on the interaction between the carer and the cancer patient and have more evidence on emotional dissonance in oncology staff. Copyright (c) 2009 John Wiley & Sons, Ltd.

AIMS AND OBJECTIVE: We searched for the clinically relevant suggestions, recommendations and findings amongst the papers on psycho oncology. The term clinically relevant for us meant 'practical and implemental modes of intervention that contribute but would not affect or interfere with the normal functioning of the present system and treatment modality of the patients.' Our intention was to use the available information for the benefit of our patients. We also searched for the data that would prove the significance of these methods. In most parts of the world it is not possible to involve a psychologist at every level of cancer care. Based on the findings, we intend to carry out our own project for the psychosocial intervention in cancer patients and make suggestions that could be adopted even by those who have little or no experience in psychology. CONCLUSION: The field of psycho oncology is a relatively new and evolving subspecialty of oncology and psychology at the same time. Current data and papers, which would make simple and implemental modes of intervention at psychosocial level, are limited. There is a dire necessity of solid data and list of suggestion to the specialists, non-specialists and those who take care of the cancer patients, to enhance the care they provide to the cancer patients.

AIMS AND OBJECTIVE: We searched for the clinically relevant suggestions, recommendations and findings amongst the papers on Psycho-oncology. The term clinically relevant for us meant 'practical and implemental modes of intervention that contribute but would not affect or interfere with the normal functioning of the present system and treatment modality of the patients.' Our intention was to use the available information for the benefit of our patients. We also searched for the data that would prove the significance of these methods. In most parts of the world it is not possible to involve a psychologist at every level of cancer care. Based on the findings, we intend to carry out our own project for the psychosocial intervention in cancer patients and make suggestions that could be adopted even by those who have little or no experience in psychology. CONCLUSION: The field of psycho oncology is a relatively new and evolving subspecialty of oncology and psychology at the same time. Current data and papers, which would make simple and implemental modes of intervention at psychosocial level, are limited. There is a dire necessity of solid data and list of suggestions to the specialists, non-specialists and to those who take care of the cancer patients, to enhance the care they provide to the cancer patients.

ABSTRACT: As health care resources become increasingly constrained, it is imperative that intensive care unit resources be optimized. In the years to come, a number of challenges to intensive care medicine will need to be addressed as society changes. Last year's Critical Care papers provided us with a number of interesting and highly accessed original papers dealing with health care resources. The information yielded by these studies can help us to deal with issues such as prognostication, early detection and treatment of delirium, prevention of medical errors and use of radiology resources in critically ill patients. Finally, several aspects of scientific research in critically ill patients were investigated, focusing on the possibility of obtaining informed consent and recall of having given informed consent.

Asthma presents special challenges to both the athletes who have it and to their health care provideers. This article briefly reviews the problem of asthma-especially exercise-induced asthma-in the competitive athlete, and then describes treatments that are effective in controlling asthma. Drug-doping regulations are explained, as is the worldwide impact of drug doping on competitive athletes who have asthma. This review concludes with recommendations for competitive athletes and their health care providers regarding how to deal with asthma in this patient population.