Acupressure wrist bands to relieve nausea and vomiting in hospice patients: Do they work? Sonja Brown David North, MD M. Kim Marvel, PhD Roger Fons
Abstract
Introduction
This study assessed the effects of acupressure wrist bands on the nausea and vomiting ofterminally ill patients. Using a single subject experimental design, six hospice patients were exposed to three conditions:
Nausea and vomiting may be the most prevalent problems forterminally ill patients, particularly those receiving chemotherapy, radiotherapy, and narcotics. Psychological distress caused by these symptoms may diminish the patient’s quality of life. Nausea and vomiting may also lead to physiological complications, such as electrolyte imbalance, anorexia, and dehydration. Thus, there is a definite need to find more effective treatment to manage these symptoms. Antiemetic drugs, such as prochloperazine, haloperidol, and metoclopramide hydrochloride, partially alleviate nausea and vomiting, but may inducea variety of side effects. For example, prochloperazine can produce neuromuscular reactions, dizziness, and hypotension; haloperidol may cause tardive dyskinesia, insomnia, and depression; metoclopramide hydrochloride can result in endocrine, CNS, and cardiovascular disturbances. Clearly, alternative treatment, free of side effects, would be extremely desirable for management of nausea and vomiting. Acupressure has been used for reduction of nausea and vomiting in a variety of settings. It involves the application of constant pressure to specific acupuncture points. Recent acupressure studies have used elastic
• An acupressure wrist band; • A placebo wrist band; • A no wrist band condition. Patients and their caregivers rated nausea and vomiting during the treatment. Despitesome d~fficultyobtaining complete data, the results of this preliminary test indicate that acupressure wrist bands were not effective in reducing nausea and vomiting in this small sample of hospice patients.
Sonja Brown is a pre-medical student in the Medical Scholars Program at the University of Wisconsin, Madison, Wisconsin. David North, MD, is Medical Director of the Hospice Program at Wausau Hospital Center andAssistantProfessorat the University ofWisconsin Department of Family Medicine and Practice, Wausau, Wisconsin. M. KimMar.’el, PhD, is a clinical psychologist a.ndAssistan:Pmfessorat the University ofWisconsin Department of Family Medicine and Practice, Wausau, Wisconsin. Roger Fons is a second year medical student at the University of Wisconsin Medical School, Madison, Wisconsin.
wrist bands with a small round plastic button on the inside surface. The button applies pressure to the P6 (Neiguan) point located on the volar surface of the forearm about two inches above the wrist joint. Acupressure at the P6 point
Acupressure has been usedfor reduction of nausea and vomiting in a variety of settings. has been reported to alleviate nausea and vomiting associated with motion sickness, morning sickness (pregnancy), postoperative recovery, and chemotherapy. Morning sickness in patients in the first trimester of pregnancy was significantly reduced with acupressure, as demonstrated by Dundee.1 Acupressure at the P6 point also was shown by Dundee to reduce nausea and vomiting in patients undergoing cancer chemotherapy.4 Given these encouraging results as well as the inherent need for an alternative treatment, further investigation of acupressure appears warranted. The purpose of this study was to determine the effects, if any, that acupressure wrist bands have on the nausea and vomiting of terminally ill patients.
The American Journal of Hospice & Palliative Care July/August 1992
26 Downloaded from ajh.sagepub.com at Harvard Libraries on June 26, 2015
• A no wrist band control condition.
Table 1. Description of the six patients. Subject no.
2
Length of treatment (days)
Age
Sex
Diagnosis
Setting
65
M
Stomach cancer
Home/ hospital
2.5
36
F
Chronic renal
Hospital
4.0
failure 3
84
M
Prostate cancer
Home
(16 hrs.)
4
82
M
Prostate cancer
Home
6.0
5
70
F
Spinal chordoma
Hospital
4.0
6
72
F
Pancreatic cancer
Hospital
1.0
Methods Participants for the study were recruited from patients of the hospice program at a rural Midwestern hospital. Potential subjects with nausea and vomiting were identified by home care and inpatient hospice nurses. These patients received a brief written description of the project and were given the opportunity to ask questions. If the patient wished to participate, he or she was asked to sign a consent form. A total of six patients volunteered to participate (see Table 1). Nine months were required in which to recruit these six subjects. A single subject experimental design was chosen for the study, given the small number of subjects available and the heterogeneity of symptoms among hospice patients. Such designs permit the intensive study of a limited number of subjects.5 An alternating treatment design was chosen from the variety of single subject designs to allow alternation of conditions within a single subject. This particular research design eliminates the need for a no treatment control group because each subject serves as his or her own control. Furthermore, the alteration of conditions allows a significant amount
The American Journal of Hospice & Palliative Care July/August 1992
of data to be gathered in a shortamount of time. This is important considering the constant changes that are occurring in the experimental conditions. Fluctuations include changes in the nausea and vomiting, progression of the disease or illness, and other changes in treatment modalities. Furthermore, patients often only experience nausea and vomiting for a brief period of three to four days. The six hospice patients were exposed to three conditions: • An acupressure wrist band; • A placebo wrist band (similar to the acupressure wrist band but without the pressure button);
For the first three participants, the conditions were alternated every eight hours for a period of four days. This interval was shortened to four hours for the final three participants so that more comparisons of the treatments could be collected in a shorter amount of time. Several forms of data were collected to detenrnne the effect of the treatments. The data collection forms, consisting of four items, were constructed by the authors (see Table 2). The items were modified and abbreviated from the Rhodes Index of Nausea and Vomiting.6 Patients were asked to indicate the frequency and intensity of vomiting and the intensity and duration of nausea. A similar rating form was completed by the primary caregiver. The caregiver also recorded the antiemetic medications taken during the assessment period. The data forms and instructions were provided to the patient and primary caregiver by a research assistant. Every effort was made to keep the instructions and procedure as simple as possible. Care was taken to avoid giving information to the patient or caregiver that would bias the ratings. The patient and family also received brief written instructions. The patient was informed that no medications would be withdrawn or withheld from
Table 2. Patient rating form. 1.
How many times did you THROW UP (vomit) or have DRY HEAVES? None
2.
1-2 3-4 times times How bad was your VOMITING/DRY HEAVES? None
3.
Moderate
7 or more times
Severe
Horrible
How long did you feel NAUSEATED orQUEASY? None
4.
Mild
5-6 times
Less than 1 hour
2-3 hours
4-6 hours
6 or more hours
Severe
Horrible
How bad was your NAUSEA or QUEASINESS? None
Mild
Moderate
27 Downloaded from ajh.sagepub.com at Harvard Libraries on June 26, 2015
Figure 1. Intensity ratings. a)
his or her present treatment. The wrist bands were provided in addition to the established treatment plan.
Figure 2. Frequency ratings. a) I—
$11
—P.1.010.1,0 —
SI’ 3
— P.O..o 0.0,0 3
P1.Pl..0b.i.,d H..H.i.nd
:
—
M.Awo~ e~
‘~ 0 Ho
Ho
Ho
P1
*0
Ho
P1
b)
II.
N.
P1
*0
P1
Results Ratings of nausea intensity and vomiting frequency are given in Figures 1 and 2. For some subjects, only partial data could be collected due to a variety of reasons. The following brief description of each of the six subjects may aid understanding of the results. 1 began the trial at home and
b)
6H2
$12
Subject Hi
c)
*0
*0
*0
P1Ho
P1
A.
0.
P1
*0
c)
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*0
P1
Sf~3
No
N
HO
P1
*0
*0
Ho
d)
P1
P1
No
*0
A.
No
P1
Ho
P1
1.
A.
No
P1
P1
No
*o
d)
$15
..
H.
Type of W,Is~b.nd
IV\~.~J
N MHOMNO
—=~-----
P1 Hi Ii Ni
It is often difficult for the caregiver to judge the intensity of nausea ofthe patient.
P1000.
*0
P1
Typo ofW,IoIb.nd
continued for two and one-half days. The trial was ended when the patient was transferred to the hospital and died subsequently. Figure 1(a) appears to show that the acupressure condition reduced the frequency of vomiting. However, examination of Figure 2(a) reveals that the no band and placebo condition also seemed to reduce the symptoms. A general overview does notindicate any significant effect of the acupressure treatment. The discrepancy between patient and family ratings can be attributed to the subjective nature of the ratings of nausea. It is often difficult for the caregiver to judge the intensity of nausea of the patient. It is also important to note that the patient was taking several antiemetic medications, including haloperidol and metoclopramide hydrochloride, throughout the trial. No reduction in dosage was seen during the acupressure condition, suggesting that the need for antiemetic medication was not affected by the treatment.
Subject 2 completed the four day trial;
—
The American Journal of Hospice & Palliative Care July/August 1992
28 Downloaded from ajh.sagepub.com at Harvard Libraries on June 26, 2015
however, the patient refused to answer all of the questions on the rating forms after the first day. The remaining information that was collected from the patient was incomplete and did not correlate well with that given by the staff caregiver. The staff ratings illustrated in Figures 1(b) and 2(b) do not indicate any significant effect of the acupressure bands. Both acupressure and placebo conditions were shown to reduce nausea and vomiting. Subject 3 discontinued the study after 16 hours, completing only two rating forms. During this time, there were no instances of vomiting and only moderate nausea. After one period of eight hours, the spouse commented, “I think he is worse instead of better. So far [I] can’t see that the bands do anything.” The trial was terminated at the request of both the patient, and his primary caregiver. Subject 4 participated in the study for six days. No significant data was available from this trial because no nausea was reported and only two instances of vomiting, both attributed to the administration of medicines. Subject 5 completed the four day trial in the hospital. No decisive evidence is indicated in this trial, as shown in Figures 1(d) and 2(d). The acupressure, placebo, and no band condition reduced the symptoms at random times. As before, the difference in the patient and staff ratings is most likely due to the subjective nature of the question. The trial may have been further affected by the antiemetic medications that the patient was taking at the time of the trial. These medications included metoclopramide hydrochloride, prochloperazine, and a scopolamine transdermal patch. Subject 6 discontinued the trial of altemating treatments after one day because she reported no symptoms. In
The American Journal of Hospice & Palliative Care July/August 1992
addition to the brief trial with the three treatment conditions, however, the patient chose to wear the acupressure bands for two extended periods (up to two days). No reduction in nausea or vomiting was reported by the patient or supervising nurse.
the use of acupressure wrist bands to reduce nausea and vomiting in a hospice setting has yet to be shown effective. Discussion Despite the difficulty of obtaining complete data, the results suggest that acupressure wrist bands do not reduce the intensity and frequency of nausea and vomiting in hospice patients, in comparison to placebo wrist bands and ano band control condition. Obviously, caution is warranted in drawing firm conclusions from the data obtained from so few subjects. Despite the limitations of sample size and partial data, we did not obtain any positive responses to justify the continued use of the acupressure bands in this particular population. This was an extremely challenging, and often frustrating, study to conduct. Subject recruitment for this study was difficult. Appropriate subjects for the study (i.e., patients experiencing nausea and/or vomiting) were not easily found. Several subjects declined to complete the data forms. In addition, several patients were unwilling to participate in the trial after no immediate relief was found. Understandably, the study was often viewed by caregivers and patients as an added burden in an already stressful situation. In addition to problematic subject recruitment, the collection of reliable data was difficult. Often, one or more
extraneous variables was changed during the experimental treatment. Many patients experienced nausea and vomiting for only briefperiods of time. During these periods, the severity of nausea and vomiting often varied a great deal, even without antiemetic medications. Also, the wrist bands were provided in addition to the medical treatment plan prescribed by the attending physician. This study highlighted the challenge of conducting applied research in a hospice population. Although the limitations of the study were noteworthy, we have concluded that the use of acupressure wrist bands to reduce nausea and vomiting in a hospice setting has yet to be shown effectiveU
References 1. Dundee JW: P6 acupressure reduces morning sickness. I Royal Soc of Mcd, l988;81(8):456-
457 2. Barsoum G: Postoperative nauseais relieved by acupressure. J Royal Soc of Mcd, 1990;83(2):86-89 3. Dundee JW: Effect of stimulation of the P6 antiemetic point on postoperative nausea and vomiting. BritJ Anaesthesia, 1989;63:612-618 4. Dundee JW: Prolongation of the antiemetic action of P6 acupuncture by acupressure in patients having cancer chemotherapy. J Royal Soc of Mcd, 1990;83:360-362 5. Kazdin AE: Single-case research designs: Methods for clinical and applied settings. New York, Oxford University Press, 1982 6. Rhodes VA, Watson PM, Johnson MH: Development of reliable and valid measures of nausea and vomiting. Cancer Nursing, l984;7(l):33-41
Acknowledgment We would like to acknowledge the cooperation and help of Linda Grilley, RN, Director of the Hospice Program at the Wausau Hospital Center, and Donna Kijak, RN, Patient Care Coordinator, as well as the nurses of the Hospice Program. Readers interested in further information (e.g., data collection forms) to expand upon this preliminary study can contact M. Kim Marvel, PhD, or David North, MD, Wausau Family Practice Center, 995 Campus Drive, Wausau, WI 54401. Thispaper was presented at the 5th Annual Wisconsin Research Network Conference, Wausau, Wisconsin, November, 1991.
29 Downloaded from ajh.sagepub.com at Harvard Libraries on June 26, 2015
Abstract
Introduction
This study assessed the effects of acupressure wrist bands on the nausea and vomiting ofterminally ill patients. Using a single subject experimental design, six hospice patients were exposed to three conditions:
Nausea and vomiting may be the most prevalent problems forterminally ill patients, particularly those receiving chemotherapy, radiotherapy, and narcotics. Psychological distress caused by these symptoms may diminish the patient’s quality of life. Nausea and vomiting may also lead to physiological complications, such as electrolyte imbalance, anorexia, and dehydration. Thus, there is a definite need to find more effective treatment to manage these symptoms. Antiemetic drugs, such as prochloperazine, haloperidol, and metoclopramide hydrochloride, partially alleviate nausea and vomiting, but may inducea variety of side effects. For example, prochloperazine can produce neuromuscular reactions, dizziness, and hypotension; haloperidol may cause tardive dyskinesia, insomnia, and depression; metoclopramide hydrochloride can result in endocrine, CNS, and cardiovascular disturbances. Clearly, alternative treatment, free of side effects, would be extremely desirable for management of nausea and vomiting. Acupressure has been used for reduction of nausea and vomiting in a variety of settings. It involves the application of constant pressure to specific acupuncture points. Recent acupressure studies have used elastic
• An acupressure wrist band; • A placebo wrist band; • A no wrist band condition. Patients and their caregivers rated nausea and vomiting during the treatment. Despitesome d~fficultyobtaining complete data, the results of this preliminary test indicate that acupressure wrist bands were not effective in reducing nausea and vomiting in this small sample of hospice patients.
Sonja Brown is a pre-medical student in the Medical Scholars Program at the University of Wisconsin, Madison, Wisconsin. David North, MD, is Medical Director of the Hospice Program at Wausau Hospital Center andAssistantProfessorat the University ofWisconsin Department of Family Medicine and Practice, Wausau, Wisconsin. M. KimMar.’el, PhD, is a clinical psychologist a.ndAssistan:Pmfessorat the University ofWisconsin Department of Family Medicine and Practice, Wausau, Wisconsin. Roger Fons is a second year medical student at the University of Wisconsin Medical School, Madison, Wisconsin.
wrist bands with a small round plastic button on the inside surface. The button applies pressure to the P6 (Neiguan) point located on the volar surface of the forearm about two inches above the wrist joint. Acupressure at the P6 point
Acupressure has been usedfor reduction of nausea and vomiting in a variety of settings. has been reported to alleviate nausea and vomiting associated with motion sickness, morning sickness (pregnancy), postoperative recovery, and chemotherapy. Morning sickness in patients in the first trimester of pregnancy was significantly reduced with acupressure, as demonstrated by Dundee.1 Acupressure at the P6 point also was shown by Dundee to reduce nausea and vomiting in patients undergoing cancer chemotherapy.4 Given these encouraging results as well as the inherent need for an alternative treatment, further investigation of acupressure appears warranted. The purpose of this study was to determine the effects, if any, that acupressure wrist bands have on the nausea and vomiting of terminally ill patients.
The American Journal of Hospice & Palliative Care July/August 1992
26 Downloaded from ajh.sagepub.com at Harvard Libraries on June 26, 2015
• A no wrist band control condition.
Table 1. Description of the six patients. Subject no.
2
Length of treatment (days)
Age
Sex
Diagnosis
Setting
65
M
Stomach cancer
Home/ hospital
2.5
36
F
Chronic renal
Hospital
4.0
failure 3
84
M
Prostate cancer
Home
(16 hrs.)
4
82
M
Prostate cancer
Home
6.0
5
70
F
Spinal chordoma
Hospital
4.0
6
72
F
Pancreatic cancer
Hospital
1.0
Methods Participants for the study were recruited from patients of the hospice program at a rural Midwestern hospital. Potential subjects with nausea and vomiting were identified by home care and inpatient hospice nurses. These patients received a brief written description of the project and were given the opportunity to ask questions. If the patient wished to participate, he or she was asked to sign a consent form. A total of six patients volunteered to participate (see Table 1). Nine months were required in which to recruit these six subjects. A single subject experimental design was chosen for the study, given the small number of subjects available and the heterogeneity of symptoms among hospice patients. Such designs permit the intensive study of a limited number of subjects.5 An alternating treatment design was chosen from the variety of single subject designs to allow alternation of conditions within a single subject. This particular research design eliminates the need for a no treatment control group because each subject serves as his or her own control. Furthermore, the alteration of conditions allows a significant amount
The American Journal of Hospice & Palliative Care July/August 1992
of data to be gathered in a shortamount of time. This is important considering the constant changes that are occurring in the experimental conditions. Fluctuations include changes in the nausea and vomiting, progression of the disease or illness, and other changes in treatment modalities. Furthermore, patients often only experience nausea and vomiting for a brief period of three to four days. The six hospice patients were exposed to three conditions: • An acupressure wrist band; • A placebo wrist band (similar to the acupressure wrist band but without the pressure button);
For the first three participants, the conditions were alternated every eight hours for a period of four days. This interval was shortened to four hours for the final three participants so that more comparisons of the treatments could be collected in a shorter amount of time. Several forms of data were collected to detenrnne the effect of the treatments. The data collection forms, consisting of four items, were constructed by the authors (see Table 2). The items were modified and abbreviated from the Rhodes Index of Nausea and Vomiting.6 Patients were asked to indicate the frequency and intensity of vomiting and the intensity and duration of nausea. A similar rating form was completed by the primary caregiver. The caregiver also recorded the antiemetic medications taken during the assessment period. The data forms and instructions were provided to the patient and primary caregiver by a research assistant. Every effort was made to keep the instructions and procedure as simple as possible. Care was taken to avoid giving information to the patient or caregiver that would bias the ratings. The patient and family also received brief written instructions. The patient was informed that no medications would be withdrawn or withheld from
Table 2. Patient rating form. 1.
How many times did you THROW UP (vomit) or have DRY HEAVES? None
2.
1-2 3-4 times times How bad was your VOMITING/DRY HEAVES? None
3.
Moderate
7 or more times
Severe
Horrible
How long did you feel NAUSEATED orQUEASY? None
4.
Mild
5-6 times
Less than 1 hour
2-3 hours
4-6 hours
6 or more hours
Severe
Horrible
How bad was your NAUSEA or QUEASINESS? None
Mild
Moderate
27 Downloaded from ajh.sagepub.com at Harvard Libraries on June 26, 2015
Figure 1. Intensity ratings. a)
his or her present treatment. The wrist bands were provided in addition to the established treatment plan.
Figure 2. Frequency ratings. a) I—
$11
—P.1.010.1,0 —
SI’ 3
— P.O..o 0.0,0 3
P1.Pl..0b.i.,d H..H.i.nd
:
—
M.Awo~ e~
‘~ 0 Ho
Ho
Ho
P1
*0
Ho
P1
b)
II.
N.
P1
*0
P1
Results Ratings of nausea intensity and vomiting frequency are given in Figures 1 and 2. For some subjects, only partial data could be collected due to a variety of reasons. The following brief description of each of the six subjects may aid understanding of the results. 1 began the trial at home and
b)
6H2
$12
Subject Hi
c)
*0
*0
*0
P1Ho
P1
A.
0.
P1
*0
c)
$13
*0
P1
Sf~3
No
N
HO
P1
*0
*0
Ho
d)
P1
P1
No
*0
A.
No
P1
Ho
P1
1.
A.
No
P1
P1
No
*o
d)
$15
..
H.
Type of W,Is~b.nd
IV\~.~J
N MHOMNO
—=~-----
P1 Hi Ii Ni
It is often difficult for the caregiver to judge the intensity of nausea ofthe patient.
P1000.
*0
P1
Typo ofW,IoIb.nd
continued for two and one-half days. The trial was ended when the patient was transferred to the hospital and died subsequently. Figure 1(a) appears to show that the acupressure condition reduced the frequency of vomiting. However, examination of Figure 2(a) reveals that the no band and placebo condition also seemed to reduce the symptoms. A general overview does notindicate any significant effect of the acupressure treatment. The discrepancy between patient and family ratings can be attributed to the subjective nature of the ratings of nausea. It is often difficult for the caregiver to judge the intensity of nausea of the patient. It is also important to note that the patient was taking several antiemetic medications, including haloperidol and metoclopramide hydrochloride, throughout the trial. No reduction in dosage was seen during the acupressure condition, suggesting that the need for antiemetic medication was not affected by the treatment.
Subject 2 completed the four day trial;
—
The American Journal of Hospice & Palliative Care July/August 1992
28 Downloaded from ajh.sagepub.com at Harvard Libraries on June 26, 2015
however, the patient refused to answer all of the questions on the rating forms after the first day. The remaining information that was collected from the patient was incomplete and did not correlate well with that given by the staff caregiver. The staff ratings illustrated in Figures 1(b) and 2(b) do not indicate any significant effect of the acupressure bands. Both acupressure and placebo conditions were shown to reduce nausea and vomiting. Subject 3 discontinued the study after 16 hours, completing only two rating forms. During this time, there were no instances of vomiting and only moderate nausea. After one period of eight hours, the spouse commented, “I think he is worse instead of better. So far [I] can’t see that the bands do anything.” The trial was terminated at the request of both the patient, and his primary caregiver. Subject 4 participated in the study for six days. No significant data was available from this trial because no nausea was reported and only two instances of vomiting, both attributed to the administration of medicines. Subject 5 completed the four day trial in the hospital. No decisive evidence is indicated in this trial, as shown in Figures 1(d) and 2(d). The acupressure, placebo, and no band condition reduced the symptoms at random times. As before, the difference in the patient and staff ratings is most likely due to the subjective nature of the question. The trial may have been further affected by the antiemetic medications that the patient was taking at the time of the trial. These medications included metoclopramide hydrochloride, prochloperazine, and a scopolamine transdermal patch. Subject 6 discontinued the trial of altemating treatments after one day because she reported no symptoms. In
The American Journal of Hospice & Palliative Care July/August 1992
addition to the brief trial with the three treatment conditions, however, the patient chose to wear the acupressure bands for two extended periods (up to two days). No reduction in nausea or vomiting was reported by the patient or supervising nurse.
the use of acupressure wrist bands to reduce nausea and vomiting in a hospice setting has yet to be shown effective. Discussion Despite the difficulty of obtaining complete data, the results suggest that acupressure wrist bands do not reduce the intensity and frequency of nausea and vomiting in hospice patients, in comparison to placebo wrist bands and ano band control condition. Obviously, caution is warranted in drawing firm conclusions from the data obtained from so few subjects. Despite the limitations of sample size and partial data, we did not obtain any positive responses to justify the continued use of the acupressure bands in this particular population. This was an extremely challenging, and often frustrating, study to conduct. Subject recruitment for this study was difficult. Appropriate subjects for the study (i.e., patients experiencing nausea and/or vomiting) were not easily found. Several subjects declined to complete the data forms. In addition, several patients were unwilling to participate in the trial after no immediate relief was found. Understandably, the study was often viewed by caregivers and patients as an added burden in an already stressful situation. In addition to problematic subject recruitment, the collection of reliable data was difficult. Often, one or more
extraneous variables was changed during the experimental treatment. Many patients experienced nausea and vomiting for only briefperiods of time. During these periods, the severity of nausea and vomiting often varied a great deal, even without antiemetic medications. Also, the wrist bands were provided in addition to the medical treatment plan prescribed by the attending physician. This study highlighted the challenge of conducting applied research in a hospice population. Although the limitations of the study were noteworthy, we have concluded that the use of acupressure wrist bands to reduce nausea and vomiting in a hospice setting has yet to be shown effectiveU
References 1. Dundee JW: P6 acupressure reduces morning sickness. I Royal Soc of Mcd, l988;81(8):456-
457 2. Barsoum G: Postoperative nauseais relieved by acupressure. J Royal Soc of Mcd, 1990;83(2):86-89 3. Dundee JW: Effect of stimulation of the P6 antiemetic point on postoperative nausea and vomiting. BritJ Anaesthesia, 1989;63:612-618 4. Dundee JW: Prolongation of the antiemetic action of P6 acupuncture by acupressure in patients having cancer chemotherapy. J Royal Soc of Mcd, 1990;83:360-362 5. Kazdin AE: Single-case research designs: Methods for clinical and applied settings. New York, Oxford University Press, 1982 6. Rhodes VA, Watson PM, Johnson MH: Development of reliable and valid measures of nausea and vomiting. Cancer Nursing, l984;7(l):33-41
Acknowledgment We would like to acknowledge the cooperation and help of Linda Grilley, RN, Director of the Hospice Program at the Wausau Hospital Center, and Donna Kijak, RN, Patient Care Coordinator, as well as the nurses of the Hospice Program. Readers interested in further information (e.g., data collection forms) to expand upon this preliminary study can contact M. Kim Marvel, PhD, or David North, MD, Wausau Family Practice Center, 995 Campus Drive, Wausau, WI 54401. Thispaper was presented at the 5th Annual Wisconsin Research Network Conference, Wausau, Wisconsin, November, 1991.
29 Downloaded from ajh.sagepub.com at Harvard Libraries on June 26, 2015
