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CE: An Evidence-Based Yoga Practice for Hospitalized Adults on Medical-Psychiatric Units. Am J Nurs 2022; 122:28-36. [PMID: 35736601 DOI: 10.1097/01.naj.0000840304.76501.96] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Yoga-based treatments, which are recognized by the National Institutes of Health's National Center for Complementary and Integrative Health as a form of complementary and alternative medicine, have proven to be beneficial for people with various psychiatric disorders, including depression, anxiety, posttraumatic stress disorder, and attention deficit-hyperactivity disorder, as well as schizophrenia and other psychotic disorders. PURPOSE The purpose of this evidence-based practice (EBP) project was to offer structured yoga sessions as a means of providing stress relief, promoting relaxation, reducing anxiety, and improving quality of care among male and female adult patients (ages 18 years and older) hospitalized in a locked medical-psychiatric unit within an academic medical center for treatment of both acute medical and acute psychiatric conditions. PRACTICE CHANGE AND IMPLEMENTATION The Iowa Model and Implementation Strategies for EBP provided the guiding framework for this pilot project. Patients were offered once weekly, 30-to-60-minute yoga sessions for 12 weeks and were screened for their ability to participate by the nurse-yoga instructor and the interprofessional team. Using a Precision Implementation Approach, a data-driven selection of strategies from the implementation framework promoted the adoption and sustainability of the practice change, which were further advanced through interprofessional reinforcement of yoga practice and internal reporting. RESULTS Patient feedback was sought before and after yoga sessions. Thirty-nine patients responded to the pre-yoga questionnaire and 38 patients responded to the post-yoga questionnaire. Patients reported improved mood after yoga, with 23% (nine of 39) reporting feelings of calm and relaxation pre-yoga compared with 76% (29 of 38) post-yoga, and 41% (16 of 39) reporting feelings of anxiety pre-yoga compared with just 5% (two of 38) post-yoga. CONCLUSION Yoga sessions provided by a nurse certified in yoga instruction improved patients' mood and sense of well-being. Instructional materials and videos were created to promote sustained use. The EBP of providing yoga sessions grew from a pilot program to a sustained change with more widespread use. In addition to patients hospitalized on medical-psychiatric units, the health system expanded the sessions to include inpatients on behavioral health units.
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Ortega MA, Alvarez-Mon MA, García-Montero C, Fraile-Martinez O, Lahera G, Monserrat J, Muñoz-Merida L, Mora F, Rodríguez-Jiménez R, Fernandez-Rojo S, Quintero J, Álvarez-Mon M. MicroRNAs as Critical Biomarkers of Major Depressive Disorder: A Comprehensive Perspective. Biomedicines 2021; 9:biomedicines9111659. [PMID: 34829888 PMCID: PMC8615526 DOI: 10.3390/biomedicines9111659] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 11/05/2021] [Accepted: 11/08/2021] [Indexed: 12/23/2022] Open
Abstract
Major Depressive Disorder (MDD) represents a major global health concern, a body-mind malady of rising prevalence worldwide nowadays. The complex network of mechanisms involved in MDD pathophysiology is subjected to epigenetic changes modulated by microRNAs (miRNAs). Serum free or vesicles loaded miRNAs have starred numerous publications, denoting a key role in cell-cell communication, systematically and in brain structure and neuronal morphogenesis, activity and plasticity. Upregulated or downregulated expression of these signaling molecules may imply the impairment of genes implicated in pathways of MDD etiopathogenesis (neuroinflammation, brain-derived neurotrophic factor (BDNF), neurotransmitters, hypothalamic-pituitary-adrenal (HPA) axis, oxidative stress, circadian rhythms...). In addition, these miRNAs could serve as potential biomarkers with diagnostic, prognostic and predictive value, allowing to classify severity of the disease or to make decisions in clinical management. They have been considered as promising therapy targets as well and may interfere with available antidepressant treatments. As epigenetic malleable regulators, we also conclude emphasizing lifestyle interventions with physical activity, mindfulness and diet, opening the door to new clinical management considerations.
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Affiliation(s)
- Miguel A. Ortega
- Department of Medicine and Medical Specialities, University of Alcala, 28801 Alcalá de Henares, Spain; (M.A.O.); (C.G.-M.); (O.F.-M.); (G.L.); (J.M.); (L.M.-M.); (M.Á.-M.)
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), 28034 Madrid, Spain
- Cancer Registry and Pathology Department, Hospital Universitario Principe de Asturias, 28806 Alcalá de Henares, Spain; (F.M.); (S.F.-R.); (J.Q.)
| | - Miguel Angel Alvarez-Mon
- Department of Medicine and Medical Specialities, University of Alcala, 28801 Alcalá de Henares, Spain; (M.A.O.); (C.G.-M.); (O.F.-M.); (G.L.); (J.M.); (L.M.-M.); (M.Á.-M.)
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), 28034 Madrid, Spain
- Department of Psychiatry and Mental Health, Hospital Universitario Infanta Leonor, 28031 Madrid, Spain
- Correspondence:
| | - Cielo García-Montero
- Department of Medicine and Medical Specialities, University of Alcala, 28801 Alcalá de Henares, Spain; (M.A.O.); (C.G.-M.); (O.F.-M.); (G.L.); (J.M.); (L.M.-M.); (M.Á.-M.)
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), 28034 Madrid, Spain
| | - Oscar Fraile-Martinez
- Department of Medicine and Medical Specialities, University of Alcala, 28801 Alcalá de Henares, Spain; (M.A.O.); (C.G.-M.); (O.F.-M.); (G.L.); (J.M.); (L.M.-M.); (M.Á.-M.)
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), 28034 Madrid, Spain
| | - Guillermo Lahera
- Department of Medicine and Medical Specialities, University of Alcala, 28801 Alcalá de Henares, Spain; (M.A.O.); (C.G.-M.); (O.F.-M.); (G.L.); (J.M.); (L.M.-M.); (M.Á.-M.)
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), 28034 Madrid, Spain
- Psychiatry Service, Center for Biomedical Research in the Mental Health Network, University Hospital Príncipe de Asturias, 28806 Alcalá de Henares, Spain
| | - Jorge Monserrat
- Department of Medicine and Medical Specialities, University of Alcala, 28801 Alcalá de Henares, Spain; (M.A.O.); (C.G.-M.); (O.F.-M.); (G.L.); (J.M.); (L.M.-M.); (M.Á.-M.)
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), 28034 Madrid, Spain
| | - Luis Muñoz-Merida
- Department of Medicine and Medical Specialities, University of Alcala, 28801 Alcalá de Henares, Spain; (M.A.O.); (C.G.-M.); (O.F.-M.); (G.L.); (J.M.); (L.M.-M.); (M.Á.-M.)
| | - Fernando Mora
- Cancer Registry and Pathology Department, Hospital Universitario Principe de Asturias, 28806 Alcalá de Henares, Spain; (F.M.); (S.F.-R.); (J.Q.)
- Department of Legal Medicine and Psychiatry, Complutense University, 28040 Madrid, Spain;
| | - Roberto Rodríguez-Jiménez
- Department of Legal Medicine and Psychiatry, Complutense University, 28040 Madrid, Spain;
- Institute for Health Research Hospital 12 de Octubre (imas 12), CIBERSAM, 28041 Madrid, Spain
| | - Sonia Fernandez-Rojo
- Cancer Registry and Pathology Department, Hospital Universitario Principe de Asturias, 28806 Alcalá de Henares, Spain; (F.M.); (S.F.-R.); (J.Q.)
- Department of Legal Medicine and Psychiatry, Complutense University, 28040 Madrid, Spain;
| | - Javier Quintero
- Cancer Registry and Pathology Department, Hospital Universitario Principe de Asturias, 28806 Alcalá de Henares, Spain; (F.M.); (S.F.-R.); (J.Q.)
- Department of Legal Medicine and Psychiatry, Complutense University, 28040 Madrid, Spain;
| | - Melchor Álvarez-Mon
- Department of Medicine and Medical Specialities, University of Alcala, 28801 Alcalá de Henares, Spain; (M.A.O.); (C.G.-M.); (O.F.-M.); (G.L.); (J.M.); (L.M.-M.); (M.Á.-M.)
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), 28034 Madrid, Spain
- Immune System Diseases-Rheumatology, Oncology Service an Internal Medicine, University Hospital Príncipe de Asturias, (CIBEREHD), 28806 Alcalá de Henares, Spain
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