Effects of Aromatherapy on Physical and Mental Health of Cancer Patients Undergoing Radiotherapy and/or Chemotherapy: A Meta-Analysis

BACKGROUP

Currently, aromatherapy is being increasingly utilized in clinical practice, particularly in managing the side effects associated with radiotherapy and chemoradiotherapy. However, it remains to be established whether aromatherapy can effectively alleviate these symptoms.

OBJECTIVE

To investigate the effects of aromatherapy on the physical and mental health of patients with cancer undergoing radiotherapy and chemotherapy.

METHODS

Seven databases were researched from inception until September 29, 2023, including PubMed, Scopus, and Web of Science, Chinese National Knowledge Infrastructure, Wanfang database, China Biology Medicine disc and VIP Chinese Medical Journal Database. Review Manager version 5.3 was utilized for data analysis. The Cochrane Risk of Bias tool RoB2 was employed to evaluate the quality of the literature included in the study. Evidence quality rating was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach through the GRADEpro GDT online tool.

RESULTS

Nineteen studies involving 1,541 patients were included. Aromatherapy can alleviate nausea [relative risk (RR)=0.64, 95% confidence interval (CI): 0.53 to 0.78, P<0.05, I2=46%; standardized mean difference (SMD)=-0.86, 95% CI: -1.21 to -0.51, P<0.05, I2=64%] and vomiting (RR=0.54, 95% CI: 0.42 to 0.69, P<0.05, I2=35%; SMD=-1.28, 95% CI: -1.52 to -1.03, P<0.05, I2=92%), improve sleep disorders [mean difference (MD)=-3.39, 95% CI: -3.95 to -2.84, P<0.05, I2=0%], relieve pain (SMD=-1.58, 95% CI: -1.96 to -1.21, P<0.05, I2=0%), mitigate fatigue (SMD=-1.28, 95% CI: -2.44 to -0.11, P<0.05, I2=93%) and enhance quality of life (SMD=0.50, 95% CI: 0.22 to 0.79, P<0.05, I2=0%) in cancer patients after radiotherapy and chemotherapy, but it may not have a significant effect on anxiety. The risk of bias was high in the included studies using the Cochrane Risk of Bias tool RoB2, and no studies were considered to be of high grade according to the GRADE system.

CONCLUSIONS

Aromatherapy is an efficacious, safe and economic adjunctive therapy for cancer patients, which can mend the physical symptoms and mental health of cancer patients. However, more high-quality studies are needed to verify it. (PROSPERO registration No. CRD42023390171).

The use of essential oils in atopic dermatitis: a review

Atopic dermatitis (AD) has become a common childhood disease that affects a large number of children worldwide and has become a chronic skin disease that causes huge economical and psychological damage to the whole family. Despite the use of steroids, immunosuppressants, and various topical preparation, the prognosis is still poor. Hence, this review aimed to explore the potential of using essential oils (EO) as an active ingredient in managing AD. The review was completed by using Pubmed, Scopus, and Medline to search for relevant articles that study the pathophysiology of AD, the properties of EO, the use of EO in managing AD, and the suitable advanced formulation to incorporate EO. From the review conducted, it was concluded that EO have huge potential in managing AD and can be used as complimentary therapeutic agents in AD treatment. Scientists and industries should venture into commercializing more topical products with EO to help manage AD more effectively.

Bergamot essential oil improves CUMS-induced depression-like behaviour in rats by protecting the plasticity of hippocampal neurons

Bergamot essential oil (BEO) is an extract of the bergamot fruit with significant neuroprotective effect. This study was to investigate the effects and the underlying mechanism of BEO in mitigating depression. GC-MS were used to identify its constituents. Antidepressive properties of BEO were evaluated by sucrose preference test (SPT), force swimming test (FST) and open field test (OFT). Nissl staining was used to determine the number of Nissl bodies in hippocampus (HIPP) of rats. Changes in HIPP dendritic length and dendritic spine density were detected by Golgi-Cox staining. Immunohistochemistry and Western blot were used to detect the postsynaptic density protein-95 (PSD-95) and synaptophysin (SYP) in the HIPP of rats. The enzyme-linked immunosorbent assay was used to determine the 5-hydroxytryptamine (5-HT), insulin-like growth factor 1 (IGF-1) and interleukin-1β (IL-1β) in the HIPP, serum and cerebrospinal fluid (CSF) of rats. Inhaled BEO significantly improved depressive behaviour in chronic unpredictable mild stress (CUMS) rats. BEO increased Nissl bodies, dendritic length and spine density, PSD-95 and SYP protein in the HIPP. Additionally, BEO upregulated serum 5-HT, serum and CSF IGF-1, while downregulating serum IL-1β. Collectively, inhaled BEO mitigates depression by protecting the plasticity of hippocampal neurons, hence, providing novel insights into treatment of depression.

Use of a Combination Lavender/Peppermint Aromatherapy Patch During Port Catheter Placement Under Monitored Anesthesia Care Does Not Reduce Time to Discharge Readiness: A Randomized Controlled Trial

Background: Intraoperative anxiety is a common problem when Monitored Anesthesia Care (MAC) is used instead of general anesthesia during minor surgical procedures such as port catheter placement. Nonpharmacological anxiolytics such as aromatherapy have been studied for their effects on preoperative anxiety, but no placebo-controlled study of aromatherapy during surgeries under MAC has yet been performed. Methods: After IRB approval, 70 patients were randomized 1:1 to receive either a lavender/peppermint aromatherapy patch (Elequil Aromatabs®; Beekley Corporation) or a matching placebo patch. The primary outcome, time to readiness for discharge from postoperative acute care units (PACU; min), was assessed every 15 min until a modified postanesthesia recovery score for ambulatory patients (PARSAP) score of 18 or higher was reached. In the preoperative holding area, the assigned patch/placebo was activated and affixed to a folded towel placed aside the subject's head, contralateral to the side of the planned surgery. The towel and patch/placebo were discarded when the subject left the operating room (OR). Results: No difference was found between the treatment and placebo groups on the primary outcome of time to discharge readiness (mean [standard deviation, SD]: 82 [15] vs. 89 [21] min, respectively, p = 0.131). No difference was found between the treatment and placebo groups on the secondary outcomes of intraoperative midazolam dose, intraoperative opioid dose, intraoperative ondansetron dose, or intraoperative promethazine dose. No difference was found between the treatment and placebo groups in the proportion of subjects requiring rescue postoperative nausea and vomiting (PONV) medication in the PACU or the proportion of subjects requiring opioids in the PACU. No difference was found between the treatment and placebo groups in pain intensity in PACU, average PONV score in PACU, or patient satisfaction in PACU. PACU patient satisfaction was high for both the patch and placebo groups (35/35 [100%] vs. 32/34 [94%] "very satisfied," p = 0.239). Conclusions: Aromatherapy treatment is not indicated intraoperatively to reduce anxiety or the use of antiemetics in patients requiring Port catheter placement. Trial registration: Clinicaltrials.gov, identifier: NCT05328973.

Effects of Multi-Mechanism Complementary Therapy on Pain and Anxiety During Labor Latency in Primiparous Women

Objective: Evaluate the efficacy of single and mixed complementary therapies, with different analgesic mechanisms, in relieving pain and anxiety during the late labor period. Design and method: In this study, 145 primiparous women with 2-3 cm dilation of the cervix were randomly assigned to one of five groups: control group (psychological comfort), comprehensive group, aroma group, auricular acupuncture group, and music group. The groups were distributed equally (1:1:1:1 ratio), and pain and anxiety scores were assessed at 30, 60, and 120 minutes post-intervention in each group. Outcomes and measures: Compared to the control group, all intervention groups showed lower pain scores. The comprehensive group had the largest reduction in pain scores at 30, 60, and 120 minutes post-intervention. The auricular point, aroma, and music groups also demonstrated significant reductions in pain scores at different time points. Only the comprehensive group had a statistically significant reduction in anxiety at 30 minutes post-intervention compared to the control group. However, at 60 and 120 minutes post-intervention, all intervention groups showed lower anxiety scores compared to the control group. Conclusion: The optimal effects of each therapy varied in terms of timing and duration. Combination therapy showed a greater effect size than single complementary therapy.

Comparison of the Effects of Aromatherapy With Damask Rose and Chamomile Essential Oil on Preoperative Pain and Anxiety in Emergency Orthopedic Surgery: A Randomized Controlled Trial

PURPOSE

Patients who are awaiting emergency surgery experience high levels of anxiety and pain. This study aimed to compare the effects of aromatherapy with damask rose and chamomile essential oil on the preoperative pain and anxiety associated with emergency orthopedic surgery.

DESIGN

A parallel-group randomized controlled design was used.

METHODS

Ninety participants were selected and randomly assigned to three groups: the damask rose group (n = 30), the chamomile group (n = 30), and the control group (n = 30). In the damask rose and chamomile groups, three drops of 40% essential of each plant were used for inhalation aromatherapy (three drops every hour for 3 hours) Visual Analog Scales were used to evaluate participants' pain and anxiety levels at baseline, immediately after the intervention, and 1 hour after the intervention.

FINDINGS

The results of repeated measures Analysis of Variance (ANOVA) showed that both of the intervention groups experienced a decrease in pain and anxiety over time compared to the control group (P < .001). ANOVA results showed that immediately after the intervention, the anxiety level of the damask rose group compared to the chamomile and control groups was significantly lower (P = .01). However, there was no significant difference in terms of anxiety between the damask rose and chamomile groups 1 hour after the intervention (P = .07).

CONCLUSIONS

The use of damask rose and chamomile in aromatherapy was found to effectively lower anxiety and pain levels in emergency orthopedic surgery patients. The antianxiety effect of damask rose is faster than chamomile.

[Essential oil of Cinnamomum camphora mitigates depression-like behavior in mice by regulating Nrf2/HO-1 pathway and inhibiting inflammatory cytokines]

This study aims to investigate the essential oil(EOL) of Cinnamomum camphora regarding its anti-depression effect and mechanism in regulating inflammatory cytokines and the nuclear factor erythroid 2-related factor 2(Nrf2)/heme oxygenase-1(HO-1) pathway. A mouse model of depression was established by intraperitoneal injection of lipopolysaccharide(LPS). Open field, elevated plus maze, and forced swimming tests were carried out to examine mouse behaviors. Western blot and qRT-PCR were employed to determine the expression of proteins and genes in the Nrf2/HO-1 pathway in the hippocampus. The levels of tumor necrosis factor(TNF)-α, interleukin(IL)-6, and IL-1β in the serum were measured by enzyme-linked immunosorbent assay(ELISA). The changes of apoptosis in mouse brain were detected by Tunel staining. Compared with the blank control group, the model group showed shortened distance travelled and time spent in the central zone and reduced number of entries in the central zone in the open field test. In the elevated plus maze test, the model group showed reduced open arm time(OT%) and open arm entries(OE%). In the force swimming test, the model group showed extended duration of immobility compared with the blank control group. Compared with the model group, the treatment with EOL significantly increased the distance travelled and time spent in the central zone and increased the number of entries in the central zone in the open field test. In addition, EOL significantly increased the OT% and OE% in the elevated plus maze and shor-tened the immobility duration in the forced swimming test. The model group showed lower expression levels of Nrf2 and HO-1 and hig-her levels of TNF-α, IL-6, and IL-1β than the blank control group. Compared with the model group, the treatment with EOL up-regulated the expression levels of Nrf2 and HO-1 and lowered the levels of TNF-α, IL-6, and IL-1β. The Tunel staining results showed that the apoptosis rate in the brain tissue of mice decreased significantly after the treatment with EOL. To sum up, EOL can mitigate the depression-like behaviors of mice by up-regulating the expression of Nrf2 and HO-1 and preventing hippocampal inflammatory damage. The findings provide empirical support for the application of EOL and aromatherapy in the treatment of depression.

Efficacy and Safety of Chinese Medicine Resuscitation Pack for Enhanced Recovery after Bronchoscopy: A Randomized, Single-Blind, Placebo-Controlled Clinical Trial

OBJECTIVE

To evaluate the efficacy and safety of a hospital-made resuscitation pack, a Chinese medicinal herbal compound formula designed to enhance recovery in post-bronchoscopy patients.

METHODS

In this randomized, single-blind, placebo-controlled clinical trial, eligible patients were randomly assigned 1:1 to either the treatment or control groups. The patients in the treatment group applied the resuscitation pack, which contained aromatic compounded Chinese herbs. The patients in the control group applied a hospital-made, single herb placebo pack. Packs were placed on the Tiantu (CV 22) acupuncture point for 4 h as soon as the bronchoscopy finished. Efficacy indicators, such as recovery time, patients' symptoms including nausea and dizziness, and adverse events (AEs) were observed and compared. The outcome indices were evaluated at baseline, 1 and 24 h after the bronchoscopy. Subgroup analysis was further performed by patients' age and depth of sedation.

RESULTS

When applying generalized estimating equations (GEE) to evaluate the intensity of post-bronchoscopy nausea and vomiting, the intensity was lower in the treatment group (163 cases) compared with the control group (162 cases; 95% CI: 0.004, 0.099, P=0.03]. Also, significantly lower intensity of nausea was observed in the 60-70 years of age subgroup (95% CI: 0.029, 0.169, P=0.006) and deep sedation subgroup (95% CI: 0.002, 0.124; P=0.04). There was no significant difference in dizziness between two groups by GEE (95% CI: -0.134, 0.297; P=0.459). In addition, no serious AEs were observed in either group.

CONCLUSIONS

Our study found that the resuscitation pack markedly improved patients' symptoms by reducing nausea and vomiting after bronchoscopy without AEs, compared with placebo in the perioperative period. (Trial registration No. ChiCTR2000038299).

Effect of aromatherapy with rose essential oil on the nausea and vomiting in chemotherapy patients: a randomized controlled trial

Background

The present study aims to determine the effect of aromatherapy with rose essential oil on the rate of nausea and vomiting in chemotherapy patients.

Materials and methods

This randomized controlled trial included 66 cancer patients who were randomly divided: the rose essential oil aromatherapy group (n=33) and the control group (n=33). The sampling period ranged from November 2022 to March 2023. The state of nausea and vomiting was assessed using the Visual Analog Scale.

Results

The average scores of nausea and vomiting of both the second and third cycle in three time periods after chemotherapy (first, second, and third six hours) were significantly lower in the intervention group than the control group (P<0.001). Also, in the second cycle of chemotherapy, unlike the third cycle of chemotherapy, there was a significant interaction between group and time (ηp2=0.100, P=0.001, F (84.70, 1.37) = 6.91). In other words, the amount of difference between the mean scores of nausea and vomiting of the two control and intervention groups depended on the variable levels of time and vice versa.

Conclusion

The results indicate the reducing effect of aromatherapy with rose essential oil on the severity of nausea and vomiting after chemotherapy in cancer patients. Therefore, it is recommended to be used in chemotherapy to reduce the severity of nausea and vomiting according to the patient's condition.

Mind-Body Therapies in the Management of Otolaryngologic Disease: A State-of-the-Art Review of Randomized Controlled Trials

OBJECTIVE

To review and assess the peer-reviewed literature on the utility of mind-body therapy (MBT) as an adjunct treatment in the management of otolaryngologic disease.

DATA SOURCES

PubMed, Embase, and Cochrane.

REVIEW METHODS

Randomized control trials (RCTs) of MBTs in the management of otolaryngologic disease from 2002 to 2022 were identified and included according to predefined criteria. Interventions requiring expensive equipment were excluded because the goal of MBT is to be cost-conscious. All studies were subjected to a two-stage blinded screening, extraction, and appraisal process. The outcomes of the intervention and control groups were compared.

CONCLUSION

RCTs of MBTs, including breathing exercises (4), aromatherapy (2), biofeedback (2), meditation, (2), and yoga (2), have been studied in several otolaryngologic conditions, including septoplasty/rhinoplasty (3), head and neck cancer (2), facial palsy (2), and tinnitus (2). Most studies were of moderate risk of bias on appraisal, and each MBT studied was found to significantly reduce subjective and objective distress associated with the otolaryngologic condition in question.

IMPLICATIONS FOR PRACTICE

Despite a paucity of strong evidence supporting the universal use of MBTs, our review suggests that MBTs are cost-effective and easily deployable complementary tools in the management of otolaryngologic disease. Future large, methodologically rigorous RCTs are needed to address the limitations of the included studies, such as improper blinding and inappropriate statistical analysis. As MBTs are studied further, a case for their current use can be made because of their low cost and minimal risk to patients.

Quality Appraisal of Research Reporting for Aromatherapy and Essential Oil Studies in Humans: Proposed Checklist for "Transparent Reporting for Essential oil and Aroma Therapeutic Studies"

Introduction: Reporting of aromatherapy-focused research often lacks sufficient quality and detail for replication and subsequent application of results. To our knowledge currently, no quality appraisal tool exists for aromatherapy research reporting. To address this gap, the Aromatic Research Quality Appraisal Taskforce (ARQAT) composed of aromatherapy professionals with varied expert backgrounds came together. Presented here is the Transparent Reporting for Essential oil and Aroma Therapeutic Studies (TREATS) checklist, which is a result of this collaborative effort. Methods: Creation of TREATS followed a three-stage process, including determination of interest/need, development, and dissemination. The shortcomings of existing aromatherapy research reporting quality were evaluated and responses to address these shortcomings were used to create checklist items that were then grouped into sections. Items for each section were brain-stormed with reference to the aromatherapy literature and ARQAT's expert knowledge, and the development of each section followed an iterative process until agreement was reached. An explanatory document was also created to assist more accurate use of the tool; it and the checklist were reviewed by a group of aromatherapy experts. Results: The TREATS checklist with 38 items in four sections was developed along with the explanatory document. The ARQAT and a global group of aromatherapy experts reviewed the TREATS. Their results and comments assisted development of the current version. The TREATS identifies key components of research involving essential oils, their application, and olfactory considerations that ARQAT considers the minimum necessary for high-quality aromatherapy research. Conclusion: The TREATS, explanatory document, and associated website (www.arqat.org) contribute to thorough aromatherapy research critique. The TREATS checklist aids appraisal of quality and can be used with any study design. It lays the foundation for the future development of aromatic research reporting guidelines.

Fennel Essential Oil as a Complementary Therapy in the Management of Diabetes

Diabetes is a serious pathology that affects a significant number of people worldwide. Its progression is rapid and leads to serious complications if glycemic control is missing. The micro and macrovascular complications of diabetes produce disabilities over time that affect the daily lives of patients. The major challenge of diabetes therapy is to reach a stable glycemic state and to delay the onset of specific complications. Aromatherapy is considered an alternative or complementary therapy, but in recent years, there has been a tendency to overuse essential oils. The present study was designed to evaluate and compare the effects produced by the topical and oral administration of fennel essential oil to diabetic rats. Eighteen compounds in fennel essential oil were identified by gas chromatography-mass spectrometry (GC-MS) analysis. The major compounds were trans-anethole (64.6%) and fenchone (24.5%). The in vivo study revealed that after a four-week treatment with fennel essential oil, the rats' glycemic levels were significantly reduced (p ≤ 0.05). Furthermore, there were no differences between the two routes of administration. In addition, an ex vivo study underlined the potential effect of this essential oil in the prevention of cataract formation.

Inhalation of Origanum majorana L. essential oil while working reduces perceived stress and anxiety levels of nurses in a COVID-19 intensive care unit: a randomized controlled trial

Background

Nurses caring for patients with coronavirus disease 2019 (COVID-19) experience higher psychosocial distress than other healthcare workers, and this can adversely affect the quality of patient care. There is evidence that inhalation of essential oil from marjoram (Origanum majorana L.) has calming effects, suggesting this intervention may help to reduce the stress and anxiety of nurses working in a COVID-19 intensive care unit (ICU). This study aimed to investigate the effect of inhalation of marjoram essential oil at work on the stress and anxiety levels of nurses in a COVID-19 ICU.

Methods

Nurses (n = 57) working in a single COVID-19 ICU were randomly assigned to inhale 3% marjoram essential oil (marjoram group, n = 29) or almond oil (control group, n = 28) for 2 h while at work. Mean arterial pressure (MAP), heart rate, state anxiety score, and score on a visual analog scale for anxiety (VAS-anxiety) and stress (VAS-stress) were measured before and after the intervention.

Results

The two groups had similar baseline variables. MAP did not have within-group or between-group differences. Heart rate increased significantly in the marjoram group after the intervention (p = 0.031), but it remained within the normal range and the increase was not clinically meaningful. There was no significant between-group difference in the state-anxiety or VAS-anxiety score after the intervention, but the marjoram group had a significantly lower state-anxiety (p = 0.001) and VAS-anxiety (p = 0.037) score at posttest vs. pretest. The VAS-stress score was significantly lower in the marjoram group at the posttest vs. the pretest (p = 0.026).

Conclusion

Nurses caring for patients in a COVID-19 ICU experience significant stress, and strategies are needed to address this important issue. Inhalation of 3% marjoram essential oil while caring for patients in a COVID-19 ICU may be a simple and effective intervention that reduces perceived stress and anxiety in nurses.Clinical Trial Registration: https://cris.nih.go.kr/, KCT0007543.

Anxiety-Reducing Effects of Lavender Essential Oil Inhalation: A Systematic Review

Anxiety disorders are the most prevalent and disabling mental disorders, causing health-related burdens. With the increasing demand for and interest in safe and acceptable anxiolytics, several studies report the anxiolytic effects of lavender aromatherapy, providing evidence of its physiological and psychological effects. However, existing reviews comprehensively cover the effects of different modes of delivering aromatherapy. Therefore, this review assesses the efficacy of lavender essential oil inhalation in reducing anxiety. The titles and abstracts of relevant articles published over the last five years were searched in PubMed, Web of Science, and Scopus databases. This review only included clinical trials that utilized lavender inhalation for anxiety treatment. Eleven studies comprising 972 participants were included. Of these, 10 reported significantly decreased anxiety levels after lavender oil inhalation. The physiological measures of vital signs, including blood pressure, heart rate, respiratory rate, pulse, and saturation, were conducted in three trials, showing that lavender oil inhalation could physiologically affect anxiety levels. Lavender oil inhalation is a safe and feasible anxiolytic intervention for treating people with diverse types of anxiety. Data from further studies with a high-quality design and accurate information are necessary to confirm the validity of these findings and elucidate the anxiety-reducing mechanisms of lavender inhalation.

Topical Application of Tea Tree Oil for the Treatment of Verruca Vulgaris

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Effectiveness of Aromatherapy in Early Palliative Care for Oncology Patients: Blind Controlled Study

BACKGROUND

Palliative care is the active holistic treatment of people of all ages who have serious health-related suffering as a result of severe illness, and especially of those who are close to the end of life. Palliative care is provided to cancer patients who experience serious suffering that cannot be relieved without professional intervention and that compromises physical, social, spiritual, and emotional functioning. A straightforward, low-risk, and affordable palliative care approach may be provided through aromatherapy, a type of complementary and alternative medicine. The study objective is to assess the comparative effectiveness of massage, aromatherapy massage, and massage combined with aromatherapy inhalation on cancer patients receiving palliative care.

METHODS

A total of 100 participants who were divided into four groups at random. The first group, designated as the control group, received standard hospital nursing care, the second group received massage only (using the odorless almond carrier oil), the third group received massage with lavender oil, and the fourth group received combined (inhalation and massage) aromatherapy. The Rotterdam Symptom Checklist (RSCL), given two weeks after aromatherapy, was used to examine participants' perspectives of care.

RESULTS

On the RSCL, combined aromatherapy performed best. In terms of reported physical symptoms, psychological symptoms, and activities, there were statistically significant differences between the scores of the control group and each of the experimental groups. Nonetheless, the total quality of life score showed no significant difference between the control group and the massage only group (t = 0.529, p = 0.60).

CONCLUSIONS

When paired with aromatherapy inhalation, massage has a positive effect on physical, psychological symptoms, activities, and overall quality of life for cancer patients receiving early palliative care. Nurses and other healthcare providers are recommended to support programs that provide message therapy to reduce reported bodily symptoms, psychological problems, and limited activities among cancer patients.

Using Aromatherapy to Improve Nighttime Comfort in Hospitalized Patients With Cancer: A Pilot Study

BACKGROUND

Sleep disturbances have been shown to have negative health effects leading to inferior well-being, increased fatigue, and impaired performance. For hospitalized patients receiving oncology care, improving nighttime comfort may positively affect well-being and health outcomes, leading to decreased length of stay. Aromatherapy can improve sleep quantity and quality.

OBJECTIVES

This pilot study aimed to determine whether aromatherapy improves nighttime comfort, in particular well-being and sleep quality, for hospitalized patients with cancer.

METHODS

This quasi-experimental pilot study with a single-arm pre-/post-test design evaluated the effects of nighttime aromatherapy for hospitalized patients with cancer. Measures were the World Health Organization-Five Well-Being Index and Pittsburgh Sleep Quality Index.

FINDINGS

A total of 34 hospitalized patients with cancer participated. After aromatherapy, mean well-being scores improved significantly. Mean sleep quality scores also improved but did not reach significance. Of participants who submitted open-ended responses, 20 of 22 described a positive experience with aromatherapy, including better sleep, relaxation, soothing effects, and nausea relief.

The Effect of Aromatherapy in the Management of Cancer-Related Pain at the End of Life: A Pilot Study

BACKGROUND

The use of clinical aromatherapy for managing pain has been studied in surgical patients and in women during childbirth. However, there are limited data on the use of aromatherapy for alleviating cancer-related pain, particularly at the end of life.

OBJECTIVES

This pilot study identifies the pre- and postimplementation effects of aromatherapy on pain level, pain perception, and the use of oral morphine equivalent among patients with cancer at the end of life.

METHODS

A survey was conducted to assess participant pain levels preimplementation of aromatherapy. Participants were then asked to rate their pain and describe how they felt 15 minutes postimplementation of aromatherapy. A chart review comparing oral morphine equivalent use pre- and postimplementation of aromatherapy was also performed.

FINDINGS

Postimplementation of aromatherapy, mean pain scores and 24-hour oral morphine equivalent use decreased. Participants also described an improved pain experience and found aromatherapy to be soothing.

A Pharmacotherapeutic Approaches for Managing Labour Pain using Synthetic Drugs and Natural Therapies

The birth of a child is a critical and potentially traumatic experience for women, entailing multiple physiological and psychosocial changes. The psychological effects of childbirth pain can have both immediate and long-term effects on the mother's health and her bond with her child. Many studies investigated the different ranges of synthetic drugs available for pain control in labour, inclusive of neuraxial analgesics, inhaled analgesics, and various opioids. The inadequate efficacy and unfavourable side effects of these synthetic drugs prevent appropriate pharmacotherapy, resulting in a quest for natural therapies for reducing labour pain. Herbal therapies (aromatherapy) using several essential oils obtained from various natural plants are another alternative that calms and manages the mind and body through aromatic compounds that have neurological and physiological effects. The review discussed the safety profile of various synthetic drugs with their dosage information and also deliberated on the mechanism and safety profile of various natural plants that are used in aromatherapy. The review also briefly highlighted the other non-pharmacological miscellaneous techniques such as TENS, hypnosis, immersion in water, acupuncture, massage, and different other tactics that aim to assist women in coping with pain in labour.

Role of Alternate Therapies to Improve the Quality of Life in Menopausal Women: A Systematic Review

Middle aged women in majority undergoing menopausal symptoms are unaware of the physiological changes happening in their body, necessary lifestyle changes and alternate therapies to overcome the symptoms. All major electronic sources of relevant information were systematically searched and collected data were pooled under specific subheadings. From the reviewed papers, the awareness on symptoms and related complications of menopause in the middle aged women were consolidated. Studies helped to identify alternative therapies replacing or in parallel with the Hormone Replacement Therapy to overcome the menopausal symptoms. Reduced oestrogen and progesterone level causes physiological, psychological, and genitourinary symptoms. Prolonged consequences cause libido, osteoporosis, and cardio vascular diseases. Hypo-estrogenic status is well managed with alternative therapies including dietary intervention, acupuncture, aromatherapy, exercise, and yoga. Dietary interventions involving foods like Fennel, Soy, Black Cohash, St. John Wort, Red Clover and Date Pollen were found to be managing vasomotor symptoms and sexual dysfunction. Non-Hormonal and Non-Pharmacological impact behind acupuncture treatment was well accepted. Various studies proved inhaling and massaging with Lavender, Neroli oil, Fennel, Rose, and Geranium essential oils balance cortisol hormone and reduce stress and anxiety. Impact of yoga therapy on neurohormonal pathways reduce both psychological and physiological symptoms. Reviews summarizes various symptoms and complications during menopausal transition and alternate ways of better management with dietary intervention, yoga, exercise, aromatherapy, and acupuncture to improve the quality of menopausal women's life.

Changes in Salivary Oxytocin Level of Term Pregnant Women after Aromatherapy Footbath for Spontaneous Labor Onset: A Non-Randomized Experimental Study

BACKGROUND

Aromatherapy is usually used to stimulate labor. However, its specific physiological effects have been scarcely examined. We evaluated whether an aromatherapy footbath increases oxytocin levels in term pregnant women.

METHODS

In this quasi-experimental study, low-risk term pregnant women in Japan underwent aromatherapy using a footbath (1) infused with clary sage and lavender essential oils, (2) infused with jasmine oil, or (3) with no infused oils (control group). The primary outcome was the salivary oxytocin level. The secondary outcomes were uterine contractions and cortisol levels.

RESULTS

In the clary sage and lavender group (n = 28), the oxytocin level increased significantly after the footbath (p = 0.035). The jasmine group (n = 27) and control group (n = 27) exhibited trends toward a respective increase and decrease in the oxytocin level; however, the changes in the oxytocin levels between the clary sage and lavender group and the control group showed no significance difference. There were no significant differences in the changes in the uterine contractions and cortisol levels between the experiment and control groups.

CONCLUSIONS

The changes in the oxytocin levels in the clary sage and lavender group did not differ significantly with those in the control group, possibly because of the small sample size. Further studies are required to examine the effects of repeated aromatherapy footbaths to stimulate labor.

Essential oils for treating anxiety: a systematic review of randomized controlled trials and network meta-analysis

Background and purpose

The findings of clinical studies exploring essential oils (EOs) for anxiety remain disputed, and no studies have yet clarified the differences in the efficacy of EOs. The purpose of the study was to directly or indirectly compare the efficacy of different types of EOs on anxiety by pooling the results of randomized controlled trials (RCTs).

Methods

PubMed, Cochrane Library, Embase, Scopus, Web of Science and the Cochrane Central Register of Controlled Trials (CENTRAL) databases were searched from inception to November 2022. Only full texts of RCTs that investigated the effects of EOs on anxiety were included. The trial data were extracted and the risk of bias was assessed by two reviewers independently. Pairwise meta-analysis and network meta-analysis were performed by Stata 15.1 or R 4.1.2 software.

Results

Forty-four RCTs (fifty study arms) involving 10 kinds of EOs and 3419 anxiety patients (1815 patients in EOs group and 1604 patients in control group) were included. Pairwise meta-analyses showed that EOs were effective in reducing State Anxiety Inventory scores (SAIS) [WMD = -6.63, 95% CI-8.17, -5.08] and Trait Anxiety Inventory scores (TAIS) [WMD = -4.97, 95% CI-6.73, -3.20]. Additionally, EOs could decrease systolic blood pressure (SBP) [WMD = -6.83, (95% CI -10.53, -3.12), P < 0.001] and heart rate (HR) [WMD = -3.43, (95% CI -5.51, -1.36), P < 0.001]. Network meta-analyses demonstrated that regarding the outcome of SAIS, Jasminum sambac (L.)Ait. (jasmine) was the most effective with a weighted mean difference (WMD) of-13.61 (95% CrI-24.79, -2.48). Followed by Citrus (citrus aurantium L.), which had a WMD of-9.62 (95% CrI-13.32, -5.93). Moderate effect sizes were observed for Rosa rugosa Thunb. (damask rose) (WMD = -6.78, 95% CrI-10.14, -3.49) and Lavandula angustifolia Mill. (lavender) (WMD = -5.41, 95% CrI-7.86, -2.98). Regarding the results of TAIS, citrus aurantium L. was the best ranked intervention with a WMD of-9.62 (95% CrI-15.62, -3.7). Moderate-to-large effect sizes were observed for Citrus limon (L.) Burm. F. (lemon) (WMD:-8.48; 95% CrI-16.67, -0.33) and lavender (WMD:-5.5; 95% CrI-8.7, -2.46).

Conclusion

According to the comprehensive analysis, EOs are effective in reducing both state anxiety and trait anxiety, and citrus aurantium L. essential oil seems to be the most recommended type of EO for treating anxiety because of its significant effects in reducing SAIS and TAIS.

Systematic review registration

https://www.crd.york.ac.uk/PROSPERO/, identifier: CRD42022331319.

The Efficacy of Regeneration Oil and Almond Oil on Split-Thickness Skin Graft Donor Sites: A Single-Blinded Randomized Controlled Trial

BACKGROUND AND OBJECTIVES

Essential oils are a complementary treatment and can play an important role in scar care. The aim of this study was to evaluate and compare the efficacy of a new essential oil (regeneration oil) with a control group on scar quality in healed split-thickness skin graft donor sites.

MATERIALS AND METHODS

A single-center blinded randomized controlled study was performed on 30 patients with healed split-thickness skin graft donor site. The patients were randomly allocated into blended regeneration oil (n = 14) and pure almond oil (n = 16) groups. Application of the assigned oil occurred twice a day for 6 months. Scarring (Patient and Observer Scar Assessment Scale), itching (ITCH Assessment Scale) and scar discoloration (colorimetry) of the donor sites were assessed after 1, 3 and 6 months.

RESULTS

We found no statistically significant differences between the groups in any applied parameter. We observed comparable outcomes (scar quality, itchiness, colorit) in healed split-thickness skin graft donor sites for both oils.

CONCLUSIONS

Regeneration oil and control oil presented comparable results regarding scar quality, itchiness and colorit in healed split-thickness skin graft donor sites after 6 months of application. Both oils are suitable for skin/scar care in split-thickness skin graft donor sites.

Travel-associated melioidosis: a narrative review

BACKGROUND

Melioidosis, caused by Burkholderia pseudomallei, may be considered a neglected tropical disease that remains underdiagnosed in many geographical areas. Travellers can act as the sentinels of disease activity, and data from imported cases may help complete the global map of melioidosis.

METHODS

A literature search for imported melioidosis for the period 2016-22 was performed in PubMed and Google Scholar.

RESULTS

In total, 137 reports of melioidosis associated with travel were identified. The majority were males (71%) and associated with exposure in Asia (77%) (mainly Thailand, 41%, and India, 9%). A minority acquired the infection in the Americas-Caribbean area (6%), Africa (5%) and Oceania (2%). The most frequent comorbidity was diabetes mellitus (25%) followed by underlying pulmonary, liver or renal disease (8, 5 and 3%, respectively). Alcohol/tobacco use were noted for seven and six patients, respectively (5%). Five patients (4%) had associated non-human immunodeficiency virus (HIV)-related immunosuppression, and three patients (2%) had HIV infection. One patient (0.8%) had concomitant coronavirus disease 19. A proportion (27%) had no underlying diseases. The most frequent clinical presentations included pneumonia (35%), sepsis (30%) and skin/soft tissue infections (14%). Most developed symptoms <1 week after return (55%), and 29% developed symptoms >12 weeks after. Ceftazidime and meropenem were the main treatments used during the intensive intravenous phase (52 and 41% of patients, respectively) and the majority (82%) received co-trimoxazole alone/combination, for the eradication phase. Most patients had a favourable outcome/survived (87%). The search also retrieved cases in imported animals or cases secondary to imported commercial products.

CONCLUSIONS

As post-pandemic travel soars, health professionals should be aware of the possibility of imported melioidosis with its diverse presentations. Currently, no licensed vaccine is available, so prevention in travellers should focus on protective measures (avoiding contact with soil/stagnant water in endemic areas). Biological samples from suspected cases require processing in biosafety level 3 facilities.

Effects of the aroma of lemone verbena (Aloysia citriodora Paláu) essential oil on anxiety and the hemodynamic profile before cesarean section: A randomized clinical trial

Background

Aromatherapy is a noninvasive method used for alleviating anxiety. Lemon verbena (Aloysia citriodora Paláu, LV) has been frequently used in traditional medicine as an anxiolytic agent due to its pharmacological ingredients.

Objective

This randomized controlled trial aimed to assess the effects of inhaling essential oil of LV on the level of anxiety and subsequent hemodynamic changes before cesarean section.

Methods

The recent study was a randomized single-blind trial. Participants (n = 84) were randomly divided into two groups: LV essential oil (group A) and placebo (group B). The intervention group underwent aromatherapy using three drops of LV essential oil at a distance of 10 cm for 30 min. The placebo group received aromatherapy in a similar fashion. The State-Trait Anxiety Inventory of Spielberger questionnaire was administered before and 5 min after aroma inhalation. Vital signs were recorded before and after aromatherapy. Likewise, pain severity was assessed using the Numeric Rating Scale and vital signs were recorded. Data were analyzed using t-test, χ ², and the Kolmogrov-Smirnov test through SPSS21 software.

Results

Anxiety level was significantly attenuated in group A after aromatherapy. Heart rate, respiratory rate, and blood pressure decreased after inhalation; but no significant variation of pain scores was observed after inhalation in both groups.

Conclusion

We concluded that LV decreased preoperative anxiety in this recent study, therefore, aromatherapy with LV essential oil as a preemptive adjuvant to relieve anxiety before cesarean section is recommended by us; although more studies are required to endorse the results.

Effect of inhaler and topical lavender oil on pain management of arteriovenous fistula cannulation

BACKGROUND

The recurrent arteriovenous fistula (AVF) intervention in the treatment of hemodialysis induces pain in patients. Lavender oil has analgesic, antimicrobial, and calming effects. This oil is widely used in patients to reduce anxiety and stress associated with pain caused by analgesics.

METHOD

The present study is a randomized controlled and experimental clinical trial in which patients (n = 90) who underwent hemodialysis with AVFs were randomly divided into three groups. The intensity of pain was measured in all patients at three different stages during the insertion of arterial needles for hemodialysis: (1) The topical application of 100% lavender essential oil, (2) the inhaler application of 100% lavender essential oil, and (3) no intervention. The placebo (water) was applied to groups 1 and 2.

RESULTS

Our findings revealed that the mean pre-application pain scores in hemodialysis patients were 57.58 ± 20.28 in the working group, 48.53 ± 20.23 in the control group, 19.49 ± 15.66 in the post-application group, and 45.33 ± 25.52 in the control group (p < 0.005). The average pain scores after the application of lavender oil were 22.66 ± 15.35 in the inhaler lavender group, 16.33 ± 15.97 in the topical lavender group, and 45.33 ± 25.52 in the control group.

CONCLUSIONS

After inhaler and topical application of lavender oil, a significant decrease in the severity of pain was recorded for patients at the time of arterial insertion of needles.

The Effects of Essential Oils on the Nervous System: A Scoping Review

Essential oils are a mixture of natural aromatic volatile oils extracted from plants. The use of essential oils is ancient, and has prevailed in different cultures around the world, such as those of the Egyptians, Greeks, Persians, and Chinese. Today, essential oils are used in traditional and complimentary medicines, aromatherapy, massage therapies, cosmetics, perfumes and food industries. The screening effect of essential oils has been studied worldwide. They demonstrate a range of biological activities, such as antiparasitic, antifungal, antibacterial, antiviral, antioxidant, anti-inflammatory, anticancer, antiaging, and neuroprotective properties. In this scoping review, we provide a 10-year updated comprehensive assessment of volatile oils and their effects on the nervous system. MEDLINE, Scopus, and Google Scholar were systematically and strategically searched for original studies investigating these effects from 2012 to 2022. Approximately seventy studies were selected as included studies. Among these studies, several outcomes were reported, including antistress, antianxiety, analgesic, cognitive, and autonomic effects. Some essential oils showed developmental benefits, with the potential to induce neurite outgrowth. The neurotransmitter receptor level can also be modified by essential oil application. Physiological and pathophysiological outcome measures were reported. For physiological outcomes, arousal, cognitive performance, circadian eating behavior, emotional modulation, consumer acceptance, preferences, and willingness to buy were investigated. For pathophysiological conditions, pain, depression, anxiety, stress, sleep disorder, mental fatigue, agitated behavior, and quality of life were measured. In conclusion, essential oils showed promising effects on the nervous system, which can be further applied to their use in functional foods, drinks, and alternative therapy.

Efficacy of Essential Oils in Relieving Cancer Pain: A Systematic Review and Meta-Analysis

Over 80% of patients affected by cancer develops cancer-related pain, one of the most feared consequences because of its intractable nature, particularly in the terminal stage of the disease. Recent evidence-based recommendations on integrative medicine for the management of cancer pain underline the role of natural products. The present systematic review and meta-analysis aims at appraising for the first time the efficacy of aromatherapy in cancer pain in clinical studies with different design according to the most updated Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) 2020 recommendations. The search retrieves 1002 total records. Twelve studies are included and six are eligible for meta-analysis. The present study demonstrates significant efficacy of the use of essential oils in the reduction of the intensity of pain associated with cancer (p < 0.00001), highlighting the need for earlier, more homogeneous, and appropriately designed clinical trials. Good certainty body of evidence is needed for effective and safe management of cancer-related pain using essential oils by establishment of a step-by-step preclinical-to-clinical pathway to provide a rational basis for clinical use in integrative oncology. PROSPERO registration: CRD42023393182.

Implementation of Aromatherapy, a Nonpharmacological Intervention, to Reduce Anxiety During the Preoperative Period

PURPOSE

The purpose of the project was to answer the following question: Does the implementation of aromatherapy before surgery reduce preoperative anxiety in adult surgical patients undergoing elective surgery?

DESIGN

This evidence-based project was a quality improvement initiative that used pre- and poststate anxiety evaluations to determine the effect of aromatherapy on preoperative anxiety among adults undergoing elective surgery.

METHODS

The project team conducted a literature review to evaluate the appropriateness of using aromatherapy to decrease preoperative anxiety. The team delivered pre- and postaromatherapy State Trait Anxiety Inventory for Adults (STAIAD) Short form Y-1 questionnaire and administered an aromatherapy diffuser clip comprised of three evidence-based scented oils to determine the effect of aromatherapy on preoperative anxiety among adults undergoing elective surgery.

FINDINGS

Pre- and postaromatherapy (STAIAD) Short Form Y-1 questionnaires indicated that exposure to aromatherapy significantly reduced preoperative anxiety. There was a statistically and clinically significant difference in state anxiety score after aromatherapy exposure, with a mean state change of 17.42 points (P < .001). This exceeded the effect size benchmark derived from the evidence, which defined a significant change in state score as 5 points. Participants above the median age exhibited the most profound decrease in anxiety regardless of gender. Qualitative survey responses indicated that 96% of patients would use preoperative aromatherapy in the future and 91% experienced increased satisfaction with their perioperative care.

CONCLUSIONS

Heightened physiological response to increased anxiety leads to increased perioperative nausea and vomiting, higher pain scores, and susceptibility to prolonged recovery from surgery. Implementing aromatherapy can reduce anxiety, thereby attenuating these complications and preventing additional accrued cost. Furthermore, this evidence-based project has the added benefit of increasing overall patient satisfaction with the perioperative process.

Reduction of Chemotherapy-Induced Nausea and Vomiting: A Pilot Study of Essential Oils in the Autologous Blood and Marrow Transplantation Population

BACKGROUND

Chemotherapy-induced nausea and vomiting (CINV) places a burden on patients receiving blood and marrow transplantation. The effects of complementary aromatherapy on CINV are documented, but more information is needed to implement practice changes.

OBJECTIVES

The purpose of this pilot study was to evaluate whether pure peppermint or ginger essential oil reduced the severity of CINV.

METHODS

A controlled randomized pilot study was conducted using peppermint oil, ginger oil, and control (canola oil) groups. Nurses applied the assigned oil every four hours. Outcome and patient feedback data were collected.

FINDINGS

Twenty patients experienced a level 2 or greater nausea event. Patients in the peppermint oil group were the least likely to experience a nausea event, followed by the ginger oil and control groups. Five patients experienced level 2 vomiting; these events did not differ between groups.

The Effect of Lavender on Anxiety and Hemodynamic Status Before Septorhinoplasy and Rhinoplasty

PURPOSE

Anxiety is one of the most common problems before surgery and surgery of the nose is one of the most concerning and challenging surgeries among the plastic surgeries. The aim of this research is to consider the impact of lavender fragrance on anxiety and hemodynamics status before the septorhinoplasty and rhinoplasty.

DESIGN

Parallel randomized control trial.

METHODS

This research was done by testing thirty-four candidates who were about to have the surgery in two groups of lavender (intervention) and control. The anxiety before and after surgery was examined by the Speilberger State Anxiety Inventory questionnaire and the hemodynamics status. For the analysis, the T- Test, Mann Whitney Test and the χ² Test were used.

FINDINGS

The demographic features of the two groups were similar. Anxiety after the experiment was meaningful. The obvious anxiety in the lavender category was 25.8% and the controlled group had that decreased to 1.8%. The latent anxiety was reduced by 24.3% in the lavender group and increased by 8% in the controlled group. The systolic, diastolic and the heart rate after the intervention was less in the lavender group.

CONCLUSIONS

Due to the ease of the inhalation of lavender and the lack of any report for the existence of any kind of side-effects for the prevention of anxiety during nose surgeries, it can be suggested that this approach can be effective for the controlling of the consistency of the patients' hemodynamics.

Cananga odorata Aromatherapy Reduces Anxiety in Unexperienced Patients Hospitalized for Interventional Neuroradiology Procedures: A Randomized Control Trial

The hospitalization and the unfamiliar experiences of patients in interventional radiology procedures cause a moderate to high levels of anxiety. This study was aimed to evaluate the anxiolytic effect of Cananga odorata essential oil (COE) aromatherapy in unexperienced patients hospitalized for interventional neuroradiology (INR) procedures. Forty-four patients admitted for their first INR procedure were randomly divided into COE and placebo control groups. COE or distilled water was dropped onto 2 pieces of mulberry paper and attached to the participant's gown at the shoulder level overnight. The main outcomes were observed from the morning salivary cortisol levels and salivary alpha-amylase activity after intervention. The Thai version of Spielberger State-Trait Anxiety Inventory (STAI) and the vital signs (blood pressure and heart rate) were also assessed before and after COE intervention as the secondary outcome. The demographic and baseline data of both groups did not show any significant difference. After intervention, COE group had a significantly lower salivary alpha-amylase activity than placebo control group. The post-intervention scores of Trait (STAI-T) and State (STAI-S) anxiety were significantly less than those of baseline in both groups. Interestingly, the COE group had a greater percentage reduction on STAI-T after intervention than placebo control group. No significant difference was observed in other outcomes. In addition, the salivary alpha-amylase activity was weak but showed significant correlation with STAI anxiety scores. This study indicates that COE aromatherapy reduces the saliva alpha amylase activity and STAI-T anxiety in unexperienced patients hospitalized for INR procedures.

Effects of aromatherapy with Rosa damascene and lavender on pain and anxiety of burn patients: A systematic review and meta-analysis

Pain and anxiety were considered the most common complications of treatment procedures in burn patients. Non-pharmacological drugs, including aromatherapy, can decrease these issues. This systematic review and meta-analysis aim to summarise the effects of aromatherapy with Rosa damascene (RD) and lavender on the pain and anxiety of burn patients. A systematic search was performed on international electronic databases such as Scopus, PubMed, and Web of Science, as well as on Iranian electronic databases such as Iranmedex and Scientific Information Database (SID) with keywords extracted from Medical Subject Headings such as "Burns", "Pain", "Pain management", "Anxiety", and "Aromatherapy" were performed from the earliest to November 1, 2022. The Joanna Briggs Institute (JBI) critical appraisal checklist assessed the quality of randomised control trials (RCTs) and quasi-experimental studies. STATA v.14 software was used to estimate pooled effect size. Heterogeneity was assessed with I² value. Random effect model and inverse-variance method using sample size, mean, and standard deviation changes were applied to determine standard mean differences (SMD). The confidence interval of 95% was considered to determine the confidence level. A total of 586 burn patients participated in six studies, including three RCT studies and three quasi-experimental studies. The results based on RCT studies showed RD significantly decreased the dressing pain average when compared to the control group (SMD: -1.61, 95%CI: -2.32 to -0.99, Z = 5.09, I² : 66.2%, P < 0.001). Aromatherapy with lavender decreased the average pain in the interventional group more than in the control group (SMD: -1.78, 95%CI: -3.62 to 0.07, Z = 1.89, I² : 97.2%, P = 0.06). Using aromatherapy with RD and lavender significantly decreased pain average in the interventional group than the control group (SMD: -1.68, 95%CI: -2.64 to -0.72, Z = 3.42, I² : 94.2%, P = 0.001). The results showed RD significantly decreased the anxiety average in the interventional group than the control group (SMD: -2.49, 95%CI: -2.98 to -2.0, Z = 9.94, I² : 51.6%, P < 0.001). Overall, this study showed that aromatherapy with RD decreased pain and anxiety of dressing procedures in burn patients. Although aromatherapy with lavender decreased pain in the patients, it was not statistically significant. More RCTs studies are required to be able to better judge the effects of aromatherapy with RD and lavender on the pain and anxiety of burn patients.

Determination of Chemical Composition and Investigation of Biological Activities of Ocimum basilicum L

This study aimed to determine the chemical composition of the essential oils (EOs) of Ocimum basilicum L., as well as to evaluate the antibacterial, antidiabetic, dermatoprotective, and anti-inflammatory properties, and the EOs and aqueous extracts of O. basilicum. The antibacterial activity was evaluated against bacterial strains, Gram-positive and Gram-negative, using the well diffusion and microdilution methods, whereas the antidiabetic activity was assessed in vitro using two enzymes involved in carbohydrate digestion, α-amylase and α-glucosidase. On the other hand, the dermatoprotective and anti-inflammatory activities were studied by testing tyrosinase and lipoxygenase inhibition activity, respectively. The results showed that the chemical composition of O. basilicum EO (OBEO) is dominated by methyl chavicol (86%) and trans-anethol (8%). OBEO exhibited significant antibacterial effects against Gram-negative and Gram-positive strains, demonstrated by considerable diameters of the inhibition zones and lower MIC and MBC values. In addition, OBEO exhibited significant inhibition of α-amylase (IC50 = 50.51 ± 0.32 μg/mL) and α-glucosidase (IC50 = 39.84 ± 1.2 μg/mL). Concerning the anti-inflammatory activity, OBEO significantly inhibited lipoxygenase activity (IC50 = 18.28 ± 0.03 μg/mL) compared to the aqueous extract (IC50 = 24.8 ± 0.01 μg/mL). Moreover, tyrosinase was considerably inhibited by OBEO (IC50 = 68.58 ± 0.03 μg/mL) compared to the aqueous extract (IC50 = 118.37 ± 0.05 μg/mL). The toxicological investigations revealed the safety of O. basilicum in acute and chronic toxicity. The finding of in silico analysis showed that methyl chavicol and trans-anethole (main compounds of OBEO) validate the pharmacokinetics of these compounds and decipher some antibacterial targets.

Efficacy of Aromatherapy at Relieving the Work-Related Stress of Nursing Staff from Various Hospital Departments during COVID-19

This study aimed to evaluate the efficacy of aromatherapy in relieving the stress of nursing staff working in different departments during COVID-19. A total of 26 nursing staff from Taiwan were recruited for this study. Bergamot essential oil was diffused for over a four-week period in four different hospital departments. We assessed heart rate variability indicators, Nurse Stress Checklist, and Copenhagen Burnout Inventory before and after the intervention. The results of the analysis showed that during a high workload period, aromatherapy had no significant effect on regulating physical stress. Subjective measurements showed a significant impact on work concern and personal fatigue. Moreover, there were large differences among the four departments; the aromatherapy treatment had a weak effect on those with a heavy workload, whereas those with a lighter workload showed a stronger effect. Finally, this study provides practical results about aromatherapy stress reduction applied during the pandemic on first-line medical staff.

Inhalation of Isopropyl Alcohol for the Management of Nausea and Vomiting: A Systematic Review

Background: The use of inhaled isopropyl alcohol (IPA) has been proposed as a therapeutic intervention for the relief of nausea in various settings. The objective of this systematic review was to evaluate the existing evidence for the use of inhaled IPA in the management of nausea and vomiting. Methods: We performed a literature search on Medline, EMBASE, Web of Science, Scopus, CINAHL, PsycInfo, and Cochrane Library databases before November 2021. The following concepts were searched using subject headings and keywords as needed "aromatherapy," "alcohol," "ethylic alcohol," "ethanol," "isopropyl alcohol," "emesis," "chemotherapy-induced," "pregnancy," "hyperemesis gravidarum," "motion sickness," "emetics," "antiemetics," "inhalation," and "inhale." Searches were not limited to a specific language. The bibliographies of identified articles were also manually searched. Two authors independently assessed the included studies for risk of bias. Results: Thirteen randomized controlled trials out of 158 studies identified met the inclusion criteria, with a total of 1253 participants. Twelve studies were conducted in the postoperative anesthesia care unit and two studies were performed in the emergency department setting. Four studies were double blinded, one was single blind, and eight were open label. Three studies assessed the use of inhaled IPA for prevention, whereas 10 studies evaluated its use in the treatment of nausea and vomiting. Seven studies reported IPA to be more effective, four studies reported no difference, and two studies reported IPA to be ineffective. Participant satisfaction was high overall, regardless of intervention received. No adverse effects were reported. The overall quality of evidence was low. Conclusion: There is a lack of strong evidence to support the use of inhaled IPA in the management of nausea and vomiting. Additional trials are warranted to confirm this finding and to further explore the use of inhaled IPA in various populations and settings.

Complementary and alternative medicine for alopecia areata: A systematic review

BACKGROUND

Despite high use of complementary and alternative medicine (CAM) for alopecia areata (AA), efficacy and safety remain unclear.

OBJECTIVE

To identify all CAM therapies studied for treatment of AA. Outcomes of interest included disease course and psychologic well-being.

METHODS

PubMed and Embase were searched to identify English articles containing original data investigating CAM in individuals with AA from 1950-2018. Quality was assessed with Oxford Centre for Evidence Based Medicine criteria.

RESULTS

Of 1015 initial citations, 16 articles met inclusion criteria: 5 randomized controlled trials, 5 prospective controlled cohorts, 4 prospective noncontrolled cohorts, 1 retrospective cohort, and 1 case series. CAM therapies with best evidence and efficacy for hair growth in AA include essential oil aromatherapy, topical garlic, and oral glucosides of peony with compound glycyrrhizin. Hypnosis and mindfulness psychotherapy represent low-quality evidence for improvement of psychologic and quality of life outcomes. Adverse events were rare and mild for all therapies evaluated.

LIMITATIONS

Inconsistent or poorly reported study methodology and nonstandardized outcomes limit the conclusions that can be made from these studies.

CONCLUSIONS

This work serves to inform physician treatment of patients with AA seeking CAM while encouraging further investigation into these therapies to address some of the therapeutic challenges of AA.

fNIRS neuroimaging in olfactory research: A systematic literature review

There are a number of key features which make olfaction difficult to study; subjective processes of odor detection, discrimination and identification, and individualistic odor hedonic perception and associated odor memories. In this systematic review we explore the role functional near-infrared spectroscopy (fNIRS) has played in understanding olfactory perception in humans. fNIRS is an optical neuroimaging technique able to measure changes in brain hemodynamics and oxygenation related to neural electrical activity. Adhering to PRISMA guidelines, results of this search found that generally the majority of studies involving healthy adult subjects observed increased activity in response to odors. Other population types were also observed, such as infants, individuals with autism, attention deficit hyperactivity disorder (ADHD), post-traumatic stress disorder (PTSD), mild cognitive impairment (MCI) and dysosmia. fNIRS coverage heavily favored the prefrontal cortex, temporal and parietal regions. This review finds that odor induced cortical activation is dependent on multiple factors, such as odorant type, gender and population type. This review also finds that there is room for improvement in areas such as participant diversity, use of wearable fNIRS systems, physiological monitoring and multi-distance channels.

Use of Topical Lavender Essential Oils to Reduce Perceptions of Burnout in Critical Care

BACKGROUND

Intensive care unit (ICU) health care workers face increased burnout. The purpose of this project was to evaluate burnout after implementing lavender essential oils.

OBJECTIVE

To assess the effectiveness of topical lavender essential oils in decreasing the instance of burnout in frontline ICU health care workers during the COVID-19 pandemic.

METHODS

A predesign and postdesign evidence-based practice project was conducted to evaluate the implications of an 8-week topical lavender oil intervention on health care worker burnout. The Maslach Burnout Inventory, including subscales of emotional exhaustion, depersonalization, and personal accomplishment, was administered before and after the intervention. Health care workers' compliance and satisfaction with the intervention were also measured.

RESULTS

Thirty-four ICU health care workers participated. Results showed significant improvements in the personal accomplishment subscale (mean [SD], 3.86 [0.81] before vs 4.14 [1.01] after intervention; P = .04). Improvements in depersonalization were not significant. Most participants were satisfied (n = 23 [67.6%]) and compliant (n = 23 [67.6%]) with the intervention.

CONCLUSION

The use of topical lavender essential oils is a cost-effective intervention that can be used to decrease components of burnout in frontline ICU workers.

Effect of Citrus aurantium Aroma on the Happiness of Pre-Hospital Emergency Staff: A Randomized Controlled Trial

Happiness is a positive internal experience and an indicator of mental health. Having happy and efficient employees is one of the ideals of healthcare organizations, given its impact on the quality of healthcare services. Emergency healthcare staff members face various unpleasant and stressful events. It has been suggested that fragrant herbs such as Citrus aurantium can have cheerfulness effects on individuals. Therefore, this study was conducted to investigate the effect of Citrus aurantium aroma on the happiness of pre-hospital emergency staff. A randomized placebo controlled clinical trial was carried out on 167 prehospital emergency medical staff who were randomly assigned into two groups of aromatherapy and placebo. The participants received Citrus aurantium aromatherapy and placebo for five work shifts and for two consecutive weeks. Aromatherapy was performed using 10% Citrus aurantium scent applied via a pendant containing 1.5 cc of Citrus aurantium scent. The distance from the nose to the container was about 20 cm with the neck straight and the head in a balanced position. Data regarding staff happiness were collected using the Oxford Happiness Questionnaire, which were analyzed using descriptive and inferential statistics. The mean level of happiness did not differ between the intervention and control groups (p = 0.99). Work experience had a statistically significant inverse association with happiness (coefficient = -0.76, 95% CI: -1.49, -0.03). The findings of this randomized controlled trial indicate that Citrus aurantium aroma has no effect on the happiness of prehospital emergency medical services workers. There is a need to study the effect of a combination of complementary and alternative methods on the creation of positive psychological feelings among pre-hospital emergency staff.

The Use of Therapeutic Inhaled Essential Oils (TIEO) as a Holistic Approach to Decrease Preoperative Anxiety in ERAS Gynecological Surgery

INTRODUCTION

Preoperative anxiety is a negative symptom frequently experienced by surgical patients. This evidence-based-practice (EBP) project evaluated the effectiveness of therapeutic inhaled essential oils (TIEO) on anxiety levels during the preoperative phase of surgery in enhanced recovery after surgery (ERAS) gynecological patients ages 18 to 65 years old.

METHODS

A prospective, preposttest, quasiexperimental design was used to evaluate preoperative anxiety scores. Patients (N = 53) scheduled for gynecological surgeries were enrolled at a level II trauma center. Upon arrival to the preoperative area on the day of surgery, patients were asked to score their anxiety level using the Visual Analog Scale for Anxiety (VAS-A). Patients were provided the TIEO intervention during their preoperative phase of surgery ranging from 15 to 60 minutes. Patients were encouraged to take mindful deep breaths and inhale the essential oil vapor. Before being transported into the operating room, patients were asked to re-evaluate their anxiety level using the VAS-A.

RESULTS

A matched paired t-test revealed the post-VAS-A measurements were significantly lower (n = 52, M = 31.37, SD = 24.334) than the pre-VAS-A measurements (n = 52, M = 53.50, SD = 26.863), t₅₁ = 8.756, P = .000). On average, postanxiety scores were 22.135 mm lower than pre-anxiety scores (95% CI [17.060, 27.209]).

CONCLUSIONS

The use of TIEO demonstrated a statistically significant decrease in preoperative anxiety scores within the ERAS gynecological population. TIEO can be used as an adjunct intervention to manage preoperative anxiety. TIEO can be successfully administered in the preoperative area. Decreasing anxiety in the preoperative period may lead to many perioperative benefits such as improving surgical outcomes, patient satisfaction, and quality of care.

Complementary Intervention in Postoperative Care: Aromatherapy's Role in Decreasing Postoperative Nausea and Vomiting

Purpose: This study analyzed the efficacy of Post-Ease, a custom essential oil aromatherapy blend, in decreasing postoperative nausea and vomiting (PONV) and the need for antiemetic drugs in an orthopaedic surgical population. Study Design: This is retrospective cohort study, utilizing electronic health record data pre- and post-implementation of a nurse-driven quality improvement intervention. Methods: The study examined the impact of an inhaled custom blend of essential oils containing lavender, peppermint, ginger and lemon to assist in decreasing PONV and reduce the use of antiemetic medications. Data on the use of antiemetic drugs in pre- and post-intervention periods were analyzed. Findings: Nurses provided the Post-Ease blend 384 times in 2020 to patients as an option before proceeding, if necessary, to antiemetic drugs. The intervention group demonstrated a statistically significant reduction in the number of unique surgical patients' need for antiemetics as treatment (22%; p = .05). Similarly, the total doses of antiemetics administered was significantly reduced (21%; p ≤ .05) during the study period. Conclusion: This study supports the use of aromatherapy to reduce PONV and minimize antiemetic use in an orthopaedic population.

The effect of topically administered lavender aromatherapy on the pain of insulin injection in diabetic patients: a double-blind randomized controlled clinical trial

BACKGROUND

Needle phobia occurs in more than half of diabetic patients due to the pain caused by frequent insulin injections. Therefore, this study evaluated the effect of topically administered lavender aromatherapy on the pain of insulin injections in diabetic patients.

METHODS

In this double-blind randomized controlled and experimental study, patients who met the study criteria were divided into three groups; topical lavender oil (n = 60), placebo (n = 60), and control (n = 60) groups. The data were collected using the "Patient Information Form", the "Follow-up Form", the "Verbal Category Scale (VCS)", and the "Visual Analogue Scale (VAS)".

RESULTS

The results revealed no significant difference between the patients in the topical lavender oil group before and during the insulin injection in terms of VAS and VCS pain scores (p > 0.05). In the placebo and control groups, the mean VAS and VCS pain scores during insulin injection were found to be significantly higher than before insulin injection (p < 0.05). Besides, the mean VAS and VCS scores during insulin injection were significantly higher in the placebo and control groups than the topical lavender oil group (p < 0.05).

DISCUSSION

: The study showed that patients who were administered topical lavender oil felt less pain after insulin injection than those in the placebo and control groups. Therefore, topically applied lavender aromatherapy can be easily used for pain control in insulindependent diabetic patients (clinical trial number NCT04767737).

The effect of aromatherapy with rose essential oil on apparent anxiety in patients with myocardial infarction

OBJECTIVES

Acute myocardial infarction (MI) and hospitalization are one of the most stressful situations for many patients. Aromatherapy is a branch of the complementary medicine that is effective in anxiety. The present study aims to determine the effect of aromatherapy with rose essential oil (REO) on apparent anxiety in patients with acute MI.

METHODS

This randomized clinical trial was carried out on patients with acute MI admitted to the cardiac ward of Heshmatieh Hospital in Sabzevar. Eighty patients were randomly assigned to two aromas and placebo groups, who received three drops of REO or placebo by inhalation three times a day for 3 days. Before and after the intervention, patients' anxiety levels were measured by the Spielberger questionnaire. Data were analyzed by chi-square and the independent and paired and t-tests.

RESULTS

Before the intervention, the mean of apparent anxiety was not significantly different in the intervention and control groups (48.44 ± 3.81 and 51.38 ± 7.21, respectively, p=0.16) while this parameter was significant after the intervention in both experimental groups (47.27 ± 7.11 and 44.16 ± 4.63, respectively, p=0.000), with a reduction in the mean of apparent anxiety in the intervention group. Moreover, the results of paired t-test revealed that the anxiety scores decreased significantly in the test group before and after the intervention (51.38 ± 7.21 and 44.16 ± 4.63, p=0.000).

CONCLUSIONS

Considering the positive effects of REO used in this study to reduce anxiety in patients with acute MI, the use of REO is recommended as a complementary treatment to reduce anxiety in these patients.

Citrus Essential Oils in Aromatherapy: Therapeutic Effects and Mechanisms

Citrus is one of the main fruit crops cultivated in tropical and subtropical regions worldwide. Approximately half (40-47%) of the fruit mass is inedible and discarded as waste after processing, which causes pollution to the environment. Essential oils (EOs) are aromatic compounds found in significant quantities in oil sacs or oil glands present in the leaves, flowers, and fruit peels (mainly the flavedo part). Citrus EO is a complex mixture of ~400 compounds and has been found to be useful in aromatic infusions for personal health care, perfumes, pharmaceuticals, color enhancers in foods and beverages, and aromatherapy. The citrus EOs possess a pleasant scent, and impart relaxing, calming, mood-uplifting, and cheer-enhancing effects. In aromatherapy, it is applied either in message oils or in diffusion sprays for homes and vehicle sittings. The diffusion creates a fresh feeling and enhances relaxation from stress and anxiety and helps uplifting mood and boosting emotional and physical energy. This review presents a comprehensive outlook on the composition, properties, characterization, and mechanism of action of the citrus EOs in various health-related issues, with a focus on its antioxidant properties.

Exploring the Chemical Composition of Bulgarian Lavender Absolute (Lavandula Angustifolia Mill.) by GC/MS and GC-FID

Lavender (L. angustifolia Mill.) is an important essential oil-bearing and medicinal plant with high commercial value. Lavender scent components can be derived not only as an essential oil but also as lavender concrete or absolute. The development of reliable analytical methods for origin assessment and quality assurance is of significant fundamental importance and high practical interest. Therefore, a comprehensive chemical profiling of seven industrial samples of Bulgarian lavender absolute (L. angustifolia Mill.) was performed by means of gas chromatography-mass spectrometry (GC/MS) and gas chromatography with flame ionization detection (GC-FID). As a result, 111 individual compounds were identified by GC/MS, and their quantitative content was simultaneously determined by GC-FID, representing 94.28-97.43% of the total contents of the lavender absolute. According to our results, the main constituents of lavender absolute (LA) are representatives of the terpene compounds (with the dominating presence of oxygenated monoterpenes, 52.83-80.55%), followed by sesquiterpenes (7.80-15.21%) and triterpenoids (as minor components). Coumarins in various amounts (1.79-14.73%) and aliphatic compounds (hydrocarbons, ketones, esters, etc.) are found, as well. The acyclic monoterpene linalool is the main terpene alcohol and, together with its ester linalyl acetate, are the two main constituents in the LAs. Linalool was found in concentrations of 27.33-38.24% in the LA1-LA6 samples and 20.74% in the LA7 samples. The amount of linalyl acetate was in the range of 26.58 to 37.39% in the LA1-LA6 samples, while, surprisingly, it was not observed in LA7. This study shows that the chemical profile of the studied LAs is close to the lavender essential oil (LO), fulfilling most of the requirements of the International Standard ISO 3515:2002.

[Feasibility and Efficacy of Training Program for Aromatherapy in Palliative Care]

Objective To explore the feasibility and efficacy of the training program for aromatherapy in palliative care. Methods Data from four aromatherapy training programs held at Peking Union Medical College Hospital from 2016 to 2019 was collected.The feasibility and efficacy of the training were measured based on the self-reported questionnaires from 120 trainees. Results A total of 56 valid questionnaires were collected.The total score of the programs was 8.09.Trainees reported that the program enriched theoretical knowledge and enhanced practical confidence.After the training,79.6% of the trainees carried out aromatherapy in practice,while those who failed to practice were mainly due to the lack of appropriate opportunities.Some trainees suggested adding more practice hours and hoped to get follow-up guidance on a case-by-case basis. Conclusions It is feasible to carry out the short-term training program of aromatherapy in palliative care,which can enrich trainees' theoretical knowledge and enhance the practical confidence.It is necessary to provide continuous guidance after training to increase the proportion of trainees adopting aromatherapy in palliative care practice.

Psychological Effects of Aromatherapy on Smokers With Depressive Tendencies During Smoking Cessation Treatment: Protocol for a Pre-Post Single-Arm Clinical Trial

Background

Cessation of smoking can markedly reduce the incidence of cardiovascular disease, improve health economics, and benefit society. Aromatherapy has the potential to be a novel option as an adjuvant therapy for smoking cessation that may alleviate depressive symptoms. However, research on the efficacy of aromatherapy as an adjuvant therapy for smoking cessation is scarce.

Objective

The aim of this study was to examine the potential effects of aromatherapy on psychological states in smokers with depressive tendencies and to determine if it is reasonable to proceed to the next step (ie, a phase III trial).

Methods

This is a pre-post single-arm clinical trial. Smokers with depression will be subjected to aromatherapy during smoking cessation treatment for 12 weeks. We will evaluate changes in scores on the Zung Self-Rating Depression Scale and the Profile of Mood States from pretreatment screening to 4 weeks and 12 weeks after the start of aromatherapy. Moreover, we will compare the group treated with aromatherapy with the group that received standard treatment in our previous randomized controlled trial (ie, the control group in that study). Furthermore, we will compare successful smoking cessation rates after 12 weeks. In addition, we will conduct an exploratory analysis of the efficacy of aromatherapy. The target sample size is 100, which is the number of subjects expected to be enrolled in this study during the 2-year study period.

Results

This study was approved by the Kyoto Medical Center Institutional Review Board (IRB approval No. 19-016). Enrollment started on July 1, 2019. As of May 2022, 76 patients have been recruited. In the original plan, recruitment should have been finished on June 30, 2021. However, the number of subjects decreased due to the COVID-19 pandemic, and the study inclusion period was extended by 1 year (ie, until the end of June 2022) with the approval of the IRB on May 17, 2021. Analyses of the results will be completed subsequently.

Conclusions

This study has some limitations. This is not a rigorous validation study because it compares the same subjects who received standard treatment in a previous study. Moreover, the sample size and methods of statistical analysis were not fully set with prior consideration of statistical rigor. To address these limitations, we plan to conduct a phase III trial that will reflect the exploratory findings of this study. This is the first study to evaluate the psychological effects of aromatherapy during a smoking cessation program, and it may help improve the quality of treatment for smoking cessation in the future.

Trial Registration

UMIN Clinical Trials Registry UMIN000043102; https://tinyurl.com/tn3hvt9w

International Registered Report Identifier (IRRID)

DERR1-10.2196/38626