Care Protocols Research Articles

Impact of a clinical care pathway developed through the action research method on the psychological well-being and quality of life in male patients with urethral stricture.

The objective of this study is to examine the development of a clinical care pathway utilizing an action research methodology for male patients with urethral stricture, and to assess the psychological and quality of life outcomes following the implementation of this pathway. Ninety patients diagnosed with urethral stricture, admitted to our hospital between May 2021 and May 2022, were selected as the study cohort. Employing a random number method, these patients were allocated into an observation group and a control group, each comprising 45 individuals. The control cohort employs standard care protocols for individuals with urethral stenosis, while the experimental group employs an action research methodology to develop a clinical care pathway specific to the management of patients with urethral stenosis, with an intervention cycle of 3 months. The investigation evaluated the impact of the intervention by scrutinizing pre- and post-intervention data through the utilization of the WHO Quality of Life Scale (WHOQOL-BREF), in addition to the Anxiety Rating Scale and the Depression Rating Scale. Prior to the intervention, no significant differences were observed in WHOQOL-BREF scores across dimensions, as well as anxiety and depression scores between the 2 groups (P > .05). Subsequent to the intervention, the patients in the observation group exhibited significantly higher scores across all WHOQOL-BREF dimensions and total scores compared to the control group, with statistical significance (P < .05). Moreover, anxiety and depression scores in the observation group were markedly lower than those in the control group, demonstrating statistical significance (P < .05). The implementation of a clinical nursing pathway rooted in action research methodology proves to be an effective strategy for enhancing clinical nursing practices, elevating patient quality of life, and diminishing the prevalence of anxiety and depression.

Determination of Incidence and Risk Factors of Medical Device-Related Pressure Injury in the ICU: A Descriptive Study.

To determine the incidence and risk factors of medical device-related pressure injury (MDRPI) in the ICU. In this descriptive study, the researchers collected data through systematic observation of patients (n = 58) in the ICU. The patients were evaluated within 24 hours of ICU admission and then followed up until they were discharged. A total of 482 patient-days were followed. The researchers used the MDRPI follow-up form, the patient descriptive form, the MDRPI follow-up form, and the Braden Scale for Predicting Pressure Sore Risk for data collection. Overall, 39.7% of the 58 patients hospitalized in the ICU developed an MDRPI, and 5.2% of the MDRPIs were evaluated as stage 2. These injuries occurred in an average of 5 days after the patient was admitted to the ICU. Among the MDRPIs that developed, 31.9% were located in the nose, 21.3% in the mouth, and 14.9% on the cheeks. Intubation tubes were used in 7.3% of the patients, nasogastric tubes in 22.4% of the patients, and radial artery catheters in 10.5% of the patients. The development of MDRPI is correlated with the type of medical device used. Providers should establish a planned care protocol based on the anatomic placement of the medical device and take necessary precautions to prevent MDRPI.

Enhanced recovery protocols after surgery: A systematic review and meta-analysis of randomized trials in cardiac surgery.

Previous meta-analyses combining randomized and observational evidence in cardiac surgery have shown positive impact of enhanced recovery protocols after surgery (ERAS) on postoperative outcomes. However, definitive data based on randomized studies are missing, and the entirety of the ERAS measures and pathway, as recently systematized in guidelines and consensus statements, have not been captured in the published studies. The available literature actually focuses on "ERAS-like" protocols or only limited number of ERAS measures. This study aims at analyzing all randomized studies applying ERAS-like protocols in cardiac surgery for perioperative outcomes. A meta-analysis of randomized controlled trials (RCTs) comparing ERAS-like with standard protocols of perioperative care was performed (PROSPERO registration CRD42021283765). PRISMA guidelines were used for abstracting and assessing data. Thirteen single center RCTs (N=1704, 850 in ERAS-like protocol and 854 in the standard care group) were selected. The most common procedures were surgical revascularization (66.3%) and valvular surgery (24.9%). No difference was found in the incidence of inhospital mortality between the ERAS and standard treatment group (risk ratio [RR] 0.61 [0.31; 1.20], p=0.15). ERAS was associated with reduced intensive care unit (standardized mean difference [SMD] -0.57, p<0.01) and hospital stay (SMD -0.23, p<0.01) and reduced rates of overall complications when compared to the standard protocol (RR 0.60, p<0.01) driven by the reduction in stroke (RR 0.29 [0.13; 0.62], p<0.01). A significant heterogeneity in terms of the elements of the ERAS protocol included in the studies was observed. ERAS-like protocols have no impact on short-term survival after cardiac surgery but allows for a faster hospital discharge while potentially reducing surgical complications. However, this study highlights a significant nonadherence and heterogeneity to the entirety of ERAS protocols warranting further RCTs in this field including a greater number of elements of the framework.

Knowledge and Awareness of Physiotherapy among Cancer Survivors

Background: Despite the established benefits of physiotherapy in oncology care, there remains a substantial gap in the awareness and utilization of rehabilitation services among cancer patients. The role of physiotherapy in improving the quality of life and functional independence of cancer survivors is well-documented, yet the integration of these services into standard cancer care protocols is not uniformly practiced. Objective: This study aimed to assess the level of awareness and the barriers to physiotherapy among oncology patients in a tertiary care hospital, with an emphasis on understanding the gender-specific differences in awareness and interest in physiotherapy services. Methods: A six-month cross-sectional survey was conducted at a tertiary care hospital in Sindh, employing a non-probability convenience sampling technique to recruit 318 participants. The sample size was determined using Raosoft sampling software, with a 95% confidence level, 5% margin of error, and 50% response distribution. Data were collected through self-administered questionnaires, focusing on patients' awareness of and interest in physiotherapy, and analyzed using SPSS version 25.0, with chi-square tests applied to assess statistical significance. Results: The study found that only 17.3% of participants were aware of physiotherapy services, with significant gender differences in awareness (p=0.013) and interest (p=0.326) observed. Barriers to physiotherapy utilization included pain (91.5%), fatigue (90.6%), and financial constraints (78.9%). A stark 84.6% of patients reported not being informed about physiotherapy during their treatment. Conclusion: The low level of awareness and significant barriers to accessing physiotherapy among cancer patients highlight the critical need for enhanced educational programs and improved communication between oncology and rehabilitation professionals. Addressing these gaps is essential for integrating physiotherapy into cancer care, thereby improving patient outcomes and quality of life.

Role of Chewing Gum in Enhancing Post-Operative Recovery 0f Bowel Function after Lower Segment Cesarean Section

Background: The frequency of cesarean sections globally exceeds the World Health Organization's recommended rates, leading to an increased focus on postoperative recovery, particularly the restoration of gastrointestinal (GIT) function. The delayed return of intestinal activity, known as postoperative ileus, can extend hospital stays and elevate healthcare costs. Chewing gum has been proposed as a simple, non-pharmacological intervention to stimulate the GIT and potentially expedite recovery. Objective: This study aimed to evaluate the efficacy of chewing gum in improving GIT activity and recovery in patients following a cesarean section, contributing to the evidence base for postoperative care practices in obstetrics and gynecology. Methods: A cross-sectional comparative analytical study was conducted at the Department of Obstetrics and Gynecology, KRL Hospital Islamabad, from May 2021 to November 2021. Two hundred patients undergoing elective cesarean sections were divided into two groups: Group A (n=100), who received chewing gum postoperatively, and Group B (n=100), who did not. The primary outcomes measured were the time to first bowel sound, time to first flatus, and time to first defecation. Data were analyzed using SPSS version 25, with a significance level set at p≤0.05. Results: Group A demonstrated a significantly faster time to first bowel sound (3.75 ± 1.31 hours vs. 7.01 ± 1.94 hours, p=0.001), first flatus (7.97 ± 1.96 hours vs. 14.75 ± 3.57 hours, p=0.001), and first defecation (32.37 ± 3.56 hours vs. 48.20 ± 6.06 hours, p=0.001) compared to Group B. These findings were consistent across age stratifications, with significant improvements in GIT recovery times in younger (18-25 years) and older (26-35 years) subsets of patients. Conclusion: Chewing gum post-cesarean section significantly accelerates the recovery of GIT functions, reducing the time to first bowel sound, flatus, and defecation. This study supports the inclusion of chewing gum as a low-cost, effective method in postoperative care protocols for cesarean section patients, potentially improving patient outcomes and reducing healthcare costs.

Return Visits in Infants Younger Than 90 Days Presenting to the Pediatric Emergency Department for Fever.

Fever in infants presenting to pediatric emergency departments (PEDs) often results in significant return visits (RVs). This retrospective study aimed to identify factors associated with RVs in febrile infants aged 0 to 90 days. Data from infants presenting to PED between 2018 and 2021 and returning within 7 days (RV group) were compared to age-matched febrile infants without RVs (control group). Each group had 95 infants with similar demographics and medical history. RVs were primarily due to positive cultures and persistent fever. The control group had higher initial hospitalization rates, longer PED stays, and increased antibiotic treatment. Prevalence of serious bacterial infections (SBIs) did not significantly differ. Higher hospitalization, prolonged PED stays, and initial antibiotic treatment were associated with reduced RV incidence despite similar SBI rates. Return visits in infants <90 days were primarily driven by persistent fever and positive cultures. Addressing these factors through targeted parental education and improved care protocols may reduce RVs.

Transition of care of adolescents with rheumatic diseases in Saudi Arabia, current practice and obstacles

BackgroundThe importance of transition of care for adolescents with rheumatological illnesses from pediatric to adult rheumatology is increasing as the childhood rheumatologic diseases continue to adulthood. Despite that, transition practice in Saudi Arabia is not yet well-developed. ObjectivesThis study aims to evaluate the current transition of care practice for adolescents with rheumatological diseases to the adult healthcare facilities and the obstacles in achieving the best transition of care in Saudi Arabia. Setting and methodsThis is a non-interventional cross-sectional study conducted using an online survey that was distributed to pediatric and adult rheumatologists in Saudi Arabia. Google forms and Microsoft Excel 2016 were used for data entry and analysis. Descriptive statistics, frequencies and percentages were performed for categorical variables. ResultsA total number of 60 rheumatologists (27 pediatric and 33 adult) participated in the survey. Fifty-six (94%) of the participants do not follow any standardized programs for transition of care. All participants agreed on the need for a defined protocol for transition of care. The major barriers for successful transition of care were lack of protocols (63%), lack of healthcare providers (56%), and lack of well-developed systems that makes it difficult to access patient's electronic health records (55%). ConclusionA well-structured protocol for transition of care of adolescents with rheumatologic illnesses from pediatric to adult rheumatology in Saudi Arabia is still an unmet need. Efforts should be directed towards improving the practice of transition of care by establishing this protocol, enhancing the connectivity between pediatric and adult healthcare facilities, and encouraging pediatric and adult rheumatologists to adapt the transition of care protocol in their daily clinical practice.

Support for the Right to Life among Neonatal Intensive Care Nurses in Korea.

The increase of high-risk newborns due to societal changes has presented neonatal intensive care unit nurses with more ethical challenges and heightened their perception of neonatal palliative care. Therefore, this study was a descriptive survey exploring the perceptions of neonatal intensive care unit nurse regarding biomedical ethics and neonatal palliative care in neonatal intensive care units. The research participants were 97 neonatal intensive care unit nurses who had been directly involved with end-of-life care for high-risk babies. Data were collected from November to December 2021 through an online survey. The Korean version of Neonatal Palliative Care Attitude Scale and the tool of biomedical ethics were used. The collected data were analyzed using the T-test, ANOVA, Scheffé test, Pearson correlation coefficient, and multiple regression analysis. The mean score for perception of biomedical ethics in neonatal intensive care unit nurses was 2.89 of 4, and that of neonatal palliative care in neonatal intensive care unit nurses was 3.10 of 5. Existence of a protocol of neonatal palliative care, the experience of patients dying, and the right to life of neonates were factors influencing the perception of neonatal palliative care. The explanatory power was 12.5%. The data support the importance of guidelines regarding systematic neonatal palliative care. Also, developing programs for sharing and supporting experiences of patients dying among colleagues and persistent education about the right to life of neonates for neonatal intensive care unit nurses can improve perception of neonatal palliative care.

Post-Polypectomy Care: Balancing Comfort and Nutritional Needs

The objective of polypectomy, a frequent endoscopic procedure, is to prevent colorectal cancer. Consequences of post-polypectomy care include minimizing complications, ensuring patient recovery, and preventing polyp recurrence. Besides monitoring polyp recurrence rates, this study assessed the effectiveness of post-polypectomy care protocols in managing patient comfort, adherence to dietary guidelines, and satisfaction with care. A cross-sectional analysis of 135 patients who underwent polypectomy at a tertiary care center was utilized in this study. Patient satisfaction, dietary adherence, post-operative comfort, and demographics were evaluated at one, three, and six months following the procedure. Recurrence of the polyp was monitored for one year. The research identified noteworthy enhancements in patient-reported comfort (P &lt; 0.05), dietary adherence (P &lt; 0.05), and overall satisfaction with care (P &lt; 0.05). Additionally, complications such as infection (3.7%), bleeding (7.41%), and adherence to a prescribed diet decreased equivalently. Despite this, a trend toward increased polyp recurrence was observed that was not statistically significant, with rates increasing from 4.44% after three months to 12.59% after one year. Amid a gradual decline in dietary recommendation adherence, patient satisfaction with care remained consistently elevated. The results indicated that although prompt post-polypectomy care effectively improves patient comfort and satisfaction, long-term dietary adherence presents obstacles. Despite lacking statistical significance, the rising incidence of polyp recurrence emphasizes the criticality of diligent long-term surveillance.

Hygiene and Care Protocols for Implant-supported Dental Prostheses in Patients with Diabetes

Background: Prophylactic dental procedures following implant placement are critical to the long-term success of implants and are also dependent on the patient maintaining effective home care. Purpose: Evaluation of the effectiveness of preventive measures in patients with diabetes during long periods after prosthetic treatment with implants. Materials and methods: The study included 62 patients with diabetes with edentulism using 146 dental implants. Patients underwent constant monitoring, including regular occupational hygiene during follow-up examinations. Their frequency was set individually from 2 to 4 times A clinical index including Bleeding on Probing (BOP), Probing Depth (PD), and Marginal Bone Loss (MBL). Results: In patients included in the preventive protocol after 12 months, the mean BOP was 1.4 ± 0.15, and PPD was 2.46 ± 0.42. After 12 months in patients mean MBL was 0.72 ± 0.6 mm, after 3 years MBL was 1.24 ± 0.25 mm. For patients who were excluded from preventive services after 12 months, the mean BOP 1.9 ± 0.25, and the mean PPD was 3.56 ± 0.28). After 12 months in patients mean MBL was 0.87 ± 0.7 mm, after 3 years MBL was 1.52 ± 0.32 mm (p &gt; 05). Compared to persons enrolled in the preventive protocol, those in the group without services were more likely to develop peri-implantitis (42.4% vs. 12,6%). The survival rate of implants after 3 years was 98.4%. The survival rate of implants in those patients who were excluded from preventive services after 3 years was 95.4%. Conclusion: For patients with diabetes, regular medical examinations, accompanied by professional oral hygiene procedures, prevent the development of negative reactions of the soft tissues surrounding the implant.

Introduction of Spiritual Psychotherapy for Inpatient, Residential, and Intensive Treatment (SPIRIT) in The Netherlands: Translation and Adaptation of a Psychotherapy Protocol for Mental Health Care

The perceived value of the integration of spirituality and religion (SR) in mental health care is growing. This study aimed to adapt an SR intervention developed in the USA (SPIRIT) for use in the Netherlands and to explore its applicability. Employing a participatory practice-based action research design, professionals, clients, and an advisory board collaborated in iterative cycles of translation, adaptation, discussion, and testing. The ongoing interfaith dialog during the adaptation process broadened the perspectives incorporated into the existing handouts. We added the term “meaning” (M) alongside SR to accommodate patients who do not identify with religion or spirituality. Additionally, several handouts were added to the original protocol: autonomy, responsibility, and liberty; loneliness and belonging; inspiring persons in the past and present; and grief and loss. Moreover, the existing handout on sacred verses was expanded to encompass versions from various outlooks on life: philosophical/humanistic, Judeo-Christian, Buddhist, Islamic, and Hindu. Finally, layout modifications and diverse exercise formats were introduced. A qualitative examination revealed that the adapted SPIRIT protocol was well received by professionals and patients, and quantitative studies on its applicability and usefulness are recommended.

Efficacy of Transcutaneous Electrical Acupoint Stimulation on Chronic Postsurgical Pain After Video-Assisted Thoracoscopic Lobectomy: Study Protocol for a Prospective Randomized Controlled Trial.

Patients undergoing video-assisted thoracoscopic lobectomy (VATL) often experience chronic postsurgical pain (CPSP). Postoperative pain can affect the recovery of postoperative lung function, prolong postoperative recovery time, and increase patient hospitalization expenses. Transcutaneous electrical acupoint stimulation (TEAS) is an alternative therapy based on acupuncture that has shown promise in postoperative recovery and pain management across various medical fields. However, research specifically focused on the improvement of CPSP after VATL is currently lacking. The purpose of this study is to evaluate whether TEAS can effectively reduce the severity and occurrence of chronic postsurgical pain in patients undergoing VATL. By investigating the potential benefits of TEAS in mitigating CPSP after VATL, this study aims to provide valuable clinical evidence to support the integration of TEAS into postoperative care protocols for patients undergoing VATL. This study is a prospective, single-center, double-blinded, randomized controlled trial to be conducted at the 920th Hospital of Joint Logistics Support Force. Eighty patients undergoing VATL will be randomly divided into an experimental group (TEAS group) and a control group (sham group). The experimental group will receive TEAS at bilateral PC6, LI4, LR3, LU5, TE5, and LI11. The control group will not receive TEAS at the same acupoints. Both groups will receive TEAS or no TEAS before anesthesia induction and 1-7days after surgery, with each session lasting 30min. The primary outcome will be the incidence of CPSP at 3months after surgery. Secondary outcomes will include the incidence of CPSP at 6months after surgery, the numerical rating scale (NRS) scores at 3 and 6months after surgery, as well as the NRS scores at 24, 48, and 72h after surgery, remifentanil consumption during general anesthesia, demand for rescue analgesics, number and duration of indwelling chest tubes, incidence of postoperative nausea and vomiting, and changes of norepinephrine (NE), cortisol (Cor), tumor necrosis factor (TNF- α), and interleukin 6 (IL-6) in serum. ChiCTR2300069458. Registered on March 16, 2023.

Protocol for VIVALDI social care: Pilot study to reduce infections, outbreaks and antimicrobial resistance in care homes for older adults.

Care home residents are vulnerable to severe outcomes from infections such as COVID-19 and influenza. However, measures to control outbreaks, such as care home closures to visitors and new admissions, have a detrimental impact on their quality of life. Many infections and outbreaks could be prevented but the first step is to measure them reliably. This is challenging in care homes due to the lack of data and research infrastructure. During the pandemic, the VIVALDI study measured COVID-19 infections in residents and staff by partnering with care providers and using routinely collected data. This study aims to establish sentinel surveillance and a research database to enable observational and future interventional studies in care homes. The project has been co-produced with care providers, staff, residents, relatives, and researchers. The study (October 2023 to March 2025) will explore the feasibility of establishing a network of 500-1500 care homes for older adults in England that is underpinned by a linked data platform. No data will be collected from staff. The cohort will be created by regularly extracting resident identifiers from Digital Social Care Records (DSCR), followed by pseudonymisation and linkage to routinely collected datasets. Following extensive consultation, we decided not to seek informed consent from residents for data collection, but they can 'opt out' of the study. Our goal is to be inclusive, and it is challenging to give every resident the opportunity to 'opt in' due to cognitive impairment and the requirement for consultees. The project, and all requests to use the data will be overseen by relatives, residents, staff, and care providers. The study has been approved by the Health Research Authority Confidentiality Advisory Group (23/CAG/0134&0135) and the South-West Frenchay Research Ethics Committee (23/SW/0105). It is funded by the UK Health Security Agency.

Factors associated with safe and successful postoperative day 1 discharge after lung operations: a systematic review and meta-analysis

BackgroundA shorter length of stay (LOS) is associated with fewer hospital-acquired adverse conditions and decreased utilization of hospital resources. While modern perioperative care protocols have enabled some ambitious surgical teams to achieve discharge as early as within postoperative day 1 (POD1), most other teams remain cautious about such an approach due to the perceived risk of missing postoperative complications and increased readmission rates. We aimed to identify factors that would help guide surgical teams aiming for safe and successful POD1 discharge after lung resection.MethodsWe searched the PubMed, Embase, Scopus, Web of Science and CENTRAL databases for articles comparing perioperative characteristics in patients discharged within POD1 (DWPOD1) and after POD1 (DAPOD1) following lung resection. Meta-analysis was performed using a random-effects model.ResultsWe included eight retrospective cohort studies with a total of 216,887 patients, of which 22,250 (10.3%) patients were DWPOD1. Our meta-analysis showed that younger patients, those without cardiovascular and respiratory comorbidities, and those with better preoperative pulmonary function are more likely to qualify for DWPOD1. Certain operative factors, such as a minimally invasive approach, shorter operations, and sublobar resections, also favor DWPOD1. DWPOD1 appears to be safe, with comparable 30-day mortality and readmission rates, and significantly less postoperative morbidity than DAPOD1.ConclusionsIn select patients with a favorable preoperative profile, DWPOD1 after lung resection can be achieved successfully and without increased risk of adverse outcomes such as postoperative morbidity, mortality, or readmissions.

What do you think it means? Using cognitive interviewing to improve measurement in implementation science: description and case example

Pragmatic measures are essential to evaluate the implementation of evidence-based interventions. Cognitive interviewing, a qualitative method that collects partner feedback throughout measure development, is particularly useful for developing pragmatic implementation measures. Measure developers can use cognitive interviewing to increase a measure’s fit within a particular implementation context. However, cognitive interviewing is underused in implementation research, where most measures remain “homegrown” and used for single studies. We provide a rationale for using cognitive interviewing in implementation science studies and illustrate its use through a case example employing cognitive interviewing to inform development of a measurement-based care protocol for implementation in opioid treatment programs. Applications of cognitive interviewing, including developing a common language with partners and collecting multi-level feedback on assessment procedures, to improve measurement in implementation science are discussed.

Landscaping tuberculosis multimorbidity: findings from a cross-sectional study in India

BackgroundMultimorbidity, the concurrent presence of two or more chronic conditions is an emerging public health challenge. Till date, most of the research have focused on the presence and interaction of selected co-morbidities in tuberculosis (TB). There exist a critical knowledge gap on the magnitude of multimorbidity among TB patients and its impact on health outcomes.MethodsWe undertook a cross-sectional study to assess the prevalence and patterns of multimorbidity among newly diagnosed TB patients in two states of India. A total of 323 patients were interviewed using a structured multimorbidity assessment questionnaire for primary care (MAQ-PC). MAQ-PC is already validated for Indian population and elicits 22 chronic conditions. We defined TB multimorbidity as the co-existence of TB with one or more chronic conditions and identified commonly occurring dyads (TB + single condition) and triads (TB + two conditions).ResultsMore than half (52%) of TB patients reported multimorbidity. Among dyads, depression, diabetes mellitus (DM), acid peptic disease (APD), hypertension, chronic alcoholism, arthritis and chronic back ache (CBA) were the most common co-occurring conditions while ‘DM + arthritis’, ‘depression + APD’, ‘depression + DM’ were the most commonly occurring triads among TB patients. Factors such as increasing age, low levels of education, alcohol abusers, drug-resistant TB and having health insurance were significantly associated with multimorbidity among TB patients.ConclusionsOur findings suggest high prevalence of multimorbidity among newly diagnosed TB patients in India. The presence of concordant and discordant conditions with TB may increase the health complexity, thus necessitating appropriate care protocols. Given, the current situation, wherein TB and non-communicable diseases (NCD) services are delivered through collaborative framework between programmes, there is a need for addressing multimorbidity at the healthcare delivery level.

Endodontic Intercurrences in The Coronal Opening During The Covid-19 Pandemic: A Cross-sectional Study

Objective: This research aimed to assess the impact of the suggestion of changing the clinical moment for the installation of rubber dam isolation during the COVID-19 pandemic, during the graduation period in Faculdade de Odontologia de Pernambuco, Universidade de Pernambuco (FOP/UPE). Materials and methods: This is an observational descriptive, cross-sectional survey of a quantitative nature, which aims to identify the main impacts of the suggestion of changing the clinical moment for the installation of rubber dam isolation in endodontic procedures, which was approved by the Ethics Committee in Research of the University of Pernambuco (CEP/UPE), under allowance ethics committee number CAAE: 47786521.4.0000.5207. The population of this research consisted of FOP/UPE undergraduate students, regularly enrolled from the 6th to the 10th period, in the years 2021 and 2022, and who accomplished dental coronal opening in endodontic treatments, in the practicing clinics of the university during the pandemic period. Information was collected through a questionnaire the researchers prepared, using the online forms application named Google Forms. Results: Only 6.7% identified intercurrences during coronal opening, restricted to difficulties in accessing the pulp chamber. Conclusion: It is understood, therefore, that the suggestions for changing the endodontic care protocol related to the prior installation of rubber dam isolation to the coronal opening procedure were used and did not increase the risk of operative complications by FOP/UPE academics, in the clinics-school during the COVID-19 pandemic.

Is adding dry needling to a standard care protocol beneficial in patients with chronic neck pain? A randomized placebo-controlled trial

PurposeTo evaluate the short-term effects of adding a dry needling therapy to a standard care protocol based on education, exercise and electrotherapy, compared to a sham procedure and to a standard care protocol in isolation in patients with chronic neck pain. Material and methodsA randomized placebo-controlled trial was performed. The participants in the dry needling group received a standard care protocol based on patient education, therapeutic exercise and electrotherapy, as well as two sessions of dry needling in the upper trapezius, levator scapulae, and/or sternocleidomastoid muscles. The participants in the sham dry needling group received the same standard care protocol and two sessions of sham dry needling. The participants in the control group received the same standard care protocol. The outcomes measured were pain intensity, pressure pain threshold, neck disability, range of movement, activation of deep cervical flexor muscles, kinesiophobia, pain catastrophizing, anxiety, and depression. ResultsNo significant group by time interactions were found for any of the outcome variables except for lower cervical spine range of movement (F = 3.79; p = 0.030). ConclusionThe addition of two sessions of dry needling in the superficial neck muscles to a standard protocol did not yield superior results compared to either the standard care alone or the standard care plus sham dry needling in patients with chronic neck pain in any outcome except for cervical range of movement.

A Quasi Experimental Study to Assess the Effectiveness of Basic First Aid Training Programme in Terms of Knowledge and Skills among Students in Selected Schools of Gurugram

Introduction: This quasi-experimental study aimed to evaluate the effectiveness of a Basic First Aid Training Program among students in selected schools of Gurugram, focusing on both knowledge acquisition and practical skills development. Objective: The research involved a pre-test/post-test design with an intervention group that received the first aid training and a control group without any intervention. Methods: The sample comprised students from diverse backgrounds in selected schools of Gurugram, ensuring a representative mix of participants. The Basic First Aid Training Program was meticulously designed, incorporating theoretical knowledge sessions and hands-on practical training. The curriculum covered essential first aid techniques such as cardiopulmonary resuscitation (CPR), wound care, choking response, and emergency response protocols. Results: The finding of the study showed that pre to posttest was improves gradually and the mean difference shows the result was statistically significant. There was an association between the education of mother with knowledge and skills of basic first aid among students. Conclusion: Basic first aid training programme shows effectiveness on knowledge and skills among the school students. The present study was intended to assess the effectiveness of basic first aid knowledge and skills training in school students of schools of Gurugram.

Nurses' views on the presence of family members during invasive procedures in hospitalised children: A questionnaire survey.

(I) To identify the opinion and practices of nursing professionals regarding the presence of family members during invasive procedures in hospitalised children; (II) to determine the knowledge of nursing professionals about the patient-and family-centred care model. Family presence in invasive procedures benefits the patient and their relatives, but varied attitudes exist among healthcare personnel, with some being favourable and others unfavourable toward family presence. Observational, descriptive, cross-sectional study. Study population: Nurses from paediatric critical care services, emergency services, hospital wards, day hospitals and outpatient clinics at a Catalan tertiary hospital who participated voluntarily between September 2021 and July 2022. Data collection instrument: A questionnaire prepared by the researchers, based on the literature and reviewed by experts. REDCap link with access to the questionnaire was sent out to potential respondents through the institutional email. Bivariate analysis was performed with the R 4.2 program. The study was approved by the hospital's Clinical Research Committee and participants gave informed consent before responding to the questionnaire. A total of 172 nurses participated, and 155 valid responses were obtained. All respondents consider the family as a key element in paediatric care and report inviting family members to participate in the care given to their child. However, 12.0% of nurses do not invite the family to be present in invasive procedures. Almost all respondents note the need for training to acquire communication skills and improve the management of emotions. The results show a favourable opinion towards the presence of family members and highlight the need to train nurses to develop communication skills. The data provided can favour the design of measures to improve and promote the presence of parents during invasive procedures, reinforcing the patient-and family-centred care model and improving the quality of care provided. One example is the creation of family care protocols where the inclusion of parents and the roles of each individual involved in the care process appears.