Routine Hospital Care Research Articles

Virtual reality on level of pain during Venipuncture among preschool children

Hospitalization is stressful condition for children of all age groups. Venipuncture is one of the common painful procedures performed in hospital. Inserting intravenous catheter is one of the most painful and frequent acts for children in hospitals, most children express this method as the most stressful and violent course of treatment. The present study attempts to assess the effectiveness of virtual reality on pain during venipuncture among preschool age children at selected hospital in Chennai. METHODOLOGY The research design used in this study was experimental post test only design and it was conducted in the paediatric general ward at Aiswarya hospital, Chennai. Samples were selected based on sample selection criteria, 60 samples were selected with lottery method with 30 experimental and 30 control group. The gadget virtual reality was administered for the experimental group, and the control group routine hospital care during the venipuncture the level of pain was assessed by using FLACC scale. RESULTS The findings revealed, The mean score value of level of pain for control group was 6.47 with standard deviation of 0.78 (3.17 ± 0.27) and the experimental group was 3.30 with 1.29 (3.30 ± 1.29) .

The effect of aromatherapy and Su Jok interventions on post-cesarean pain

ObjectiveThe aim of this study was to determine the effect of aromatherapy and Su Jok interventions as nonpharmacological methods of relieving pain after cesarean section. Materials and methodsThis randomized controlled trial was conducted with 120 women who had cesarean delivery in the gynecology and obstetrics department of a training and research hospital between February 9 and October 2, 2019. The participants were allocated to the aromatherapy group, Su Jok group, Su Jok and aromatherapy group, or control group using block randomization based on parity. Su Jok was performed using buckwheat seed; aromatherapy was applied using lavender, eucalyptus, or rose oil. Data were collected using a participant information form and pain was assessed using the Visual Analog Scale. ResultsThere was no significant difference between the groups in mean pain levels before or after the intervention, although the control group had less initial pain compared to the intervention groups. However, all three intervention groups showed significant decreases in pain levels immediately and 30 min after the intervention compared to pre-intervention levels (p < 0.05). The intervention in all three groups reduced the level of pain. In particular, the pain level of the Su Jok group reached from moderate to mild. There was no significant change in the control group. ConclusionsAromatherapy and Su Jok interventions performed separately and simultaneously in addition to routine hospital care were more effective in reducing post-cesarean pain than routine care alone.

SEROPREVALENCE OF CYTOMEGALOVIRUS AMONG PREGNANT WOMEN IN AD-DHALE'E CITY - YEMEN

This study aimed to determine the seroprevalence of Cytomegalovirus virus (CMV) infection among pregnant women in Ad Dhale'e city, Yemen. A cross-sectional study was conducted among 130 pregnant women attended for routine antenatal care in Al-Nasser hospital in Ad-Dhale'e city. Serum was obtained and tested for seropositivity of CMV IgG and IgM using electro-chemiluminescence immunoassays (ECLIA) test. Of 130 blood sample, 122 (93.8 %) and 5 (3.8%) were identified with CMV IgG and CMV IgM seropositive respectively. While, 8 (6.2%) were seronegative (susceptible) to CMV infection. Statistically significant association (P&lt; 0.05) was found between CMV IgG seropositivity and age. This study concluded that there was high seroprevalence of cytomegalovirus infections among pregnant women in Ad-Dhale'e city. Routine antenatal screening of pregnant women for CMV infection should be considered. Further studies with more sample size using advanced methods is recommended.

Effect of nursing interventions protocol on patients' clinical outcomes undergoing peri cerebral aneurysm coiling

Introduction: Cerebral aneurysm coiling considers ideal treatment for intracranial aneurysms. Objective: to evaluate the effect of nursing interventions protocol on patients' clinical outcomes undergoing peri cerebral aneurysm coiling. Materials and methods: Quasi-experimental study conducted at the Neuro-psychiatry Center affiliated to Tanta University. A Convenience sample of 60 adult patients undergoing peri cerebral aneurysm coiling for the first time. Four tools used Tool I Patients Structured interview schedule. Tool II Glasgow Coma Scale. Tool III Numerical rating scale. Tool IV: Post aneurysmal patient assessment tools. Results: The present study shows that less than half of both study and control group age ranged from 41-60 years, also it shows that more than half of study group and approximately two third of control group were female. In addition, it reveals that there was improvement of post aneurysmal coiling nursing interventions protocol mean results which include that majority of study group post nursing interventions protocol and minority of control group post routine hospital care haven’t localized pain and neck stiffness, furthermore all patients of study group and less than two third of control group haven’t localized hematoma, Moreover majority of study group and less than one quarter of control group haven’t aneurysmal nausea.

Effects of Routine Health Care Combined with Oral Vitamin D on Linear Growth in 5-Year-Old Children.

Objective The aim is to evaluate the effects of routine health care combined with oral vitamin D on linear growth in 5-year-old children. Materials and Methods The 5-year-old children who received routine health care in Shiyan Maternal and Child Health Care Hospital from January 2019 to January 2021 were retrospectively analyzed. They were divided into the supplement group and the non-supplement group according to whether or not they received oral vitamin D, and reasons for not taking oral vitamin D and its influence on children's linear growth were analyzed. Results A total of 368 children were enrolled, including 228 children in the supplement group, accounting for 61.96%. The analysis of the influencing factors of vitamin D supplementation showed that the proportion of children with well-educated parents and living in cities and towns was higher (all P < 0.05). Comparing the general situation of children in the two groups, it was found that the height, weight, and head circumference of children in the supplement group were notably higher than those in the non-supplement group (all P < 0.05). At age 4 and 5, the height of the supplement group was significantly higher than that of the non-supplement group (all P < 0.001). Linear analysis showed that the relationship between height and age in the supplement group was Y (height, cm) = 10.07 × X (age, years) + 61.18, while that in the non-supplement group was Y (height, cm) = 8.296 × X (age, years) + 62.81, with significant difference (all P < 0.05). Serum 25-hydroxyvitamin D concentration in the supplement group was significantly higher than that in the non-supplement group, and the proportion of children ≥75 nmol/L was evidently higher than that in the supplement group (all P < 0.05). In addition, the incidence of vitamin D-related hypercalcemia in the supplement group was significantly higher than that in the non-supplement group (all P < 0.05). Conclusion There are still more children without vitamin D supplement, which is closely related to their parents' education background and place of residence. Additionally, vitamin D supplementation can promote growth and improve 25-hydroxyvitamin D levels in children, but with the risk of related complications.

Population Pharmacokinetics of Vancomycin in Pregnant Women.

Objective: Vancomycin is a glycopeptide antibacterial indicated for serious gram-positive infections. Pharmacokinetics (PK) of vancomycin have not been described in pregnant women. This study aims to characterize the PK disposition of vancomycin in pregnant women based on data acquired from a database of routine hospital care for therapeutic drug monitoring to better inform dosing decisions. Methods: In this study, plasma drug concentration data from 34 pregnant hospitalized women who were administered intravenous vancomycin was analyzed. A population pharmacokinetic (PPK) model was developed using non-linear mixed effects modeling. Model selection was based on statistical criterion, graphical analysis, and physiologic relevance. Using the final model AUC0-24 (PK efficacy index of vancomycin) was compared with non-pregnant population. Results: Vancomycin PK in pregnant women were best described by a two-compartment model with first-order elimination and the following parameters: clearance (inter individual variability) of 7.64 L/hr (32%), central volume of 67.35 L, inter-compartmental clearance of 9.06 L/h, and peripheral volume of 37.5 L in a typical patient with 175 ml/min creatinine clearance (CRCL) and 45 kg fat-free mass (FFM). The calculated geometric mean of AUC0-24 for the pregnant population was 223 ug.h/ ml and 226 ug.h/ ml for the non-pregnant population. Conclusion: Our analysis suggests that vancomycin PK in pregnant women is consistent with non-pregnant adults and the dosing regimens used for non-pregnant patients may also be applicable to pregnant patients.

Effect of ankle pump exercise on fatigue sensation, comfort, and lower limb hemodynamics among deep vein thrombosis patients

Background: Ankle pumping exercises utilize a calf muscle pump function to pump blood to the heart by muscle contraction. Ankle pumping exercises are often used for the relief of edema and the prevention of deep vein thrombosis. So, the current study aimed to evaluate the effect of ankle pump exercise on fatigue sensation, comfort, and lower limb hemodynamics among deep vein thrombosis patients. Design: This study was carried out using a quasi-experimental research design. Setting: This study was applied in the Orthopedic Department at Ain Shams University Hospital. Subjects: It consisted of a convenient sampling technique enrolled to select a sample of 100 patients with deep vein thrombosis in the previously selected department who agreed to participate in the study and were randomly assigned into two equal groups, with 50 patients in each group (the intervention group who received ankle pump exercise and the control group who received routine hospital care only). Tools: three tools were used (I): A patient interviewing sheet, (II): Rating of Perceived Exertion (RPE), and (III): Comfort evaluation scale.

Follow-up of severely injured patients can be embedded in routine hospital care: results from a feasibility study

ABSTRACT Objective Understanding the longitudinal patient experience outcomes following major trauma can promote successful recovery. A novel, hospital-led telephone follow-up program was implemented by a multi-disciplinary clinical trauma service team at a Level I trauma center. This process evaluation examined what factors promoted or impeded the program’s implementation. Methods A prospective convergent mixed-methods process evaluation design was used. Quantitative data included patient and injury demographics and program feasibility data such number of telephone calls attempted/completed and call duration. Qualitative data consisted of semi-structured interviews with program participants (staff, patients, and caregivers) who had participated in the program. Descriptive statistics and thematic analysis were applied to quantitative and qualitative data, respectively. Data were collected concurrently and merged in the results to understand and describe the implementation and sustainability of the program.274 major trauma patients (ISS ≥ 12) were eligible for follow-up. A response rate of over 75% was achieved, with nurses responsible for most of the calls. Limited time and competing clinical demands were identified as barriers to the timely completion of the calls. Results Participants valued the preexisting trauma service/patient relationship, and this facilitated program implementation. Clinicians were motivated to evaluate their patient’s recovery, whilst patients felt ‘cared for’ and ‘not forgotten’ post-hospital discharge. Teamwork and leadership were highly valued by the clinical staff throughout the implementation period as ongoing source of motivation and support. Staff spontaneously developed the program to incorporate clinical follow-up processes by providing guidance, advice, and referrals to patients who indicated ongoing issues such as pain or emotional problems. Conclusion Telephone follow-up within a clinical trauma service team is feasible, accepted by staff and valued by patients and families. Despite time constraints, the successful implementation of this program is reliant on existing clinical/patient relationships, staff teamwork and leadership support.

Effect of Active and Passive Heating Methods Used in Different Areas of Perioperative Processes on Thermal Comfort and Anxiety: A Randomized Control Trial

Purpose: This study was conducted to determine the effects of active and passive heating methods applied in different parts of the perioperative process on thermal comfort, anxiety, and vital signs.&#x0D; Design: This study was conducted with patients admitted for open abdominal surgery between October 1, 2018 and January 10, 2019. Patients were randomly allocated into three groups as follows: Group A (n = 33), Group B (n = 33), and Group C (control group; n = 33).&#x0D; Methods: This study is a randomized, pretest–posttest controlled experimental design. Intervention Group A and B gowns blowing warm air were used as intervention tools. Procedural care (Group C) received routine hospital care. Vital signs, thermal comfort, and anxiety levels of the patients were evaluated.&#x0D; Findings: Compared to those in Group B, for patients in Group A, the thermal comfort levels were higher and the anxiety levels were lower. The highest body temperature was seen in the patients in Group A. No difference was noted in blood pressure values between the groups. The pulse values of the patients in Groups A and B were significantly lower. &#x0D; Conclusion: The use of gowns blowing warm air had a positive effect on the patients’ anxiety, thermal comfort, and vital signs.

Effect of Oral Vasopressors Used for Liberation from Intravenous Vasopressors in Intensive Care Unit Patients Recovering from Spinal Shock: A Randomized Controlled Trial.

Background Early vasopressor utilization has been associated with improved outcomes of patients with spinal shock; however, there are difficulties in weaning off vasopressors, in which patients after recovery from spinal shock develop a state of persistent vasodilation, which may take a few days to resolve and delays the discharge in the intensive care unit (ICU). Therefore, we tested the hypothesis using two oral vasopressors (midodrine and minirin) to facilitate weaning off intravenous vasopressors, reducing the ICU length of stay, and compare them for more efficacy. Methods A randomized controlled trial was conducted in the trauma ICU at the Assiut University Hospital in Egypt in patients with spinal shock who required intravenous vasopressor for ≥24 h. A convenience sample was classified into three groups, in which 30 patients were included for each group. The midodrine group received midodrine 10 mg per oral every 8 h with gradual weaning off intravenous (IV) vasopressor (noradrenaline) after receiving 4 doses, the minirin group received minirin 60 μg per oral every 8 h with gradual weaning off IV vasopressor after receiving 4 doses, whereas the control group received IV vasopressor (noradrenaline) with gradual weaning according to the routine hospital care without adding oral vasopressors. The primary outcome was shortening the duration of IV vasopressor requirements. The secondary outcome was reducing the ICU length of stay. Results Our results showed that the duration of IV vasopressor requirements in the midodrine (3.3 ± 1.32) and minirin groups (4.8 ± 1.83) was significantly lower than in the control group (6.93 ± 2.32). Additionally, the ICU length of stay (days) in the midodrine (5.13 ± 1.83) and minirin groups (5.5 ± 1.91) was significantly lower than in the control group (9.03 ± 3.74). Conclusion Midodrine and minirin accelerated liberation from intravenous noradrenaline and effective in reducing the ICU length of stay in patients with spinal shock.

Experiences of stigma in hospitals with addiction consultation services: A qualitative analysis of patients' and hospital-based providers' perspectives

BackgroundAddiction consultation services (ACS) provide evidence-based treatment to hospitalized patients with substance use disorders (SUD). Expansion of hospital-based addiction care may help to counteract the stigma that patients with SUD experience within the health care system. Stigma is among the most impactful barriers to seeking care and adhering to medical advice among people with SUD. We aimed to understand how the presence of an ACS affected patients' and hospital-based providers' experiences with stigma in the hospital setting. MethodsWe conducted a qualitative study utilizing focus groups and key informant interviews with hospital-based providers (hospitalists and hospital-based nurses, social workers, pharmacists). We also conducted key informant interviews with patients who received care from an ACS during their hospitalization. An interprofessional team coded and analyzed transcripts using a thematic analysis approach to identify emergent themes. ResultsSixty-two hospital-based providers participated in six focus groups or eight interviews. Twenty patients participated in interviews. Four themes emerged relating to the experiences of stigma reported by hospital-based providers and hospitalized patients with SUD: (1) past experiences in the health care system propagate a cycle of stigmatization between hospital-based providers and patients; (2) documentation in medical charts unintentionally or intentionally perpetuates enacted stigma among hospital-based providers resulting in anticipated stigma among patients; (3) the presence of an ACS reduces enacted stigma among hospital-based providers through expanding the use of evidenced-based SUD treatment and reframing the SUD narrative; (4) ACS team members combat the effects of internalized stigma by promoting feelings of self-worth, self-efficacy, and mutual respect among patients with SUD. ConclusionsAn ACS can facilitate destigmatization of hospitalized patients with SUD by incorporating evidence-based SUD treatment into routine hospital care, by providing and modeling compassionate care, and by reframing addiction as a chronic condition to be treated alongside other medical conditions. Future reductions of stigma in hospital settings may result from promoting greater use of evidence-based treatment for SUD and expanded education for health care providers on the use of non-stigmatizing language and medical terminology when documenting SUD in the medical chart.

Internal Medicine Residents’ Experience Performing Routine Assessment of What Matters Most to Patients Upon Hospital Admission

Problem Failure to elicit patients’ values, goals, and priorities can result in missed opportunities to provide patient-centered care. Little is known about resident physicians’ direct experience of eliciting patients’ values, goals, and priorities and integrating them into routine hospital care. Intervention In 2017, we asked resident physicians on general internal medicine wards rotations to elicit and document a “Personal History” from patients upon hospital admission, in addition to a traditional social history. We defined a Personal History as documenting “what matters most to the patient and why.” The purpose of the Personal History was to understand and consider patients’ values, goals, and priorities. We then conducted qualitative interviews of the resident physicians to understand their experiences eliciting and integrating patients’ values, goals, and priorities in routine hospital care. Context We performed this exploratory intervention at a large high-volume urban hospital. Two teams from general medicine wards participated in the Personal History intervention. We conducted voluntary interviews of eligible residents (n = 14/15; 93%) about their experience after they completed their general wards rotations. Using the coproduction model, our aim was to explore how patients’ self-expertise can be combined with physicians’ medical expertise to achieve patient-centered care. Impact Four major themes were identified: 1) Taking a Personal History had value, and eliciting patients’ self-expertise had the potential to change medical decision making, 2) Situational and relational factors created barriers to obtaining a Personal History, 3) Variability in buy-in with the proposed intervention affected effort, and 4) Meaningful Personal History taking could be an adaptive and longitudinal process. Perceived benefits included improved rapport with patients, helpful for patients with complex medical history, and improved physician-patient communication. Barriers included patient distress, lack of rapport, and responses from patients which did not add new insights. Accountability from attending physicians affected resident effort. Suggested future applications were for patients with serious illness, integration into electronic health records, and skills taught in medical education. Lessons Learned Resident physicians had generally positive views of eliciting a Personal History from patients upon admission to the hospital. Overall, many residents conveyed the perceived ability to elicit and consider patient’s values, goals, and priorities in certain situations (e.g., patient not in distress, adequate rapport, lack of competing priorities such as medical emergencies or overwhelming workloads). External factors, such as electronic health record design and accountability from attending physicians, may further promote residents’ efforts to routinely incorporate patients’ values, goals, and priorities in clinical care. Increasing familiarity among both resident physicians and patients in routinely discussing patients’ values, goals, and priorities may facilitate patient-centered practice.

Assess the Effectiveness of Using Kangaroo Mother Care on Reducing Postpartum Bleeding among Laboring Women: A Randomized Control Trial

Background: Kangaroo Mother Care (KMC) is one of the important interventions that must be implemented immediately after birth, contributing to minimizing postpartum bleeding. Aim: To assess the effectiveness of using KMC in reducing postpartum bleeding among laboring women. Materials and Methods: A randomized controlled clinical trial (Posttest design) was used in the present study. The study was conducted in the labor and delivery unit at King Abdulaziz Medical City (KAMC), Jeddah. 100 laboring women were recruited for the study randomly and divided into two equal groups. The intervention group had KMC while the control group received routine hospital care. Results: The homogeneity is shown among the participants and approved as there is no significant difference between both groups according to socio-demographic and obstetric data. There were statistically significant differences between the intervention and control groups regarding the amount of blood loss related to KMC (p-value = 0.000). Also, a successful first breastfeeding was higher among the intervention group than the control group (p-value = 0.002). Conclusions: The mothers who had KMC immediately after birth had lesser amounts of blood loss and experienced early successful breastfeeding initiation and continuous education and training programs to all midwives and nurses working in the labor and delivery about the importance of implementing KMC.

Remote Consultations Versus Standard Face-to-Face Appointments for Liver Transplant Patients in Routine Hospital Care: Feasibility Randomized Controlled Trial of myVideoClinic.

BackgroundUsing technology to reduce the pressure on the National Health Service (NHS) in England and Wales is a key government target, and the NHS Long-Term Plan outlines a strategy for digitally enabled outpatient care to become mainstream by 2024. In 2020, the COVID-19 response saw the widespread introduction of remote consultations for patient follow-up, regardless of individual preferences. Despite this rapid change, there may be enduring barriers to the effective implementation of remote appointments into routine practice once the unique drivers for change during the COVID-19 pandemic no longer apply, to which pre-COVID implementation studies can offer important insights.ObjectiveThis study aims to evaluate the feasibility of using real-time remote consultations between patients and secondary care physicians for routine patient follow-up at a large hospital in the United Kingdom and to assess whether patient satisfaction differs between intervention and usual care patients.MethodsClinically stable liver transplant patients were randomized to real-time remote consultations in which their hospital physician used secure videoconferencing software (intervention) or standard face-to-face appointments (usual care). Participants were asked to complete postappointment questionnaires over 12 months. Data were analyzed on an intention-to-treat basis. The primary outcome was the difference in scores between baseline and study end by patient group for the three domains of patient satisfaction (assessed using the Visit-Specific Satisfaction Instrument). An embedded qualitative process evaluation used interviews to assess patient and staff experiences.ResultsOf the 54 patients who were randomized, 29 (54%) received remote consultations, and 25 (46%) received usual care (recruitment rate: 54/203, 26.6%). The crossover between study arms was high (13/29, 45%). A total of 129 appointments were completed, with 63.6% (82/129) of the questionnaires being returned. Patient satisfaction at 12 months increased in both the intervention (25 points) and usual care (14 points) groups. The within-group analysis showed that the increases were significant for both intervention (P<.001) and usual care (P=.02) patients; however, the between-group difference was not significant after controlling for baseline scores (P=.10). The qualitative process evaluation showed that—according to patients—remote consultations saved time and money, were less burdensome, and caused fewer negative impacts on health. Technical problems with the software were common, and only 17% (5/29) of patients received all appointments over video. Both consultants and patients saw remote consultations as positive and beneficial.ConclusionsUsing technology to conduct routine follow-up appointments remotely may ease some of the resource and infrastructure challenges faced by the UK NHS and free up clinic space for patients who must be seen face-to-face. Our findings regarding the advantages and challenges of using remote consultations for routine follow-ups of liver transplant patients have important implications for service organization and delivery in the postpandemic NHS.Trial RegistrationISRCTN Registry 14093266; https://www.isrctn.com/ISRCTN14093266International Registered Report Identifier (IRRID)RR2-10.1186/s13063-018-2953-4

Effect of Educational Program on Knowledge of Early Adulthood Women about Reproductive Tract Infections at Qena City

Abstract Background: Reproductive Tract infections (RTIs) in women is one of the wide spread health concerns. Untreated RTIs can lead to adverse health and pregnancy outcomes, so there is a need for education and consultation on it. Aim: This study aimed to assess effect of educational program on knowledge of early adulthood women about RTIs. Methods: Quasi experimental research design was used in this study. It was conducted at gynecological outpatient clinics of South Valley University’s Hospital and General Qena Hospital. Sample included 380 women. Structured interview questionnaire was used and involved four sections (personal, obstetrics, gynecological and RTIs' knowledge). An educational program about RTIs was implemented on early adulthood women. Results: There is statistical significant difference between pre and post intervention regarding total knowledge about RTIs P- values are 0.001. Conclusion: There was an improvement in the total knowledge about RTIs after implementation educational program about RTIs. Recommendations: Planning and implementing educational program as a routine hospital care with providing a booklet about RTIs and its preventive measures to reduce rate of RTIs among women. Keywords: Educational Program, knowledge, Reproductive Tract Infections, Early Adulthood

The Effect of Nursing Rehabilitation Program on Symptoms Severity and Functional Status in Patients with Carpal Tunnel Syndrome Undergoing Surgery.

Background: Carpal Tunnel Syndrome (CTS) is the most common upper extremity peripheral compression neuropathy and typically occurs because of the compression and damage of the median nerve between the transverse carpal ligament and flexor tendons in the carpal tunnel of the wrist. Objectives: was to assess the effect of the rehabilitation program on symptoms severity and functional status in patients with carpal tunnel syndrome undergoing surgery. Setting: The study was conducted at the Neurosurgery Department of Alexandria Main University Hospital and the affiliated Outpatient Clinic. Subjects: This study comprised a convenient sample of 40 adult patients admitted to the above-mentioned setting and diagnosed with carpal tunnel syndrome undergoing surgery. The study subjects were divided randomly into two equal groups; a study group, consisting of 20 adult patients who received the program and control consisting of 20 adult patients who received the routine hospital care only. Tools: Three tools were used Tool I: Patient’s Sociodemographic Characteristics and clinical data tool, Tool II: Carpal Tunnel Syndrome Questionnaire, and Tool III The Disabilities of the Arm, Shoulder, and Hand. Results: There were highly statistically significant differences between the study and control regarding pain intensity 1 month after the surgery. It was found that significant improvement among the study group, after fourteen days and one month postoperatively concerning the disabilities of the arm, shoulder, and hand. A statistically significant improvement in the symptom severity and functional status was noticed among the study group. Conclusion: Applying for a rehabilitation program significantly enhanced the studied patients' pain intensity, disabilities of the arm, shoulder, and hand., symptom severity, and functional status postoperatively than their control. Keywords - Carpal Tunnel Syndrome, Nursing Rehabilitation Program, Symptoms Severity, Functional Status

Effect of nursing instructional guidelines on fatigue and pain associated with knee osteoarthritis

Background Knee osteoarthritis (KOA) is the most widespread type of arthritis and considered as the main health problem all over the world. It is a progressive degenerative joint disease that produces joint pain, declines the physical function, and leads to progression of disability. Therefore, nursing instructions are crucial to improve and enhance patient’s quality of life. The aim of the current study was to evaluate the effect of nursing instructional guidelines on fatigue and pain associated with KOA at a university hospital. Hypotheses H1–patients with KOA who receive nursing instructional guidelines will have significantly lower mean scores of fatigue compared with those who receive routine hospital care. H2–patients with KOA who receive nursing instructional guidelines will have significantly lower mean scores of related pain compared with those who receive routine hospital care. Design Pretest/posttest nonequivalent control group design was utilized to achieve the aim of the current study. Tools (a) Demographic and medical data form related to age, sex, level of education, family history of OA, type of KOA, BMI, etc.; (b) numerical pain rating scale; and (c) (SF-36) multidimensional assessment of fatigue scale were used for assessment. Setting The study was conducted at the medical and orthopedic departments in addition to the outpatient clinic at a university hospital in Egypt. Sample A purposive sample of 60 adult male and female patients was recruited over six consecutive months, who are diagnosed as having mild (stage 2) or moderate (stage 3) KOA and divided randomly into study and control groups; 30 patients in each group were recruited in the current study. Results It was found that 30% of the patients had an age from 50 to less than 60 years, with mean±SD of 50.83±9.97 years. Females were 90% in the study group and 83.3% in the control group. Moreover, 80% of the study group compared with 70% of the control group had grade II OA, with χ 2=3.21, P=0.91. There was no statistically significant difference regarding three pain readings in the study and control groups. However, there was marked difference in the mean±SD total related pain score between the study and control groups at the third pain reading (mean±SD=5.50±2.46 and 6.06±1.91, respectively). Moreover, there was a statistically significant difference over the three pain readings in the study group, as analysis of variance=32.56 and P=0.000, compared with an absence of a statistically significant difference over the three pain readings in the control group. There was a statistically significant difference in the third reading between study and control groups, as t test=3.9, as well as over the three fatigue readings in the study group, as analysis of variance=95.68 and P=0.000, compared with an absence of a statistically significant difference over the three fatigue readings in the control group. Conclusion Nursing instructional guidelines were effective in improving fatigue associated with KOA and reducing pain level. Recommendation Patients with KOA should be encouraged to follow nursing instructions through continuous health teaching to improve patient quality of care over the long term. Nursing implications: the instructional nursing guidelines could be applied in curriculum, nursing practice, and patients’ health.

The incorporation of body composition assessments as part of routine clinical care in a tertiary hospital's dietetic department: a best practice implementation project.

Our aim was to incorporate body composition assessment (BCA) into dietetic department procedures using interventions tailored to previously identified barriers and enablers. BCA is recommended as part of routine malnutrition assessment and follow-up but is not yet part of usual care. Evidence-informed strategies to overcome barriers and enablers were operationalized and delivered as three overarching interventions: upskilling (professional development strategy), modelling and reducing fear of change (Clinical Champion project), and embedding as usual practice (departmental integration). Process evaluation assessed intervention fidelity. A survey assessed utilization of BCA devices, (perceived) competency, and attitudes of clinical dietitians towards BCA before and after interventions. Two of the three elements were incorporated as planned (upskilling and embedding as usual practice), with one element (modelling and reducing fear of change) modified through iterative processes. The Clinical Champion project ran for 12 rather than 6 months, and resulted in the majority of champions confident with their skills, completing BCA within their daily clinical workload and feeling BCA was useful. Pre-surveys and post-surveys within the department of 26 dietitians showed a marked reduction in most perceived barriers and improved recognition of enablers across all theoretical framework domains; with a large proportion of 'not applicable' responses given for many barriers at follow-up. This evidence-informed implementation strategy successfully integrated BCA into dietitians' practice and departmental processes highlighting direction for future service changes. Continual assessment of barriers and success of integration into routine workloads is required to facilitate this.

The effects of continuous labor support by midwife: a randomized control trial

Objective: The aim of this study was to evaluate the effects of continuous labor support by midwife. Methods: This study was a randomized controlled experimental design. Seventy primipara women were randomized into two groups, the continuous labor support by midwife group (n=35) and control group (n=35). In the experiment group was given the continuous midwife support and in the control group were undergone to routine hospital care in the clinic. Visual Analog Scale was used to assess women’s anxiety level and coping with labor pain. All interventions and childbirth time were recorded by the researcher. Results: Anxiety level decreased and the level of coping with labor pain increased in the experimental group (p&amp;lt;0.05). The total childbirth time in the intervention group was shorter by 2 hours and 21 minutes. Labor induction, episiotomy, amniotomy and perineal trauma were higher in the control group (p&amp;lt;0.05). Conclusion: Continuous labor support should be provided at each childbirth to enhance childbirth outcomes.

Effects of Aerobic Exercise on Cognitive Function in Women With Methamphetamine Dependence in a Detoxification Program in Tianjin, China: A Randomized Controlled Trial.

Cognitive impairment is prevalent among individuals, especially women, with methamphetamine dependence. Although aerobic exercise has been shown to affect cognitive function in humans and animals, few related studies have focused on subjects with methamphetamine dependence. The aim of this study was to assess the detoxification-related effects of aerobic exercise on cognitive function in women with methamphetamine dependence. A randomized controlled trial was used with 98 women with methamphetamine dependence undergoing a detoxification program at a mental hospital. The women were distributed using a computer-generated grouping random method into either the study or control group. The investigator conducting the baseline questionnaire, the neuropsychologist assessing the cognitive function, and the data analyst were blinded to group assignment. In addition to hospital routine care, the study group received an aerobic exercise intervention for 3 months. The control group only received hospital routine care. Attention and working memory were measured using the Trail Making Test and Digit Span Test, verbal memory was measured using Logical Memory (LM) and Memory for Persons Data (MPD), and executive function was measured using the Color-Word Stroop Test. Forty-nine participants were randomized into each group, and the valid data of 43 participants in the study group and 46 in the control group were analyzed. The study group showed significantly more improvement over time in terms of Digit Span Test, Trail Making Test, LM-delayed, MPD-5 minutes delayed, MPD-30 minutes delayed, and Color-Word Stroop Test than the control group (p < .05). LM-immediate and MPD-immediate scores showed that the effects of time and the interaction between time and group were significant but that the main effect of group was not. Women undergoing detoxification for methamphetamine dependence may practice aerobic exercise to improve attention, working memory, executive function, and parts of verbal memory. Aerobic exercise may be incorporated into detoxification treatment programs to facilitate the recovery of cognitive functions in women.