Ice Packs Research Articles

Managing acute pain after abdominal surgery: examples from practice

Background: Following abdominal surgery, ischaemia and neuropeptide release cause pain at the trauma site, and there is a high incidence of moderate-to-severe pain. Inadequate pain management leads to complications, delayed recovery and prolonged hospitalisation, and thus, effective management is essential. This study describes an implementation of acute pain management after abdominal surgery. Methods: A multidimensional assessment tool collected data on demographics, medical history and surgical situation, as well as interventions used, their administration route and their side effects. Pain level was recorded on a scale of 0–10, both at rest and during physical activity, by postoperative day. Patient participation and satisfaction were also recorded. Results: Nine patients met the inclusion criteria. Pharmacological analgesic interventions included opioids (morphine, fentanyl and tramadol) and paracetamol. Administration was either intravenous, epidural or via patient-controlled analgesia. These were combined with non-pharmacological interventions, specifically cold gel packs, massage therapy and music therapy. All patients achieved the adequate management goals of pain at rest below 3/10 and during activity below 4/10, and all participated in pain decision-making, were satisfied with pain treatment, and reported the usefulness of preoperative information. Conclusions: Pain management following abdominal surgery is vital, and the use of a combination of pharmacological and non-pharmacological techniques was effective.

A Survey on Fever Monitoring and Management in Patients With Acute Brain Injury: The SUMMA Study.

Fever is common in patients with acute brain injury and worsens secondary brain injury and clinical outcomes. Currently, there is a lack of consensus on the definition of fever and its management. The aims of the survey were to explore: (a) fever definitions, (b) thresholds to trigger temperature management, and (c) therapeutic strategies to control fever. A questionnaire (26 items) was made available to members of the European Society of Intensive Care Medicine via its website between July 2016 and December 2016. Among 231 respondents, 193 provided complete responses to the questionnaire (84%); mostly intensivists (n=124, [54%]). Body temperature was most frequently measured using a bladder probe (n=93, [43%]). A large proportion of respondents considered fever as a body temperature >38.3°C (n=71, [33%]). The main thresholds for antipyretic therapy were 37.5°C (n=74, [34%]) and 38.0°C (n=86, [40%]); however, lower thresholds (37.0 to 37.5°C) were targeted in cases of intracranial hypertension and cerebral ischemia. Among first-line methods to treat fever, ice packs were the most frequently utilized physical method (n=90, [47%]), external nonautomated system was the most frequent utilized device (n=49, [25%]), and paracetamol was the most frequently utilized drug (n=135, [70%]). Among second-line methods, intravenous infusion of cold fluids was the most frequently utilized physical method (n=68, [35%]), external computerized automated system was the most frequently utilized device (n=75, [39%]), and diclofenac was the most frequently utilized drug (n=62, [32%]). Protocols for fever control and shivering management were available to 83 (43%) and 54 (28%) of respondents, respectively. In this survey we identified substantial variability in fever definition and application of temperature management in acute brain injury patients. These findings may be helpful in promoting educational interventions and in designing future studies on this topic.

Evaluation of the Clinical Efficacy of Using Thermal Camera for Cryotherapy in Patients with Total Knee Arthroplasty: A Prospective Study.

Background and objectives: Cryotherapy is a method of treatment using cold application. This study aimed to evaluate postoperative clinical and hematological parameters and pain associated with total knee arthroplasty in patients and compared cryotherapy to the conventional method of cold ice pack compressions. Materials and Methods: Between January 2015 and January 2016, 90 patients who underwent total knee arthroplasty for grade 4 gonarthrosis were prospectively evaluated. The patients were divided into three groups (n = 30, each): Group 1, cryotherapy was applied in the pre- and postoperative periods; Group 2, cryotherapy was applied only in the postoperative period; and Group 3 (control group), only a cold pack (gel ice) was applied postoperatively. In all groups, pre- and postoperative evaluations at 6, 24, and 48 h, hemorrhage follow-up, knee circumference measurement, visual analog scale pain score, knee circumference, and temperature measured by thermal camera were recorded. Results: Of the 90 patients, 10% were men and 90% were women. The mean age was 64.3 ± 8.1 (range: 46–83) years. The patella upper end diameter values were significantly lower in the postoperative period in Groups 1 and 2 than in Group 3 (p = 0.003). Hemoglobin levels at 24 and 48 h postoperatively were significantly lower in Group 3 than in Group 1 (p < 0.001, each) and Group 2 (p = 0.038, p < 0.001). At 6, 24, and 48 h follow-ups, pain values were significantly lower in Group 2 than in Group 3 (p < 0.001). Preoperative 6, 24, and 48 h temperature values were significantly lower in Group 1 than in Group 3 (p < 0.001 for each). It was found that the difference between preoperative and postoperative knee flexion measurements was significantly different in both groups or the difference between the groups was changed in each period (p < 0.001). Conclusions: Postoperative cryotherapy is a potentially simple, noninvasive option and beneficial for the reduction of reducing pain, bleeding, length of stay, analgesic requirement and swelling after total knee arthroplasty. Moreover, there was no early or late prosthesis infection in cryotherapy groups, which may be considered as an additional measure to prevent prosthesis infection.

Comment on "A Better Way to Decrease Knee Swelling in Patients with Knee Osteoarthritis: A Single-Blind Randomised Controlled Trial".

Objective. In this study, we compared the effects of intermittent pneumatic compression along with conventional treatment with cold-pack treatment along with conventional treatment on clinical outcomes in patients with knee osteoarthritis. Methods. Eighty-nine patients with knee osteoarthritis participated in this study. One group received ultrasound, transcutaneous electrical nerve stimulation, electrical stimulation, exercise, and cold packs. The second group received ultrasound, transcutaneous electrical nerve stimulation, electrical stimulation, exercise, and intermittent pneumatic compression. Range of motion, muscle strength, knee swelling, pain intensity, and functional status were measured at baseline and 4th week. Results. We found significant improvements in range of motion, muscle strength, pain intensity, and functional status after the treatment in both groups ( ). When comparing the effects of these two treatment programs, it was observed that the intermittent pneumatic compression treatment group had a better outcome in terms of knee swelling ( ). Conclusions. According to the results, we could report that intermittent pneumatic compression therapy in addition to conventional treatment has significant positive effects on clinical outcomes in patients with knee osteoarthritis. We could also report that intermittent pneumatic compression therapy along with conventional treatment is superior to cold-pack therapy along with conventional treatment in terms of knee swelling in patients with knee osteoarthritis. This trial is registered with NCT03806322 .

Development of Reheatable Thermo Jackets

Since the past two decades, there has been a constant increase in upper quadrant body pain among people of different age groups. Taking view of the effectiveness of heat therapy in curing pain, the present study was undertaken to develop reheatable thermo jackets using heating gel packs. A functional design consisting of pockets for insertion of gel packs in thermo jacket was created digitally. The jacket was developed using casement and PVC fabrics. Two jackets, one for male and female respectively were developed with variation in colours. To study the effectiveness of the developed jackets on the basis of functionality and cost, ten respondents suffering from upper quadrant pain were selected purposively and jacket was given to each one of them to use for five days. The results revealed that 60 percent male and 80 percent female respondents found the jacket to be extremely comfortable and relieved them off their pain even while at work. Majority of the respondents did not face any problem in heating and placing gel packs in the jacket and more than 60 percent of them were highly relieved from their pain and found the jackets to be functionally and cost effective. The jacket was highly appreciated by respondents as it proved to be a multi pain relaxer for them while the selected experts opined that jackets retained the heat of gel packs for a longer duration as compared to other commercially available substitutes.

The effect of the application of cold on hematoma, ecchymosis, and pain at the catheter site in patients undergoing percutaneous coronary intervention

ObjectiveThis study was conducted to determine the effect of the application of cold on hematoma, ecchymosis, and pain in patients undergoing percutaneous coronary intervention. MethodsIt is a quasi-experimental study with a control group. A total of 200 patients (100 in the control group and 100 in the experimental group) were included in the research. In the experimental group, a cold pack was applied to the bottom of the sandbag for the first 15 min after withdrawing the femoral arterial catheter. Both groups were assessed and followed up at the first 15th minute and 4th, 48th and 72 nd h. ResultsAfter the femoral arterial catheter was withdrawn, ecchymosis and hematoma were smaller and pain was less in the experimental group at the catheter entry site compared to the control group, and the difference was statistically significant (P < 0.01). ConclusionIt was determined that the application of cold reduced the formation of hematomas, ecchymoses and pain in patients after the withdrawal of the femoral arterial catheter.

Do Ice Packs Reduce Postoperative Midline Incision Pain, NSAID or Narcotic Use?

Adequate postoperative analgesia, especially after major abdominal surgery is important for recovery, early mobility, and patient satisfaction. We aimed to study the effects of cryotherapy via an ice pack in the immediate postoperative period, for patients undergoing major abdominal operations. This prospective study was conducted at our tertiary care referral center in a low-middle-income country setting. The preoperative patient characteristics, intra-operative variables, and postoperative outcomes were compared between two sets of patients. Cryotherapy was delivered via frozen gel packs for 24h immediately following laparotomy. Pain relief was assessed with visual analog pain scores (VAS). Comparisons between groups were measured by Chi-square test, Fischer's exact test, or Mann-Whitney U test as appropriate. Sixty-eight patients were included in the study: 33 in the cryotherapy group and 35 in the non-cryotherapy group. Mean postoperative pain scores (VAS) were significantly lower in the cryotherapy group versus the control group (3.97 ± 0.6 vs. 4.9 ± 0.7 on postoperative day (POD) 1; p < 0.001, and 3 ± 0.5 vs. 09 ± 0.8 on POD2; p < 0.001). The median narcotic use in morphine equivalents was lesser in the cryotherapy group from POD 1-3 (66 (IQR-16) vs. 89 (IQR-17); p = 0.001). No significant difference was seen in the NSAID use between the groups. The cryotherapy group was also found to have a lesser incidence of surgical site infection (p = 0.03) and better lung function based on incentive spirometry (p = 0.01) and demonstrated earlier functional recovery based on their ability to perform the sit-to-stand test (p = 0.001). Ice packs are a simple, cost-effective adjuvant to standard postoperative pain management which reduce pain and narcotic use and promote early rehabilitation.

Optimizing the operational process of a cold chain fruit pack house

Optimizing the operational process of a cold chain fruit pack house

Upaya Pemadaman Kebakaran Hutan Dan Lahan Menggunakan Gel Pemadam (Gel Pack Extinguishing Agent)

Forest and land fires become serious problems in Indonesia that could not be well managed until today. This is then the reasons why there is so many activties being conducted in order to find the best solution including fire suppression method. Until today the suppresion methods mostly using water rather than other sources, which actually is not so effective and efficient. The research is proposed to make sure that Gel Pack Extinguishing Agent (GPEA) could be used for fire suppression. Three different fuels used were Pinus merkusii, Shorea leprosula, and Dicranopteris linearis at different of 55g, 65g, 75g, dan 85g. The results of research shown that GPEA with 5 small box per litter of water was the best dosage. The fastes suppression time based on the three fuels was Dicranopteris linearis, and the lowest was Pinus merkusii.Keywords: fuels, forest and land fires, Gel, suppresion methode, dosage

Effects of temperature on the survival of Sarcoptes scabiei of black bear (Ursus americanus) origin.

For two decades, the incidence and range of sarcoptic mange in black bears (Ursus americanus) in Pennsylvania has increased. The causative agent, Sarcoptes scabiei, can be directly or indirectly transmitted; therefore, data on environmental persistence is important for guiding management and public communications. The objective of this study was to determine the survival of S. scabiei at different temperatures. Full section skin samples and superficial skin scrapes were collected from bears immediately after euthanasia due to severe mange. After ~ 24h on ice packs (shipment to lab), samples were placed in dishes at 0, 4, 18, or 30°C and 60, 20, 12, and 25% relative humidity, respectively, and the percentage of mites alive, by life stage, was periodically determined. Humidity was recorded but not controlled. Temperature significantly affected mite survival, which was shortest at 0°C (mostly ≤ 4h) and longest at 4°C (up to 13days). No mites survived beyond 8days at 18°C or 6days at 30°C. Mites from full-thickness skin sections survived significantly longer than those from superficial skin scrapes. Adults typically survived longer than nymphs and larvae except at 30°C where adults survived the shortest time. These data indicate that at cooler temperatures, S. scabiei can survive for days to over a week in the environment, especially if on host skin. However, these data also indicate that the environment is unlikely to be a long-term source of S. scabiei infection to bears, other wildlife, or domestic animals.

Subcutaneous emphysema in patients undergoing root canal treatment: a systematic review of the factors affecting its development and management.

Subcutaneous emphysema is an infrequent mishap during root canal treatment which, in rare cases, can lead to severe complications. To systematically review the literature on the factors affecting the development of subcutaneous emphysema during root canal treatment, and on its management. An electronic search was conducted in EMBASE (1947-2018), LILACS (1982-2018), PubMed (1950-2018), SciELO (1997-2018), Scopus (1970-2018), Web of Science (1900-2018) and two grey literature databases. Moreover, all issues of nine journals and four endodontic textbooks were hand-searched. The retrieved studies were screened by two reviewers to select clinical studies, case reports or case series describing subcutaneous emphysema that developed during or immediately after root canal treatment in adult patients. Included studies were critically appraised according to a custom list of quality requirements. The extracted data were arranged in tables, and combined through a narrative synthesis. The search retrieved 99 unique articles. Thirty six case reports and 15 case series describing a total of 65 cases of subcutaneous emphysema were included in this review. The methodological quality was medium. Reported cases of emphysema more often involved females and maxillary teeth. Drying of the root canal system with air under pressure, inadvertent extrusion of hydrogen peroxide through the apical foramen, the air-water spray produced by handpieces or laser devices, and the use of ozone gas were the most commonly suspected causes. Its management involved prescription of antibiotics and NSAIDs/analgesics, local application of ice packs or compresses and hospitalization. The signs and symptoms resolved completely within 1-17days. Case reports and case series are a low level of evidence. Subcutaneous emphysema can develop during both nonsurgical and surgical root canal treatment. Pressurized air streams or air-water sprays should not be directed towards the root canals or areas with mucosal discontinuity. None of the management approaches were clearly related to expedited recovery. Guidelines should be developed in order to avoid unnecessary or potentially harmful interventions.

Interventions and Management of Postpartum Hemorrhage: A Literature Review

Bleeding is the main cause of maternal mortality in the world, the mortality rate due to bleeding about 30.3% in Indonesia in 2013. Dealing bleeding during and after labor is very important for health professionals including nurses. Research on the management of postpartum hemorrhage is still limited. The purpose of this literature review was to determine the management of postpartum hemorrhage from various countries. The method, this literature review involved articles that published in 2008-2018. The articles searched from several databases, including ProQuest, 32 articles, PubMed 22 articles, and Google 21 scholar articles. Keywords for article search included postpartum hemorrhage, nurse, prevention, treatment, management, and intervention. 75 articles were assessed for the quality using the JBI instrument (Joanna Briggs Institute), and finally, 10 articles were found and met the inclusion criteria. The results show that there are two types of actions to deal with postpartum hemorrhage including direct treatment and indirect treatment. The direct treatment includes bimanual compression, maneuvering techniques, balloon tampons, and tools resembling a butterfly shape for bimanual compression. Indirect actions include training of health workers, initiation of early breastfeeding and ice packs. Conclusion, effective management both directly and indirectly is able to overcome postpartum hemorrhage. Health workers are expected to master effective ways to deal with postpartum hemorrhage.

Comparative Study between Absorbable Carboxymethyl Cellulose and NonAbsorbable Merocel Nasal Packs after Sinonasal Surgery

Background: Nasal packings can help in control of postoperative bleeding and healing following functional endoscopic sinus surgery (FESS) and nasal surgeries, but traditional non-resorbable packs have several inherent drawbacks. Objectives: This study was done to evaluate the effect of carboxy methyl cellulose (CMC) gel and merocel nasal packs after sinonasal surgery regarding postoperative bleeding, pain, pressure headache and formation of synechia. Patients and Methods: A total of 40 patients who had undergone sinonasal surgery were studied prospectively. At the end of the operation each patient was packed with dissolvable CMC gel in the right side of the nose and merocel in the left side. The haemostatic effect of the CMC and merocel was assessed during the recovery period. Results: six (15%) of the patients packed with CMC had primary postoperative bleeding during the recovery period. Bleeding appeared in four (10%) patients packed with merocel. We observed significant intergroup differences in the level of pain and pressure headache. The CMC group was superior to merocel group and there was a significant low level of pain and pressure headache in the CMC group. Two (5%) of CMC patients and six (15%) of merocel patients developed a synechia at the 4 weeks period. Four (10%) of CMC patients and Ten (25%) of merocel patients developed synechia at the 8 weeks period post operative. Conclusion: We found that dissolvable CMC pack is associated with very low levels of localised pain, pressure headache and with low levels of postoperative bleeding and synechia formation.

Comparative Study between Absorbable Carboxymethyl Cellulose and NonAbsorbable Merocel Nasal Packs after Sinonasal Surgery

Background: Nasal packings can help in control of postoperative bleeding and healing following functional endoscopic sinus surgery (FESS) and nasal surgeries, but traditional non-resorbable packs have several inherent drawbacks. Objectives: This study was done to evaluate the effect of carboxy methyl cellulose (CMC) gel and merocel nasal packs after sinonasal surgery regarding postoperative bleeding, pain, pressure headache and formation of synechia. Patients and Methods: A total of 40 patients who had undergone sinonasal surgery were studied prospectively. At the end of the operation each patient was packed with dissolvable CMC gel in the right side of the nose and merocel in the left side. The haemostatic effect of the CMC and merocel was assessed during the recovery period. Results: six (15%) of the patients packed with CMC had primary postoperative bleeding during the recovery period. Bleeding appeared in four (10%) patients packed with merocel. We observed significant intergroup differences in the level of pain and pressure headache. The CMC group was superior to merocel group and there was a significant low level of pain and pressure headache in the CMC group. Two (5%) of CMC patients and six (15%) of merocel patients developed a synechia at the 4 weeks period. Four (10%) of CMC patients and Ten (25%) of merocel patients developed synechia at the 8 weeks period post operative. Conclusion: We found that dissolvable CMC pack is associated with very low levels of localised pain, pressure headache and with low levels of postoperative bleeding and synechia formation.

Effect of delayed plasma centrifugation on equine adrenocorticotropic hormone concentration.

Plasma adrenocorticotropic hormone (ACTH) concentration is used in the diagnosis of pituitary pars intermedia dysfunction (PPID) in horses. We enrolled 10 horses, 5 PPID-positive and 5 PPID-negative, in our study, September 20-22, 2016. On day 0, 5 mL of whole blood was collected into each of 6 EDTA tubes and immediately placed in a refrigerator at 7°C. One tube was centrifuged within 15 min of collection, followed by centrifugation of one tube from each horse at 4, 8, 12, 24, and 36 h following collection. At each time, centrifuged plasma was pipetted into 1.5-mL polypropylene tubes and stored at -80°C. None of the plasma samples were turbid, hemolyzed, or icteric. Plasma was shipped frozen with cold packs overnight to the Animal Health Diagnostic Center of Cornell University (Ithaca, NY) for analysis. The percent change from baseline (PCFB) was reported to standardize the data given that baseline values differed. The mean PCFB was 2.8 (95% confidence interval: -2.9%, 7.0%). Neither refrigeration of whole blood for up to 36 h prior to centrifugation nor freezing affected plasma ACTH concentrations significantly.

Comparison of the use of evaporative coolants and ice packs for the management of preoperative edema and pain in ankle fractures: a prospective randomized controlled trial.

The use of evaporative coolants in the management of acute musculoskeletal injury has received increasing attention recently. However, its efficacy compared with conventional cryotherapy in treating injured human subjects remains unclear. The purpose of this study is to compare the efficacy of evaporative coolants with that of ice packs in preoperative management of edema and pain in patients with an ankle fracture. Sixty-three patients in need of surgical treatment for ankle fracture were randomly assigned to either an evaporative coolant group or an ice pack group. Both treatments were applied for 5 days after injury and outcomes were measured daily. The primary outcome was a reduction in edema as measured by the figure-of-eight-20 method and the secondary outcome was measured by visual analog scale (VAS) for pain. Two-way analysis of variance with repeated measures showed no significant group effect and no significant group-by-time interaction in terms of reduction of edema and VAS score for pain between two groups. No adverse effects were reported in either group. Evaporative coolants exhibited comparable efficacy to ice packs in preoperative cryotherapy of ankle fractures without adverse effects. While evaporative coolants are more expensive than ice packs, they can present a viable option for cryotherapy. Level I, prospective randomized study.

Multimodal opioid-sparing postoperative pain regimen compared with the standard postoperative pain regimen in vaginal pelvic reconstructive surgery: a multicenter randomized controlled trial

Postoperative pain control after urogynecological surgery has traditionally been opioid centered with frequent narcotic administration. Few studies have addressed optimal pain control strategies for vaginal pelvic reconstructive surgery that limit opioid use. The objective of the study was to determine whether, ice packs, Tylenol, and Toradol, a novel opioid-sparing multimodal postoperative pain regimen has improved pain control compared with the standard postoperative pain regimen in patients undergoing inpatient vaginal pelvic reconstructive surgery. This was a multicenter randomized controlled trial of women undergoing vaginal pelvic reconstructive surgery. Patients were randomized to the ice packs, Tylenol, and Toradol postoperative pain regimen or the standard regimen. The ice packs, Tylenol, and Toradol regimen consists of around-the-clock ice packs, around-the-clock oral acetaminophen, around-the-clock intravenous ketorolac, and intravenous hydromorphone for breakthrough pain. The standard regimen consists of as-needed ibuprofen, as-needed acetaminophen/oxycodone, and intravenous hydromorphone for breakthrough pain. The primary outcome was postoperative day 1 pain evaluated the morning after surgery using a visual analog scale. Secondary outcomes included the validated Quality of Recovery Questionnaire, satisfaction scores, inpatient narcotic consumption, outpatient pain medication consumption, and visual analog scale scores at other time intervals. In all, 27 patients in each arm were required to detect a mean difference of 25 mm on a 100 mm visual analog scale (90% power). Thirty patients were randomized to ice packs, Tylenol, and Toradol and 33 to the standard therapy. Patient and surgical demographics were similar. The median morning visual analog scale pain score was lower in the ice packs, Tylenol, and Toradol group (20 mm vs 40 mm, P= .03). Numerical median pain scores were lower at the 96 hour phone call in the ice packs, Tylenol, and Toradol group (2 vs 3, P= .04). Patients randomized to the ICE-T regimen received fewer narcotics (expressed in oral morphine equivalents) from the postanesthesia care unit exit to discharge (2.9 vs 20.4, P < .001) and received fewer narcotics during the entire hospitalization (55.7 vs 91.2, P < .001). At 96 hour follow up, patients in the ice packs, Tylenol, and Toradol group used 4.9 ketorolac tablets compared with 4.6 oxycodone/acetaminophen tablets in the standard group (P= .81); however, ice packs, Tylenol, and Toradol patients required more acetaminophen than ibuprofen by patients in the standard arm (10.7 vs 6.2 tablets, P= .012). There were no differences in Quality of Recovery Questionnaire or satisfaction scores either in the morning after surgery or at 96 hour follow up. The ice packs, Tylenol, and Toradol multimodal pain regimen offers improved pain control the morning after surgery and 96 hours postoperatively compared with the standard regimen with no differences in patient satisfaction and quality of recovery. Ice packs, Tylenol, and Toradol can significantly limit postoperative inpatient narcotic use and eliminate outpatient narcotic use in patients undergoing vaginal pelvic reconstructive surgery.

Evaluation of the effect of cooling strategies on recovery after surgical intervention

IntroductionDifferent cooling strategies exist for emergency treatments immediately after sports trauma or after surgery. The aim of this study was to investigate the effects of three cooling regimen during the...

A Pilot Study to Assess Stool Sample Collection Methods for Gut Microbiome Research in Large Prospective Cohort Studies (FS07-01-19)

ObjectivesColonic microbiota can be modified by diet and other environmental exposures that are associated with risk of cancer and other diseases. In addition, the stool metabolome represents products formed by gut microbial utilization of foods, nutrients, and other compounds. The collection of stool samples for analyses of the microbiome and metabolome in prospective cohort studies may lead to a better understanding of diet and other factors in disease etiology.Most studies of the gut microbiome and metabolome have been small clinical studies and relied on the collection of stool samples that were quickly flash-frozen and stored with no preservative. However, this method of collection is not feasible in large epidemiologic studies in which participants would self-collect and ship samples to a central repository. Other methods may preclude metabolomic analyses or result in a limited amount of stool. MethodsWe designed a pilot study to inform stool collection procedures for participants enrolled in a nationwide prospective cohort study. In this pilot study, stool samples will be collected by 10 volunteers who will aliquot their sample into: 1) OMNIgene Gut collection kit, 2) 95% ethanol collection kit, (3) Fecal Occult Blood Test cards, and (4) a vial for fresh-frozen sample with no solution (i.e., the gold standard in this analysis). Fresh-frozen samples will be shipped overnight on dry ice to a central biorepository. The remaining samples will be: 1) shipped overnight on cold packs; 2) shipped overnight at ambient temperature; 3) shipped overnight after 4 days at ambient temperature; and 4) shipped overnight at ambient temperature, followed by 4-day incubation at 50 °C to mimic maximum shipment temperature. The reproducibility, stability, and accuracy of 16S sequencing and metabolomics in stool will be compared among the collection kits, and shipping and storage conditions. ResultsInitial results are anticipated by June 2019. ConclusionsThe findings of this pilot study will inform future stool collection among Cancer Prevention Study-3 (CPS-3) participants, which, when analyzed with food frequency questionnaire data, will broaden our understanding of the role of diet in cancer risk. Funding SourcesThe American Cancer Society funds the creation, maintenance, and updating of CPS-3.

PB2279 EFFECT OF EDUCATIONAL TRAINING PROGRAM ON IMPROVING PEDIATRIC ONCOLOGY NURSES, PRACTICE REGARDING NON PHARMACOLOGICAL PAIN MANAGEMENT

Background:Pain in cancer children poses a significant challenge for health professionals. It is most often not adequately treated because of inexperience and unfounded fears of analgesic treatment. Non pharmacological interventions support patients in coping with the disease consequences and in playing an active role in the management of their condition. Nurses are the professionals most responsible for caring for patient's pain and play a critical role in efficient pain management.Aims:to identify the effect of an educational training program on improvement of pediatric oncology nurses’ practice regarding non‐ pharmacological pain management.Methods:A quasi‐experimental study design was conducted on a sample of 23 nurses who were working in in Pediatric Hematology and Oncology unit at Zagazig university children hospitals. Two tools were used in the present study at three phases (pretest, post‐test and follow up after 2 months); first: a questionnaire interview sheet to assess nurses’ knowledge related to pain and non‐ pharmacological pain management, the second: a structured observational checklist for nurses’ practice.Educational training program was developed to train pediatric oncology nurses about non‐pharmacological pain management in children (Massage technique,Reflexology massage,Hotand cold Pack Application,Slow rhythmic breathing).Results:from the present study we revealed that none of the studied nurses had good knowledge score before implementation of the program. This percentage increased to 100.0% after implementation of the program and decreased to 52.2% at follow up phases of the program. Pediatric oncology nurses practice had been improved significantly after implementation of the educational training program either immediately or 2 months later.Summary/Conclusion:it was concluded that educational training program to pediatric oncology nurses had improved their knowledge and practice regarding non pharmacological pain management as there was a statistical significant difference throughout the three phases of the study. Based on the results of the present study continuous formal training programs for updating the knowledge and practice of pediatric oncology nurses about non‐pharmacological pain management was recommended.