Improve Patient Comfort Research Articles

Preoperative anxiety and postoperative pain associated with cataract surgery under local anesthesia.

Although cataract surgery is a routine outpatient surgery, anxiety and pain remain two significant concerns seen in patients. To describe preoperative anxiety and postoperative pain related to cataract surgery under local anesthesia and identify the factors determining their occurrence. This is a cross-sectional, descriptive and analytical, study which included patients who underwent cataract surgery for the first eye in the ophthalmology department of Habib Bourguiba University Hospital in Sfax-Tunisia. Preoperative anxiety was assessed using the Amsterdam Preoperative Anxiety and Information Scale. Postoperative pain was measured using the visual analog scale. A total of 203 patients were included with a sex ratio (M/F) of 0.79. The average age was 67.73±9.4 years. The mean overall preoperative anxiety score was 10.8±5.2. The average score for the need for information among patients was 3.45±1.5. The most anxiety-provoking factor was the possibility of surgery failure and loss of the operated eye. The determining factors for anxiety were young age and female gender. The average postoperative pain score in our patients was 3.51±1.8. A weakly positive correlation was noted between pain and duration of the procedure. Managing anxiety and pain related to cataract surgery through preoperative education and adequate management is necessary to improve patient comfort and well-being.

Polyvinylpyrrolidone hydrogel coating for ureteral stent: Safety and performance evaluation.

Ureteral stents are commonly used in urology. However, complications such as encrustation and infection on the surface of the stent, and injury to the ureteral mucosa can occur after implantation, causing discomfort for patients. We intend to confirm the biosafety of polyvinylpyrrolidone (PVP) hydrophilic coating and its lubrication properties for surface modification of ureteral stents to reduce friction and improve patient comfort. Based on our previous studies, we have developed a PVP hydrophilic coating for surface modification of ureteral stents. We firstly investigated the cytotoxicity, intradermal irritation, delayed type hypersensitivity, and acute systemic reactions of stent coating extracts. We further characterized the break strength, retention strength, and dynamic friction of the stent. The cell survival rate of all experimental groups was greater than 70%. No hypersensitivity reaction, systemic toxicity reaction, or obvious intradermal reaction were observed. The above results indicate that the test results of the modified stent meet the requirements of ISO 10993-5: 2009 (Cytotoxicity); ISO 10993-10:2021 (Sensitization and Irritation); ISO 10993-11:2017 (Acute Systemic Toxicity). After soaking in artificial urine for an extended period, there was no obvious change in its super-slip performance. Our results confirm the safety and lubrication characteristics of PVP hydrophilic coating for ureteral stent surface modification. The performance of this coating has the potential to reduce complications after stent implantation, thereby improving patient comfort, reducing medical burden, and has a good clinical application prospect.

Comparison of USG guided with Anatomical Landmark guided TAP Block following Total Abdominal Hysterectomy

A crucial part of a multimodal anaesthetic strategy utilized to accelerate recovery following lower abdominal procedures is the Transversus Abdominis Plane (TAP) Block. The TAP Block is administered in the petit triangle, with its base being formed by the iliac crest, the external oblique in front of it, and the latissimus dorsi at its rear. The intercostal, subcostal, iliohypogastric, and ilioinguinal nerves are housed in this interfascial plane. The TAP block reduces pain from the incision site during both inpatient and outpatient surgical procedures, as well as open and laparoscopic abdominal operations, by obstructing sensory signals from the nerves providing the anterior wall of the abdomen (anterior division of the segment of the spinal cord responsible for T6-L1). Postoperative pain can be effectively alleviated with TAP blocks. Through the use of supplementary drugs such as opioids, opioid agonist antagonists, ketamine, and alpha-2 agonists, including Nalbuphine, clonidine, and dexmedetomidine in blockade of peripheral nerves and field blocks, the duration of pain relief following surgery can be extended. Specifically, a combination of 10 mg of Nalbuphine and bupivacaine, on either side with a volume of 20 ml, improves patient comfort and pain management, allows for early patient mobilization, prolongs postsurgical pain relief, and lowers the need for rescue analgesia. This research aims to assess the efficacy of the Anatomical Landmark against Ultrasound-Guided TAP Block for patients undergoing Total Abdominal Hysterectomy under Subarachnoid Block.

Surface guided radiotherapy practice in paediatric oncology: a survey on behalf of the SIOPE Radiation Oncology Working Group.

Surface guided radiotherapy (SGRT) is increasingly being implemented to track patient's surface movement and position during radiation therapy. However, limited information is available on the SGRT use in paediatrics. The aim of this double survey was to map SIOPE (European Society for Paediatric Oncology)-affiliated centres using SGRT and to gain information on potential indications, observed, or expected benefits. A double online survey was distributed to 246 SIOPE-affiliated radiotherapy (RT) centres. Multiple choices, yes/no, and open answers were included. The first survey (41 questions) was active from February to March 2021. A shortened version (13 questions) was repeated in March 2023 to detect trends in SGRT use within the same community. Respectively, 76/142 (54%) and 28/142 (20%) responding centres used and planned to use SGRT clinically, including 4/34 (12%) new centres since 2021. Among the SGRT users, 33/76 (43%) already applied this technology to paediatric treatments. The main benefits of improved patient comfort, better monitoring of intrafraction motion, and more accurate initial patient set-up expected by future users did not differ from current SGRT-users (P = .893). Among non-SGRT users, the main hurdles to implement SGRT were costs and time for installation. In paediatrics, SGRT is applied to all anatomical sites. This work provides information on the practice of SGRT in paediatrics across SIOPE-affiliated RT centres which can serve as a basis for departments when considering the purchase of SGRT systems. Since little information is available in the literature on the use of SGRT in paediatrics, the results of this double survey can serve as a basis for departments treating children when considering the purchase of an SGRT system.

Comparison of different methods of local anesthesia for platelet rich plasma injections to scalp in patients with hair loss - A prospective study

Background: Platelet-rich plasma injection (PRP) for hair loss is a widely accepted treatment modality at present. The most common problem with PRP is the pain that is associated with the procedure. The type of anesthesia is decided mostly based on preference rather than protocol. Aims and Objectives: The current study was undertaken to establish a standardized anesthetic protocol for PRP based on the response of the patients undergoing the treatment plan. Materials and Methods: The study included 60 patients who underwent four sittings of PRP at 1-month intervals for hair loss treatment. The modality of anesthesia was different during each of the sessions - topical anesthesia, vibration anesthesia, nerve block, and ring block. The order of anesthetic modality was different in each patient, to avoid bias. Responses by the patients for the following questions related to anesthetic pain during the procedure was recorded and analyzed based on the type of anesthetic procedure adopted. Results: Vibration anesthesia had the highest mean intra procedure numerical pain scale value. Nerve block was the least acceptable modality with maximal problems including the pain of the local anesthetic injection and the unsightly visible bulge in the supra orbital region. Post procedural pain was highest for vibration anesthesia and least for ring block. Highest acceptance was seen with the ring block technique. Conclusion: This is a preliminary study aimed at standardizing the anesthetic protocol for PRP. This modality of treatment involves multiple sittings with long total duration. Improving patient comfort with adequate anesthesia will improve compliance to a great extent.

How Should Intensive Care Unit Nurses Organize End-of-life Care? A Mixed-methods Study

Purpose: This study aimed to explore intensive care unit nurses' perceptions of end-of-life care and to identify strategies for improving patient comfort in the intensive care unit.Methods: This was a mixed-methods study comprising two phases. In Phase 1, we conducted focus group interviews to investigate how intensive care unit nurses perceived end-of-life care and its specific components within an intensive care unit setting. Phase 2 involved a descriptive questionnaire, utilizing items derived from the focus group interviews to assess how intensive care unit nurses evaluated the components of end-of-life care they provided in the intensive care unit.Results: The findings of the study’s two phases revealed that in end-of-life care, nurses aimed to provide comfort by connecting patients with their families, spiritual beliefs, social networks, and life experiences, while addressing challenges within the broader scope of nursing practice in the intensive care unit.Conclusion: This study examined intensive care unit nurses' perceptions of end-of-life care, the elements of end-of-life care, their practical implementation, and the associated priorities. These findings will help nurses in intensive care units determine and organize priorities in end-of-life care. For patients facing death in the intensive care unit and for the nurses who care for them, the obstacles involved in end-of-life care must be better overcome.

Utilization of Dental Laser for Analgesia to enhance patient comfort in Dentistry: A Review

Background: Pain management is a critical aspect of dental care, impacting patient experience, treatment outcomes, and overall satisfaction. Traditional methods of analgesia, such as local anesthesia, may not always suffice, leading to discomfort and anxiety among patients. Dental lasers have emerged as innovative tools for pain control, offering precise, minimally invasive, and efficient analgesic mechanisms across various dental procedures. Purpose: This review provides a detailed examination of the current state of utilizing dental lasers for analgesia, encompassing their mechanisms of action, clinical applications, efficacy, safety considerations, and future directions. Method: By synthesizing evidence from scientific literature and clinical studies, this review aims to elucidate the potential of dental lasers in revolutionizing pain management in dentistry, ultimately enhancing patient comfort and improving treatment outcomes. Conclusion: Dental lasers show considerable promise in dentistry’s pain management domain, providing precise, minimally invasive, and effective analgesic methods during different dental procedures. As technologies advance and research progresses, dental lasers could transform pain management in dentistry, significantly improving patient comfort, satisfaction, and treatment results

Digitalization of Pediatric Dentistry: A Review

In recent years, digitization has revolutionized various sectors, with pediatric dentistry being no exception. This review comprehensively summarizes the impacts and advancements of digitization in pediatric dentistry. The utilization of digital technologies has notably enhanced diagnostic accuracy, treatment planning, patient engagement, and educational tools for both dental practitioners and their young patients. Through the integration of digital radiography, intraoral scanning, three-dimensional printing, and teledentistry, the field has seen improvements in patient comfort, reduced procedure durations, and the personalization of dental care. The review aims to highlight the latest developments, potential challenges, and future directions in the digital realm of pediatric dentistry.

Antiadhesive Hyaluronic Acid-Based Wound Dressings Promote Wound Healing by Preventing Re-Injury: An In Vivo Investigation.

Wound dressings are widely used to protect wounds and promote healing. The water absorption and antifriction properties of dressings are important for regulating the moisture balance and reducing secondary damages during dressing changes. Herein, we developed a hyaluronic acid (HA)-based foam dressing prepared via the lyophilization of photocrosslinked HA hydrogels with high water absorption and antiadhesion properties. To fabricate the HA-based foam dressing (HA foam), the hydroxyl groups of the HA were modified with methacrylate groups, enabling rapid photocuring. The resulting photocured HA solution was freeze-dried to form a porous structure, enhancing its exudate absorption capacity. Compared with conventional biopolymer-based foam dressings, this HA foam exhibited superior water absorption and antifriction properties. To assess the wound-healing potential of HA foam, animal experiments involving SD rats were conducted. Full-thickness defects measuring 2 × 2 cm2 were created on the skin of 36 rats, divided into four groups with 9 individuals each. The groups were treated with gauze, HA foam, CollaDerm®, and CollaHeal® Plus, respectively. The rats were closely monitored for a period of 24 days. In vivo testing demonstrated that the HA foam facilitated wound healing without causing inflammatory reactions and minimized secondary damages during dressing changes. This research presents a promising biocompatible foam wound dressing based on modified HA, which offers enhanced wound-healing capabilities and improved patient comfort and addresses the challenges associated with conventional dressings.

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 < 0.05), dietary adherence (P < 0.05), and overall satisfaction with care (P < 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.

Insertable Biosensors: Combining Implanted Sensing Materials with Wearable Monitors.

Insertable biosensor systems are medical diagnostic devices with two primary components: an implantable biosensor within the body and a wearable monitor that can remotely interrogate the biosensor from outside the body. Because the biosensor does not require a physical connection to the electronic monitor, insertable biosensor systems promise improved patient comfort, reduced inflammation and infection risk, and extended operational lifetimes relative to established percutaneous biosensor systems. However, the lack of physical connection also presents technical challenges that have necessitated new innovations in developing sensing chemistries, transduction methods, and communication modalities. In this review, we discuss the key developments that have made insertables a promising option for longitudinal biometric monitoring and highlight the essential needs and existing development challenges to realizing the next generation of insertables for extended-use diagnostic and prognostic devices.

Updated Scenario on Negative Pressure Wound Therapy.

Negative pressure wound therapy (NPWT) is a widely used and effective treatment for managing complex wounds. This document discusses how NPWT can be used in wound care in an updated way. The updated scenario on NPWT provides a concise overview of the current state of NPWT and its implications in clinical practice. It highlights recent developments in NPWT, as well as the advancements in this field. As part of NPWT, vacuum-assisted closure is used and negative pressure is applied to the wound bed. It discusses the key components and mechanisms. In addition to improving wound healing, NPWT also reduces infection rates and improves patient comfort, among other benefits. In addition, this document discusses the specific indications and contraindications of NPWT, as well as the types of wounds that can be treated with NPWT, including diabetic foot ulcers, pressure ulcers, and traumatic wounds. The document emphasizes the importance of choosing patients appropriately and assessing wounds to ensure optimal outcomes. In addition, it provides evidence-based guidelines and clinical recommendations on NPWT. In addition to reviewing the latest research findings supporting NPWT in a variety of clinical settings, it also discusses randomized controlled trials and systematic reviews. In addition, it discusses the potential complications and challenges associated with NPWT, including pain, bleeding, and device malfunction. The purpose of this document is to shed light on the role of NPWT in wound care management by providing an updated scenario. NPWT can be incorporated into clinical practice by healthcare professionals if they understand its principles, benefits, indications, and limitations. Healthcare providers can optimize patient outcomes and improve wound healing in diverse patient populations by staying abreast of the latest advancements in NPWT.

(273) The Use of In-Office Nitrous Oxide to Aid in Diagnosing Hypertonic Pelvic Floor and Improve Patient Comfort with Pelvic Exams

Abstract Introduction Nitrous oxide is an anesthetic, anxiolytic, and analgesic commonly used for general and dental anesthesia, sedation, and severe pain. Studies show that nitrous oxide is also used in several in-office gynecological and urological procedures as a sedative and anxiolytic agent with a safer drug profile than other anesthetic agents. It is also being trialed as a treatment for mood disorders. Nitrous oxide does not render individuals unconscious, making it a more favorable option for stressful and painful medical procedures than general anesthesia because it allows the patient to feel more in control of their body and aware of the proceedings. Objective To analyze the use of in-office nitrous oxide during medical procedures and evaluate its effectiveness in reducing pain and anxiety levels to predict the utility of it during pelvic exams in patients with vestibulodynia. Methods A literature review was performed through the PubMed database between 2007-2022. The authors independently and thoroughly screened abstracts and full-text articles and assessed the relevant medical literature that acknowledged the use of nitrous oxide in in-office medical procedures. Key terms used to refine the search include [“nitrous oxide in medical procedures”], [“nitrous oxide in gynecology”], [“nitrous oxide in urology”]. Results One study explored the use of nitrous oxide during childbirth in women diagnosed with PTSD, and the results were significant for nitrous oxide reducing PTSD symptom severity. Multiple studies suggest the use of nitrous oxide during dental procedures reduces patient anxiety; one specifically measured sixty anxious patients pre- and post-endodontic procedures and noted a significant reduction in anxiety during the procedure with the use of nitrous oxide. Various studies of gynecological and urological procedures report the successful use of nitrous oxide in reducing peri-procedural pain compared to other analgesic alternatives. A common example is its use during intrauterine device insertion, which is correlated with higher patient satisfaction as it decreases pain. Additionally, a study among patients undergoing extracorporeal shockwave lithotripsy found no significant difference between the use of meperidine, an opioid, and nitrous oxide in post-procedural Visual Analog Scale pain scores with no adverse events reported in the nitrous oxide group. Another study revealed that using local anesthesia in transrectal prostate biopsies resulted in some patients experiencing notable anxiety and pain. At the same time, no such relationship was observed among patients who received nitrous oxide before this procedure. Conclusions Vestibulodynia is a subset of genitopelvic pain isolated to the vulvar vestibule. Vestibulodynia has three proposed etiologies: tissue neural proliferation, musculoskeletal, and hormonally mediated. Discriminating these three etiologies can be difficult, especially when a proper pelvic exam cannot be achieved due to patients’ discomfort. The three etiologies are biologically intertwined, often resulting in vestibulodynia patients experiencing pelvic floor hypertonicity without regard to specific etiology. A painful pelvic exam is stressful and often an anxiety-producing experience for patients with pelvic hypertonicity and vulvodynia. Hence, with the data provided, we suspect that nitrous oxide will be a useful treatment option to mitigate these consequences for the patient, with the added benefit of easing the exam for the provider, leading to a more accurate diagnosis. Disclosure No.

The Scalloped Surgical Guide as an Alternative to Flat Bone Reduction Guide in Full-arch Implant Restoration.

The goal of this clinical report was to present an alternative to traditional flat bone reduction guides, using a custom-designed 3D printed guide according to the future gingival margin of the planned dentition. A 61-year-old female with concerns regarding her smile appearance was presented. The initial examination revealed excessive gingival show accompanied by excessive overjet. The dentition was in a failing situation. The proposed treatment plan, relying on the sufficient amount of bone and keratinized tissue, consisted of re-contouring of the alveolar ridge and gingiva and placement of six implants and a FP-1 prosthesis after extraction of all remaining maxillary teeth. Digital smile design was completed, and a fully-digitally-guided surgery was planned. This consisted of utilizing three surgical guides. Starting with the fixation pin guide and continuing with the scalloped hard and soft tissue reduction guide and finally, the implant placement template. Following the surgery, the patient received a temporary restoration and on the 4-month follow-up, a new poly-methyl meta-acrylate temporary prosthesis was delivered. The patient's 7-month follow-up is presented in the paper. The report of this triple-template guided surgery indicated that digital 3D planning is a considerably predictable tool to properly establish and evaluate future occlusal plane, smile line, and lip support. Scalloped guides seem to be an excellent alternative to conventional bone reduction guides since they require less bone removal and improve patient comfort during surgery.

Mannitol Reduces Pain and Trismus After Impacted Mandibular Third Molar Surgery

BackgroundThe removal of the lower third molar is a routine procedure in oral surgery , yet it often leads to postoperative side effects, particularly inflammation.Despite various interventions explored in prior studies, there is still a need for effective strategies, such as anti-inflammatory substances, to address postoperative side effects. PurposeThe purpose of this study is to answer the following clinical question: Does the local injection of 0.9M mannitol reduce postoperative pain, trismus, and swelling in patients undergoing bilateral symmetrically impacted mandibular third molar extraction? Study Design, Setting, SampleThis prospective, single-blind, split-mouth study at Hamadan Dental School involved 30 patients with bilateral symmetrically impacted mandibular third molars. Inclusion criteria were: no current medication, no anesthesia allergies, bilateral symmetrically impacted mandibular third molars, non-smokers, and the absence of systemic diseases. Exclusion criteria were: poor oral hygiene, alcohol/cigarette use, drug consumption, diabetes, systemic/gastrointestinal disorders, infection at the surgical site, lack of patient cooperation, and mannitol/anesthetic allergy. Predictor/Exposure/Independent VariableThe predictor variable was therapeutic injection, and it was grouped into two categories, 0.9M mannitol solution or distilled water. Main Outcome VariableThe primary outcome variable was pain. Secondary outcomes are trismus, swelling, patient satisfaction, and analgesic consumption CovariatesCovariates included demographic information and operative details. AnalysesStatistical analyses included repeated measures and paired t-tests with a significance level set at P < 0.05. ResultsThe study comprised 30 participants (mean age: 22.6 ± 3.59 years; 6 men, 24 women). In the test group, pain intensity significantly decreased from 5.30 on surgery day to 0.00, with subsequent values of 2.97, 1.30, 0.40, 0.17, and 0.03. The control group also decreased from 7.68 to 0.00, with values of 4.73, 2.67, 0.97, 0.23, and 0.07. The difference was statistically significant (p < 0.001). No significant swelling differences at T1, T3, T5, and T7 (p > 0.05). The intervention group had improved maximum mouth opening at T1, T3, T5, and T7 (p = 0.011) compared to the control group. Conclusion and RelevanceMannitol infiltration significantly reduces postoperative pain and trismus in impacted third molar surgery. This finding underscores the potential for improved patient comfort and recovery in this context.

Perceived stress, coping strategies, symptoms severity and function status among carpal tunnel syndrome patients: a nurse-led correlational Study

BackgroundCarpal tunnel syndrome (CTS) is a prevalent condition characterized by hand pain, tingling, and numbness. The severity of symptoms and functional status in CTS patients may be influenced by perceived stress and how individuals cope with it. However, scarce knowledge exists about the role of coping strategies as moderators in this relationship. Unfolding the role of perceived stress and coping strategies for CTS management will help the nurse to provide comprehensive and tailored nursing care. This will ultimately improve patient comfort, functionality, and quality of life.PurposesThis study aimed to examine the role of coping strategies (adaptive and maladaptive) in the relationship between perceived stress and both symptoms severity and function status among those patients.MethodWe employed a multisite, correlational study design with moderation analysis. The study included 215 patients with CTS from neurosurgery outpatient clinics at three hospitals in Egypt. After obtaining their consent to participate, eligible participants completed anonymous, self-reported measures of perceived stress, the brief COPE inventory, and the Boston Carpal Tunnel Questionnaire. Demographic and biomedical data were also collected. The questionnaire took about 20 min to be completed. The data was collected over six months, starting in February 2023.ResultsThe results showed that perceived stress, adaptive coping, and maladaptive coping were significant predictors of symptoms severity and functional status. Adaptive coping moderated the relationships between perceived stress and both symptoms severity and function status, while maladaptive coping did not. The interaction between perceived stress and adaptive coping explained a moderate effect on symptoms severity and function status after controlling for the main effects and the covariates.ConclusionThis study explored the relationship between perceived stress, coping strategies, and outcomes in patients with CTS. The results indicate that nurses play a vital role in assessing and assisting patients to adopt effective coping strategies to manage perceived stress and alleviate symptoms and functional impairment. Moreover, the findings support the need for psychological interventions that address both perceived stress and coping strategies as a way to enhance the functioning status and quality of life of patients with CTS.

Interpretation of the Visual Field in Neuro-ophthalmic Disorders.

In this review, we will describe current methods for visual field testing in neuro-ophthalmic clinical practice and research, develop terminology that accurately describes patterns of field deficits, and discuss recent advances such as augmented or virtual reality-based perimetry and the use of artificial intelligence in visual field interpretation. New testing strategies that reduce testing times, improve patient comfort, and increase sensitivity for detecting small central or paracentral scotomas have been developed for static automated perimetry. Various forms of machine learning-based tools such as archetypal analysis are being tested to quantitatively depict and monitor visual field abnormalities in optic neuropathies. Studies show that the combined use of optical coherence tomography and standard automated perimetry to determine the structure-function relationship improves clinical care in neuro-ophthalmic disorders. Visual field assessment must be performed in all patients with neuro-ophthalmic disorders affecting the afferent visual pathway. Quantitative visual field analysis using standard automated perimetry is critical in initial diagnosis, monitoring disease progression, and guidance of therapeutic plans. Visual field defects can adversely impact activities of daily living such as reading, navigation, and driving and thus impact quality of life. Visual field testing can direct appropriate occupational low vision rehabilitation in affected individuals.

Effect of acupressure on pain intensity and physiological indices in patients undergoing extracorporeal shock wave lithotripsy: a randomized double-blind sham-controlled clinical trial

BackgroundDespite the widespread use of extracorporeal shock wave lithotripsy (ESWL) as a treatment for kidney stones, it is essential to apply methods to control pain and improve patient comfort during this procedure. Therefore, this study aimed to investigate the effect of acupressure at the Qiu point on pain intensity and physiological indices in patients undergoing ESWL.MethodsThis randomized, sham-controlled clinical trial was conducted at the Shahid Beheshti Educational-medical Center in Hamadan City (western Iran) from May to August 2023. Seventy-four eligible patients were split into intervention (n = 37) and sham (n = 37) groups. Ten minutes before lithotripsy, the intervention group received acupressure at the Qiu point, while the sham group received touch at a neutral point. The primary outcomes were pain intensity measured by the Visual Analog Scale (VAS) and physiological indices such as blood pressure and heart rate at baseline, 1, 10, 20, 30, 40, and 50 min after the intervention. The secondary outcomes included lithotripsy success and satisfaction with acupressure application.ResultsThe analysis of 70 patients showed no significant differences in the demographic and clinical information of the patients across the two groups before the study (P > 0.05). Generalized estimating equations revealed that the interaction effects of time and group in pain and heart rate were significant at 30 and 40 min (P < 0.05). The results of this analysis for systolic blood pressure revealed a significant interaction at 30 min (P = 0.035). However, no significant interaction effects were found for diastolic blood pressure changes (P > 0.05).ConclusionsAcupressure at the Qiu point positively impacts pain in patients undergoing ESWL treatment and increases their satisfaction. However, these results for physiological indices require further studies. Thus, acupressure can be considered a simple, easy, and effective option for pain management in patients during this procedure.Trial registration[https://en.irct.ir/trial/69117], identifier [IRCT20190524043687N4].

Terminal Care in Parkinson's Disease: Real-Life Use of Continuous Subcutaneous Apomorphine Infusion to Improve Patient Comfort.

There are currently no recommendations on the therapeutic management of Parkinson's disease (PD) patients at the end of life. To describe a cohort of patients with PD who benefited from continuous subcutaneous apomorphine infusion (CSAI) initiation at the end of their life as comfort care. This real-life cohort includes 14 PD patients, who benefited from 24-h, low-dose CSAI (0.5-3 mg/h) in the context of terminal care. Patient's comfort (pain, rigidity, and/or ability to communicate) and occurrence of CSAI-related side-effects (nausea/vomiting, cutaneous and behavioral manifestations) were evaluated based on medical records. All patients (age 62-94 years, disease duration 2-32 years) presented with late-stage PD and a compromised oral route. Treatment lasted from a few hours to 39 days. CSAI led to substantial functional improvement, with a good safety profile. Overall clinical comfort was deemed improved by the medical team, the patient, and/or caregivers. CSAI might be a promising approach in PD terminal care, as it reduces motor symptoms and overall discomfort, with an apparent good safety profile. Use of the apomorphine pen, sublingual film or a classic syringe pump might be considered when apomorphine pumps are not available. Larger observational cohorts and randomized controlled trials are needed to establish the efficacy and tolerability of apomorphine in the context of terminal care and more broadly, in an advance care planning perspective.

Efficacy of ultrasound-guided erector spinae plane block on analgesia and quality of recovery after minimally invasive direct coronary artery bypass surgery: protocol for a randomized controlled trial

BackgroundMinimally invasive direct coronary artery bypass (MIDCAB) surgery offers an effective option for coronary artery disease (CAD) patients with the avoidance of median sternotomy and fast postoperative recovery. However, MIDCAB is still associated with significant postoperative pain which may lead to delayed recovery. The erector spinae plane block (ESPB) is a superficial fascial plane block. There have not been randomized controlled trials evaluating the effects of ESPB on analgesia and patient recovery following MIDCAB surgery. We therefore designed a double-blind prospective randomized placebo-controlled trial, aiming to prove the hypothesis that ESPB reduces postoperative pain scores in patients undergoing MIDCAB surgery.MethodsThe study protocol has been reviewed and approved by the Ethical Review Committee of Peking University People’s Hospital. Sixty adult patients of either sex scheduled for MIDCAB surgery under general anesthesia (GA) will be included. Patients will be randomly allocated to receive either a preoperative single-shot ESPB with 30 mL of ropivacaine 0.5% (ESPB group) or normal saline 0.9% (control group). The primary outcomes are the difference between the two groups in numeric rating scale (NRS) scores at rest at different time points (6, 12, 18, 24, 48 h) after surgery. The secondary outcomes include NRS scores on deep inspiration within 48 h, postoperative hydromorphone consumption, and quality of patient recovery at 24 h and 48 h, using the Quality of Recovery-15 (QoR-15) scale. The other outcomes include intraoperative fentanyl requirements, the need for additional postoperative rescue analgesics, time to tracheal extubation and chest tube removal after surgery, incidence of postoperative nausea and vomiting (PONV) and postoperative cognitive dysfunction (POCD), intensive care unit (ICU) length of stay (LOS), hospital discharge time, and 30-day mortality. Adverse events will be also evaluated.DiscussionThis is a novel randomized controlled study evaluating a preoperative ultrasound-guided single-shot unilateral ESPB on analgesia and quality of patient recovery in MIDCAB surgery. The results of this study will characterize the degree of acute postoperative pain and clinical outcomes following MIDCAB. Our study may help optimizing analgesia regimen selection and improving patient comfort in this specific population.Trial registrationThe study was prospectively registered with the Chinese Clinical Trial Registry (trial identifier: ChiCTR2100052810). Date of registration: November 5, 2021.