Non-pharmacological Interventions Research Articles

The effects of aromatherapy and music on pain, anxiety, and stress levels in palliative care patients.

Pain and anxiety levels in palliative care patients negatively impact their quality of life, highlighting the need for research on non-pharmacological methods. This study aimed to evaluate the effects of music and aromatherapy interventions on pain, anxiety, and stress levels in these patients. The research was designed as a single-blind, four-group, randomized controlled trial. The sample consisted of 88 patients hospitalized in a palliative care center (receiving palliative care services with terminal or advanced diseases). Patients were randomly assigned to four groups (n = 22, music, aromatherapy, music and aromatherapy, and control group). Patients in the experimental groups received the intervention to which they were assigned for 20min each day for three consecutive days: music, aromatherapy, or music accompanied by aromatherapy. No intervention was applied to the control group. The patients' levels of pain, anxiety, and stress were assessed before and after the intervention using the Visual Analog Scale (VAS), the Facial Anxiety Scale (FAS), and the Distress Thermometer. No significant differences were found in the demographic characteristics of the groups (p > 0.05). The Wilcoxon Signed-Rank and Kruskal-Wallis tests indicated statistically significant differences in pre- and post-intervention scores for VAS, FAS, and Distress across all experimental groups on all follow-up days (p < 0.05). Implementing music, aromatherapy, and their combination effectively reduced pain, anxiety, and stress levels in palliative care patients, suggesting these non-pharmacological interventions can improve their quality of life. ClinicalTrails.gov (Registration number: NCT06024954) at 05-SEP-2024.

Beyond Pharmacotherapy: Investigating the Role of Classical Music in Preoperative Anxiety Management for Cesarean Sections

Preoperative anxiety is a prevalent concern among women undergoing cesarean sections (C-sections), potentially impacting maternal and neonatal outcomes. While pharmacotherapy is commonly used to manage anxiety, non-pharmacological interventions like music therapy offer a promising alternative or adjunct. This study aimed to investigate the efficacy of classical music in reducing preoperative anxiety levels in women scheduled for C-sections. A randomized controlled trial was conducted involving 100 women scheduled for elective C-sections. Participants were randomly assigned to either the intervention group (classical music listening) or the control group (standard care). Anxiety levels were assessed using the State-Trait Anxiety Inventory (STAI) before and after the intervention. Physiological parameters such as heart rate and blood pressure were also monitored. The intervention group demonstrated a significant reduction in both state and trait anxiety scores compared to the control group (p &lt; 0.05). Additionally, the intervention group exhibited lower heart rate and blood pressure levels post-intervention. In conclusion, classical music listening can be an effective non-pharmacological intervention for reducing preoperative anxiety in women undergoing C-sections. The findings suggest that integrating music therapy into standard preoperative care may enhance patient well-being and contribute to improved surgical outcomes.

Sexual health and wellbeing and the menopause: An EMAS clinical guide

IntroductionSexual health and wellbeing are significant aspects of quality of life. However, taking a sexual history is often avoided in medical practice, leaving a void in management and awareness. As the menopause can have a major impact on sexual health, it is imperative that healthcare providers are appropriately trained in sexual health and wellbeing and the aligned disciplines in order to achieve optimal care. AimTo provide an evidence-based clinical guide for the assessment and management of sexual problems at the menopause and beyond. Materials and methodsReview of the literature and consensus of expert opinion. Results and conclusionThe assessment of sexual problems includes history taking, examination and laboratory investigation (if indicated), and occasionally the use of specific validated questionnaires. Management of sexual problems requires a multidimensional approach using biopsychosocial measures. Medical management and psychosexual counselling include pharmacological and non-pharmacological interventions, and sex therapy and psychoeducation. Furthermore, perimenopausal women should be advised about the need for contraception if they wish to avoid pregnancy. Also, sexually transmitted diseases can be acquired at any age. To conclude, taking a sexual history should be incorporated into medical practice and healthcare providers should be appropriately trained to assess and manage sexual problems at the menopause and beyond.

Proteinuric and Non-Proteinuric Diabetic Kidney Disease: Different Presentations of the Same Disease?

Background: Diabetic kidney disease (DKD) is a leading cause of end-stage kidney disease (ESKD) worldwide. This review examines the potential differences in clinical presentation, outcomes, and management between individuals with proteinuric DKD (P-DKD) and non-proteinuric DKD (NP-DKD). Methods: We analyzed articles published globally from 2000 and 2024. Results: Individuals with NP-DKD generally have lower blood pressure levels and a more favorable lipid profile. In contrast, histological studies show that P-DKD is associated with more severe glomerulosclerosis, mesangial expansion, arteriolar hyalinosis, interstitial-fibrosis/tubular atrophy, and immune complex deposits. Additionally, those with P-DKD are more likely to develop diabetic retinopathy and have a higher risk of all-cause mortality and progression to ESKD. Strategies to slow DKD progression, applicable to both NP-DKD and P-DKD, include non-pharmacologic and pharmacologic interventions such as renin–angiotensin system blockers, sodium-glucose co-transporter-2 inhibitors, finerenone, and glucagon-like protein receptor agonists. Conclusions: NP-DKD and P-DKD represent different presentations of the same underlying disease.

Hubungan Perilaku Cerdik Terhadap Hipertensi di Puskesmas Kelurahan Pekayon Tahun 2024

Hypertension is a non-communicable disease that increases every year. The CERDIK program is one of the non-pharmacological treatments that can be used in an effort to prevent hypertension. This study aims to determine the relationship between smart behavior and hypertension at the Pekayon Village Health Center in 2024. This study uses a quantitative method with a Cross Sectional design. The sample consisted of 96 respondents using Accidental Sampling as the sampling technique. Data analysis used univariate, bivariate, and multivariate analysis. This study shows that at the Pekayon Village Health Center there are 91 people (71.7%) who routinely do health checks. Avoiding cigarette smoke is in the good category as many as 88 people (69.3%), diligently doing physical activity as many as 84% ​​(66.1%), having a balanced diet as many as 88 people (69.3%), getting enough rest as many as 84 people (66.1%), and being able to manage stress well as many as 105 people (82.7%). The results of this study indicate that there is a relationship between CERDIK behavior and hypertension with a p value of &lt;0.05, so there is a correlation between CERDIK behavior and the level of hypertension in patients at the Pekayon Village Health Center.

Effects of home-based EEG neurofeedback training as a non-pharmacological intervention for Parkinson's disease

ObjectivesAberrant movement-related cortical activity has been linked to impaired motor function in Parkinson's disease (PD). Dopaminergic drug treatment can restore these, but dosages and long-term treatment are limited by adverse side-effects. Effective non-pharmacological treatments could help reduce reliance on drugs. This experiment reports the first study of home-based electroencephalographic (EEG) neurofeedback training as a non-pharmacological candidate treatment for PD. Our primary aim was to test the feasibility of our EEG neurofeedback intervention in a home setting. MethodsSixteen people with PD received six home visits comprising symptomology self-reports, a standardised motor assessment, and a precision handgrip force production task while EEG was recorded (visits 1, 2 and 6); and 3 × 1-hr EEG neurofeedback training sessions to supress the EEG mu rhythm before initiating handgrip movements (visits 3 to 5). ResultsParticipants successfully learned to self-regulate mu activity, and this appeared to expedite the initiation of precision movements (i.e., time to reach target handgrip force off-medication pre-intervention = 628 ms, off-medication post-intervention = 564 ms). There was no evidence of wider symptomology reduction (e.g., Movement Disorder Society Unified Parkinson's Disease Rating Scale Part III Motor Examination, off-medication pre-intervention = 29.00, off-medication post intervention = 30.07). Interviews indicated that the intervention was well-received. ConclusionBased on the significant effect of neurofeedback on movement-related cortical activity, positive qualitative reports from participants, and a suggestive benefit to movement initiation, we conclude that home-based neurofeedback for people with PD is a feasible and promising non-pharmacological treatment that warrants further research.

Palliative care in advanced pulmonary fibrosis.

Updated clinical practice guidelines for pulmonary fibrosis recommend early integrated palliative care using a primary palliative approach. Clinicians need to be aware of the various palliative interventions in order to implement guidelines' recommendations. This review provides an update on evidence-based palliative therapies. Literature review indicates early integration of palliative care in pulmonary fibrosis is feasible and meets patient needs. Key components of a primary palliative approach include comprehensive symptoms and needs screening, systematic symptom management using nonpharmacologic interventions, supplemental oxygen and opioids for dyspnea and cough. Patient-centered communication is essential for successful integration of palliative care. Early, iterative advance care planning in clinic to understand patient goals, values and preferences for current and future care, improves patient care and satisfaction. Prioritizing caregiver inclusion in clinics can address their needs. Collaborating with a multidisciplinary allied team facilitates integration of palliative care and supports patients throughout the disease course. Different models of palliative care delivery exist and can be adapted for local use. The use of artificial intelligence algorithms and tools may improve care and continuity. Clinicians must develop competency in palliative care. Organizational and policy support is essential to enable seamless integration of palliative care throughout the care continuum.

Management of intensive care unit withdrawal syndrome

Intensive care unit (ICU) patients frequently develop physical and psychological dependence on analgesic and sedative medications, which can lead to Iatrogenic withdrawal syndrome (IWS) upon discontinuation or tapering. The incidence of IWS in adult ICU patients varies significantly, with reported rates ranging from 12% to 100%. Identified risk factors for IWS include advanced age, obesity, medication dosage, and duration of exposure. The clinical manifestations of IWS are varied and include increased excitability of the central nervous system, gastrointestinal disturbances, and sympathetic nervous system hyperactivity. Preventive and therapeutic strategies for IWS encompass individualized medication regimens, structured withdrawal protocols, and a combination of pharmacological and non-pharmacological interventions. This review emphasizes the critical need for heightened awareness and improved management strategies to mitigate the incidence of IWS in ICU patients.

Sleep Hygiene Education as a Treatment for Depression in Adolescents

Adolescent depression, exacerbated by disrupted sleep patterns, presents a significant concern. This quality improvement project introduces personalized sleep hygiene education (SHE) as a nonpharmacologic intervention to address depressive symptoms. The efficacy of personalized SHE plans in reducing depressive symptoms among adolescents in outpatient clinical settings, measured by the 9-item Patient Health Questionnaire (PHQ-9), was evaluated. The goal was a clinically significant reduction in PHQ-9 scores with a 65% compliance rate within 4 to 6 weeks. A pre-post design was used. Adolescents diagnosed with depression received personalized SHE plans during their initial visit. Follow-up assessments conducted at 4 to 6 weeks evaluated changes in depressive symptoms. Participants were stratified based on medication use. Of 25 eligible adolescents, 16 (64%) participated, showing significant reductions in PHQ-9 scores. Improvements demonstrated shifts from moderate to mild depression levels and minimal symptoms. This project underscores personalized SHE as a cost-effective, clinically meaningful intervention for adolescent depression management within clinical settings.

Estrategias para la prevención y tratamiento no farmacológico de la diabetes. Modelos de atención

Diabetes is a highly prevalent, chronic disease that over time generates potentially serious complications. In the treatment of diabetes, the use of drugs that have shown significant benefits is important, but, in addition, the use of non-pharmacological interventions is essential, which constitute an efficient and effective way to reduce the appearance of diabetes itself and the complications of the disease. These interventions, which are described here, include health education, aimed at incorporating a healthier lifestyle, dietary modifications, increased physical activity or psychological support. Finally, the characteristics that a care system for people with diabetes must meet to achieve the established objectives are discussed.

A Systematic Review of Non-Pharmacological Treatment Options for Skin Picking Disorder (SPD).

While Skin Picking Disorder (SPD) is a well-described neuropsychiatric disorder that causes severe stress and impairment, there is no clear protocol for treating patients and a relatively small body of literature evaluating treatment approaches. This review aims to summarize and compare recent publications and provide an up-to-date guide of current non-pharmacological treatments for SPD. A literature review was conducted on all non-pharmacological SPD treatment studies published between 2017-2023 using PubMed, CINAHL Plus with Full text (EBSCO), and Scopus. Search terms included skin picking, excoriation, psychiatry, treatment, and psychodermatology. Studies including SPD within other body-focused repetitive behaviors (BFRBs), studies using pharmacological agents, and studies not available in English were excluded. A minimum of 2 authors screened each abstract while blinded to minimize bias to assess for inclusion. 11 studies (2068 participants) were included, with a variety of study designs including feasibility, randomized control trial, longitudinal cohort, multiple baseline experimental, naturalistic trial, and controlled single case design with multiple baseline studies. The treatments include cognitive behavioral therapy (CBT), Acceptance and Commitment Therapy (ACT), ACT-Enhanced Group Behavioral Therapy (AE-GBT), ACT-Informed Exposure Therapy, group therapy, psychotherapy, Repetitive Transcranial Magnetic Stimulation (rTMS), online self-help modules, and Expressive Writing (EW). Studies implementing CBT, Habit Reversal Therapy (HRT), AE-GBT, online self-help modules, and EW demonstrated the best results in treating SPD. Several studies achieved significant outcomes for SPD participants, confirming the usefulness of non-pharmacological treatment in SPD. Based on our results, CBT, AE-GBT, online self-help modules, and EW appear to be the most effective in treating SPD. Additionally, most of these treatment modalities can be tailored to meet patient-specific needs. Some limitations of the studies include small sample sizes, lack of control groups/randomization, limited long-term follow-up data, and lack of gender variability.

Hypercholesterolemia - non-pharmacological treatment, monotherapy or combination therapy. Review of the literature

Introduction: As the number of scientific studies on lipid metabolism disorders increases, awareness among the medical community and the general population about the impact of hypercholesterolemia on the risk of cardiovascular diseases is growing. Elevated cholesterol levels in the blood are a major factor in the development of atherosclerosis, thereby increasing the likelihood of sudden cardiovascular events such as heart attacks or strokes. Maintaining normal cholesterol levels in the blood requires effective collaboration between the doctor and the patient, combining optimal pharmacotherapy with effective non-pharmacological methods based on the introduction of a balanced diet and moderate, regular physical activity. Current guidelines, based on numerous scientific studies, provide a clear framework for lipid-lowering treatment, with statins being an integral part. In cases where monotherapy is ineffective, ezetimibe and monoclonal antibodies, among others, can be used. In our work, we will discuss the possibilities of both non-pharmacological therapy and pharmacotherapy. Aim of the study: The aim of this study is to review current knowledge on non-pharmacological and pharmacological therapy in hypercholesterolemia. Material and method: This article presents the current state of knowledge about non-pharmacological and pharmacological therapy in hypercholesterolemia. Publications reviewed using the PubMed platform contain recent report in field of lipid metabolism disorders. The search included the keywords: ‚Hypercholesterolemia’, ‚LDL-C’, ‚Statin’, ,Ezetimibe’, ,PCSK9 inhibitors’.

Contributions of neuroimaging in central poststroke pain: a review.

Central neuropathic poststroke pain (CNPSP) affects up to 12% of patients with stroke in general and up to 18% of patients with sensory deficits. This pain syndrome is often incapacitating and refractory to treatment. Brain computed tomography and magnetic resonance imaging (MRI) are widely used methods in the evaluation of CNPSP. The present study aims to review the role of neuroimaging methods in CNPSP. We performed a literature review of the main clinical aspects of CNPSP and the contribution of neuroimaging methods to study its pathophysiology, commonly damaged brain sites, and possible differential diagnoses. Lastly, we briefly mention how neuroimaging can contribute to the non-pharmacological CNPSP treatment. Additionally, we used a series of MRI from our institution to illustrate this review. Imaging has been used to explain CNPSP pathogenesis based on spinothalamic pathway damage and connectome dysfunction. Imaging locations associated with CNPSP include the brainstem (mainly the dorsolateral medulla), thalamus (especially the ventral posterolateral/ventral posteromedial nuclei), cortical areas such as the posterior insula and the parietal operculum, and, more recently, the thalamocortical white matter in the posterior limb of the internal capsule. Imaging also brings the prospect of helping search for new targets for non-pharmacological treatments for CNPSP. Other neuropathic pain causes identified by imaging include syringomyelia, multiple sclerosis, and herniated intervertebral disc. Imaging is a valuable tool in the complimentary evaluation of CNPSP patients in clinical and research scenarios.

Mental Health Across the Menstrual Cycle in Polycystic Ovary Syndrome: Insights and Implications.

We reviewed a wide body of emerging research highlighting the possibility for premenstrual exacerbations of mood symptoms in polycystic ovary syndrome (PCOS). Neuroendocrine dysregulation, sensitivity to ovarian hormone fluctuations as well as higher levels and types of adverse childhood experiences and demographic factors are emerging factors explaining high rates of psychiatric disorders in PCOS. Ovulatory dysfunction, common in PCOS, significantly interferes with one's identity and quality of life. Results on pharmacologic and non-pharmacologic treatments for mood symptoms are mixed, though improvements in the physical sequalae of PCOS could also improve mood symptoms. However, significant improvements on the methodological quality are needed, particularly the evaluation of mood symptoms across the menstrual cycle. Evidence is preliminary on whether there are premenstrual exacerbations of psychiatric symptoms in PCOS. Prospective, longitudinal studies with larger sample sizes are needed to comprehensively understand the psychiatric profile in PCOS.

Circulation and Seasonality of Respiratory Viruses in Hospitalized Patients during Five Consecutive Years (2019–2023) in Perugia, Italy

The emergence of SARS-CoV-2 and the non-pharmacological interventions adopted to counter its spread appear to have led to changes in the normal circulation and seasonality of respiratory viruses. Our study aims to investigate changes related to the circulation of respiratory viruses, not SARS-CoV-2, among hospitalized patients in Perugia, Central Italy, between 2019 and 2023. The samples were collected from individuals who went to the emergency room (ER) or were hospitalized and analyzed using a molecular multiplex test. The results underline that non-pharmaceutical interventions altered the typical seasonal circulation patterns of different respiratory viruses. Those mostly affected were enveloped viruses like influenza viruses that disappeared in 2021; the least impact was recorded for Rhinovirus, which was detected during the pandemic period, maintaining the same seasonality observed in the pre-pandemic period although with a reduction in the number of positive samples. Our data underline the importance of the continuous monitoring of these viruses, especially to understand the timing with which prevention measures, not only non-pharmacological interventions but also the equipment of vaccine doses and monoclonal antibodies, should be adopted to reduce their circulation, particularly in the population at risk of developing severe forms of lower respiratory tract infection.

Pharmacological Treatment of Tourette Disorder in Children.

Background: Tourette disorder (TD) is a neurodevelopmental disorder characterized by childhood onset of tics lasting more than one year, with multiple motor tics and at least one phonic tic at some point during the course of the symptoms. Treatment of tics may include psychoeducation, non-pharmacologic treatment, or pharmacologic treatment. We review pharmacologic treatment here. Methods: We performed a literature review on pharmacologic treatments for TD. Results: There is no current evidence to suggest that medications impact the prognosis of tic disorders, so current clinical guidelines recommend reassurance of the patient and family and monitoring if there is no change in function or quality of life due to tics. If treatment is indicated, it must be chosen based on the needs of each individual patient. Comprehensive behavioral intervention for tics (CBIT) is considered first-line management for most individuals with bothersome tics, especially if they are mild to moderate in severity. Pharmacotherapy should be considered when tics are impairing daily functioning, causing social problems, accompanied by other neuropsychiatric symptoms, or when the patient is not likely to benefit from CBIT. Current recommended pharmacotherapy options include alpha-2 adrenergic agonists, dopamine modulators, GABAergic medications, dopamine depleters, and botulinum toxin injections. Additionally, there are other novel medications that are being studied in ongoing clinical trials. Conclusions: This review summarizes available pharmacotherapy options for TD in children. It provides an overview of new medications and offers guidance to physicians when selecting appropriate treatments. If medications are indicated for tic management, treatment should be chosen based on the needs of the individual patient.

Dieta para controlar la hipertensión arterial en el barrio Primavera Occidental de Bogotá

The study seeks to evaluate the effect of a diet on the health of patients with high blood pressure in the Primavera neighborhood of Bogotá. The research adopts a quantitative, descriptive and non-experimental cross-sectional approach, with a sample of 35 individuals from the Primavera Occidental neighborhood of Bogotá, who were the subject of surveys and interviews. The findings reveal that the majority of respondents experience symptoms that could affect their quality of life and receive both pharmacological and non-pharmacological treatments. It was observed that these residents maintain a balanced diet according to the instruments used, although they show ignorance about the impact of certain foods consumed on their health. The application of the recipe book developed in this study is recommended to improve your diet.

Effectiveness of a mobile app-based individualized non-pharmacological intervention on behavioral and psychological symptoms of dementia in community-dwelling older adults: Study protocol for a randomized control trial

Effectiveness of a mobile app-based individualized non-pharmacological intervention on behavioral and psychological symptoms of dementia in community-dwelling older adults: Study protocol for a randomized control trial

Psychiatric symptoms of Huntington's disease

Huntington's disease (HD) is an autosomal dominant inherited disease, which leads to motor, cognitive and psychiatric symptoms. The diagnosis can be confirmed by genetic testing for extended CAG repeats in the Huntingtin gene. Mental and behavioral symptoms are common in HD and can appear several years before the onset of motor symptoms. The psychiatric symptoms include apathy, depression, anxiety, obsessive-compulsive symptoms and, in some cases, psychoses and aggression. These are currently restricted to symptomatic treatment as disease-modifying treatment approaches are still under investigation. The current clinical practice is based on expert opinions as well as experience with the treatment of similar symptoms in other neurological and mental health diseases. This article provides an overview of the complex psychiatric manifestations of HD, the diagnostic options and the established pharmacological and nonpharmacological treatment approaches.

Preoperative anxiety management for elderly patients undergoing cataract surgery: An integrative review

BackgroundPreoperative anxiety in elderly cataract surgery patients presents challenges, demanding effective non-pharmacological interventions to ensure patient safety. MethodA comprehensive review was conducted on PubMed, CINAHL, and Embase from 2013 to 2023. Twelve experimental studies were analyzed. Interventions such as music therapy, education videos, hand massages, and non-fasting protocols were evaluated, with anxiety measured using various scales and physiological indicators. ResultOverall, the findings highlight the efficacy of these interventions in managing preoperative anxiety among elderly cataract surgery patients. Seven studies measured physiological indicators such as blood pressure or heart rate alongside anxiety scales, with four studies showing significant reductions of those indicators alongside anxiety reduction. ConclusionThese non-pharmacological interventions offer an effective alternative to pharmacological approaches, enhancing patient safety and potentially reducing healthcare costs related to polypharmacy. The international scope of the studies suggests broad applicability across diverse cultural contexts, advocating for their inclusion in hospital protocols.