Non-pharmacological Management Research Articles

Understanding Adolescents' Experiences With Menstrual Pain to Inform the User-Centered Design of a Mindfulness-Based App: Mixed Methods Investigation Study.

Digital interventions are increasingly popular for the provision of nonpharmacological pain interventions, but few exist for adolescents with menstrual pain. User-centered design involves incorporating users across phases of digital health intervention design, development, and implementation and leads to improved user engagement and outcomes. A needs assessment is the first step of this approach. The goal of this study was to conduct a needs assessment to understand menstrual pain management needs and preferences and mindfulness experiences, preferences, and knowledge of adolescents with menstrual pain to inform the future development of an app for managing menstrual pain. We used an explanatory sequential mixed method design that included a survey followed by focus groups. Adolescents aged 13-17 years completed a survey (n=111) and participated in focus groups (n=16). Data were analyzed using descriptive statistics and thematic content analysis and synthesized to provide specific recommendations based on adolescent responses. Adolescents (n=111) who completed the survey reported a moderate understanding of mindfulness and menstrual pain. Over three-quarters (n=87, 78%) of participants practiced some form of mindfulness and 87% (n=97) of survey participants used nonpharmacological pain management strategies. Teens had a moderate perception that mindfulness could help their menstrual pain (mean 4.51/10, SD 2.45, with higher scores suggesting more interest). Themes were generated related to mindfulness experiences, menstrual pain knowledge and experiences, and app functionality. These themes underscored adolescents' need for continued support and flexible access to mindfulness activities; their awareness of multiple influences to pain, with potential for further education in this area; and the need for menstrual pain-specific content, along with content relevant to typical day-to-day experiences of adolescents. Adolescents with menstrual pain have an interest in using a mindfulness app for pain but have unique needs that need to be addressed to ensure app engagement and relevance for this population. Concrete recommendations for future app development are provided.

Client and clinician perspectives about a virtual education and exercise chronic disease management programme for people with hip and knee osteoarthritis.

Osteoarthritis (OA) is one of the most prevalent chronic conditions in Canada. Despite the established benefits of non-pharmacological management (education, exercise) for people with OA, many do not receive treatment, resulting in pain, decreased physical function, and poorer quality of life. Virtual programme options grew significantly during the recent pandemic and may provide longer-term opportunities for increased uptake by reaching individuals otherwise unable to participate. This study explored the experiences and perspectives of clients participating in and clinicians providing the Good Life with osteoArthritis: Denmark (GLA:DTM) Canada remote programme. This qualitative descriptive study recruited 10 clients with hip and/or knee OA and 11 clinicians across Canada using purposive sampling. An online pre-interview survey was completed, and individual interviews were conducted, audio-recorded, transcribed verbatim and analysed independently by two researchers using inductive thematic analysis. Coding and analyses were initially conducted separately by group and then compared and combined. Four overarching themes (and 11 subthemes) were identified: (1) Expected and unexpected benefits of virtual programs; (2) Drawbacks to virtual programs; (3) Programme delivery in a virtual world; (4) Shifting and non-shifting perspectives. Although initially sceptical, after completion of the programme, clients were in favour of virtual delivery with many benefits described. Clinicians' perspectives varied about feedback aimed to correct client movement patterns. Clients and clinicians identified important experiential and procedural elements for virtual chronic disease management programs that include education and exercise. Additional work is needed to understand if the GLA:DTM remote outcomes are equivalent to the in-person programme.

Nursing Care of a Child With Delirium Receiving Venoarterial Extracorporeal Membrane Oxygenation: A Case Report.

Children receiving extracorporeal membrane oxygenation are prone to delirium. This case report describes the nursing care of a child with delirium who received venoarterial extracorporeal membrane oxygenation. Relevant interventions and precautions are also discussed. A 6-year-old girl was admitted to the pediatric intensive care unit with a 2-day history of vomiting and fever. The child underwent cannulation for venoarterial extracorporeal membrane oxygenation. The child was diagnosed with acute fulminant myocarditis, cardiac shock, and ventricular arrhythmia. On the third day of extracorporeal membrane oxygenation, bedside nurses began using the Cornell Assessment of Pediatric Delirium to assess the child for delirium symptoms. The team of physicians and nurses incorporated a nonpharmacologic delirium management bundle into pediatric daily care. Delirium screening, analgesia and sedation management, sleep promotion, and family participation were implemented. During the 18 days of pediatric intensive care unit hospitalization, the child had 6 days of delirium: 1.5 days of hypoactive delirium, 1.5 days of hyperactive delirium, and 3 days of mixed delirium. The child was successfully discharged home on hospital day 22. Caring for a child with delirium receiving venoarterial extracorporeal membrane oxygenation required multidimensional nursing capabilities to prevent and reduce delirium while ensuring safe extracorporeal membrane oxygenation. This report may assist critical care nurses caring for children under similar circumstances.

EFFECTS OF GARCINIA MANGOSTANA LINN PERICARP EXTRACT AND PHYSICAL EXERCISE ON ATHEROEMBOLIC HISTOPATHOLOGIC FEATURES KIDNEY IN WISTAR RATS WITH METABOLIC SYNDROME

Background: Renal atheroembolism is an under-recognized cause of renal failure . Atheroembolism is caused by cholesterol crystals from ulcerated atherosclerotic plaques and is influenced by inflammation and endothelial dysfunction. The formation of complicated atherosclerotic lesions is a prerequisite for the development of cholesterol crystal emboli. Non-pharmacological therapeutic management (such as diet and physical exercise) is an important factor in preventing and reducing the risk of atherogenesis. Garcinia Mangostana Linn pericarp can inhibit the process of atherosclerosis through the reduction of free radicals and improvement of endothelial function Objective: To investigate the effect of Garcinia Mangostana Linn Pericarp administration along with Physical Exercise on the histopathologic features of renal atheroembolism in Wistar rats with metabolic syndrome. Methods: This study is a true experimental study with research subjects in the form of male Rattus norvegicus Wistar rats which were randomly divided into 3 groups. K (not given therapy), P1 (garcinia pericarp extract 800 mg / kg / day with physical exercise), and P2 (nanoemulsion 50 mg / kg / time of administration with physical exercise). Results: In the group treated with garcinia pericarp extract 800 mg/kg bw/day with physical exercise and the group with nanoemulsion 50 mg/kg bw/day with physical exercise, there were no fatty streaks, inflammation, and impaired myocyte coherence. There was 0-5% fibrous connective tissue, one layer of foam cell layer and myocyte-lipid, no cholesterol crystal embolism was found. Conclusion: The administration of Garcinia Mangostana Linn pericarp extract and/or nanoemulsion with physical exercise can have an effect on the histopathological picture of the kidneys of Wistar rats with metabolic syndrome. There was no difference in effect between the two treatments. However, it could not be compared with the group that was not given any treatment because it had died completely before the end of the study period.

Plasma miR-203a-3p as a Novel Predictor of Dementia in Patients with Parkinson's Disease.

The early detection of cognitive decline in Parkinson's disease is important for providing drug therapy and non-pharmacological management. The circulating microRNAs present in plasma are promising biomarkers of PD with dementia (PDD) due to their critical roles in synaptic plasticity and the regulation of neurodegeneration-associated proteins. In this study, we aimed to identify plasma microRNAs that may differentiate PD with or without cognitive impairment. Global microRNA expression was obtained from a discovery set of 123 participants who were divided into four groups, namely normal controls (HC), PD with no dementia (PDND), PD with mild cognitive impairment (PD-MCI), and PDD, using next-generation sequencing. The BOLD selector was used for microRNA candidate selection. Six miRNAs, namely miR-203a-3p, miR-626, miR-662, miR-3182, miR-4274, and miR-4295, were clustered as potential candidates for use in identifying PDND from PD-MCI. Another independent cohort of 120 participants was further recruited in a validation step in order to detect candidate microRNAs via droplet digital PCR (ddPCR), which was used for its high sensitivity in detecting low miRNA concentrations. Our results show that the ratio of miR-203a-3p/miR-16-5p, in which miR-16-5p was used as a reference control miRNA, was significantly increased in PDD compared to that seen in PD-MCI and PDND individually, and was negatively correlated with the MoCA scores (r = -0.237, p = 0.024) in patients with PD. However, there was no significant difference in the ratio of miR-203a-3p/miR-16-5p between HC and PDND, PD-MCI, or PDD individually. The ROC curve of the logistic regression model, factoring in the variables of age, the ratio of miR-203a-3p/miR-16-5p, and the UPDRS III score, demonstrated an AUC of 0.883. Our findings suggest that the ratio of miR-203a-3p/miR-16-5p, used with age and motor score, could be a predictor of dementia among PD patients.

The Effect of Acupressure Points L14 and SP 6 on Pain Intensity in the First Stage Labor

Purpose: The aim of this study is to investigate the effectiveness of acupressure points L14 and SP6 in reducing the intensity of pain during the first stage of labor at PMB Meita in Sidoarjo. Recognizing the physiological and psychological impacts of labor pain on both mothers and infants, the research seeks to assess the potential of acupressure as a non-pharmacological intervention to alleviate labor pain and enhance maternal well-being during childbirth.
  
 Methods: This research adopts a Quasi Experimental Design with a One Group Pre-Post Test Design approach. The study population comprises maternity mothers receiving prenatal care at PMB Meita in Sidoarjo. Accidental sampling is utilized to select a sample of 30 respondents. Data collection involves observing acupressure treatments using the Numerical Rating Scale (NRS) to measure pain intensity. Univariate analysis, employing frequency distribution, and bivariate analysis, utilizing paired t-test, are conducted to analyze the data.
  
 Results and Discussion: The findings indicate that the mean labor pain intensity before administering acupressure points SP6 and L14 was 6.48, which decreased to 3.84 after acupressure treatment. The bivariate analysis demonstrates a significant effect of the SP6 and L14 acupressure technique on reducing labor pain during the active phase I of labor at PMB Meita in Sidoarjo (p–value 0.0001 <0.05), with a mean decrease of 2.64. These results suggest that acupressure therapy holds promise as a complementary intervention for managing labor pain and enhancing maternal comfort during childbirth.
  
 Implications of the Research: The research outcomes have implications for midwifery care and maternal health practices, particularly in the context of promoting non-pharmacological pain management strategies during labor. By demonstrating the effectiveness of acupressure in reducing labor pain intensity, the study highlights the importance of integrating complementary therapies into maternity care protocols to improve maternal experiences and outcomes during childbirth.
  
 Originality/Value: This study contributes to the literature by providing empirical evidence of the efficacy of acupressure points L14 and SP6 in alleviating labor pain during the first stage of labor. By employing a quasi-experimental design and utilizing specific assessment tools, the research offers valuable insights into the potential benefits of acupressure therapy as a non-pharmacological intervention for pain management in childbirth. The findings underscore the importance of holistic and individualized approaches to maternity care, emphasizing the integration of complementary therapies to enhance maternal well-being and satisfaction during the childbirth process.

The detect consensus report on Attention Deficit/Hyperactivity Disorder and its management among Turkish children and adolescents (Detect: consensus report on ADHD among Turkish youth).

Attention Deficit/Hyperactivity Disorder (ADHD) is one of the most common and heritable neurodevelopmental disorders which may last through the life-span. A consensus report on diagnosis and management of ADHD among Turkish youth was prepared previously. However, the participants as well as the management options were rather limited and developments in the past decade necessitated a revision and update of the consensus. Therefore, this review aims to summarize the consensus among Child and Adolescent Psychiatrists from Türkiye on the nature and management of pediatric ADHD. For those aims, the etiology of ADHD, diagnostic and evaluation process, epidemiology, developmental presentations, differential diagnoses and comorbidities, course/outcome and pharmacological as well as non-pharmacological management options were reviewed and suggestions for clinical practice are presented. Since ADHD is a chronic disorder with wide-ranging effects on functionality that is frequently accompanied by other mental disorders, a multidimensional therapeutic approach is recommended. However, since the disorder has neurobiological basis, pharmacotherapy represents the mainstay of treatment. Additional therapies may include psychosocial therapy, behavioral therapy, school-based therapeutic approaches, and family education. This review provides recommendations for ADHD at the national and global levels. It contains information about ADHD that will contribute to and facilitate clinicians' decision-making processes. It is advisable to consider this guideline in clinical practice.

The Benefits and Barriers of Providing Non-Pharmacological Pain Relief to Women in Labour during COVID-19: A Qualitative Study of Midwives in South Africa

Pregnancy is an exceptional event in a woman’s life. As a result of the intense pain associated with childbirth, women require encouragement and support during this crucial phase. Midwives play a crucial role in the maternal care paradigm, managing labour pain alongside ensuring the mother and baby’s safety during the labour process. This study explored midwives’ perspectives concerning the utilisation and barriers of non-pharmacological labour pain reduction methods during COVID-19 in Matjhabeng Municipality hospitals in South Africa’s Free State Province. Ten midwives participated in a semi-structured interview wherein the audio was recorded and transcribed verbatim. The data were analysed using Tesch’s approach for open-coding data analysis. Midwives’ experiences with non-pharmacological therapeutic options for relieving labour pain were varied. They used mobilisation techniques, warm bathing, deep breathing exercises, back massaging, and psychological support. Midwives affirmed that non-pharmacological labour pain interventions were poorly implemented because of staff shortages, heavy workload, and COVID-19 regulations at the time. In efforts to address the obstacles in managing labour pain and alleviate the pain of women during labour, midwives recommended the provision of education and advocacy, the employment of additional midwives and auxiliary staff, and improvement in hospital infrastructure. Due to staff shortages, heavy workloads, and COVID-19 restrictions that limit birth companions, non-pharmacological pain reduction methods are not properly implemented. Health education; employing additional midwives, professional doulas, and students; and improving health infrastructure are midwives’ concerns. Prioritising midwife training in non-pharmacological labour pain management is crucial for delivering the best possible care during childbirth.

Bibliometric Analysis of the Top-100 Cited Articles on Postoperative Sleep During the Last 10 Years

Background The quality of postoperative sleep is vital for surgical patients. A large number of patients after surgery suffer from sleep disorders. There are plenty of studies on postoperative sleep disorders. The aim of this study is to do a bibliometric analysis of the top-100 cited articles on postoperative sleep during the last 10 years, providing some clues to the investigators. Methods Publication retrieval was conducted in Web of Science (WoS) Core Collection on 12 January 2024. The 100 most frequently cited articles on postoperative sleep were identified and analyzed by VOSviewer and Excel. We mainly analyzed the publication year, citations, usage count, author, institution, country/region, journal and keywords. Results The number of citations ranged from 20 to 124 in WoS Core Collection, with a median of 35 and a mean of 40.79. USA (n = 39), China (n = 22) and Canada (n=9) ranked top three in terms of the number of publications and citations. Univ Copenhagen, Univ Toronto, and Lundbeck Ctr Fast Track Hip & Knee Arthroplasty were the top three institutions leading the researches on postoperative sleep. The journals specialized in Anesthesiology recorded the most high-quality articles. Postoperative pain, sleep, sleep quality, quality of life and postoperative delirium were the highly used keywords, while general anesthesia, fatigue, cognitive impairment and postoperative cognitive dysfunction were the latest topics. Conclusion At present, postoperative sleep researches have focused on the impacts of postoperative sleep disorders and pharmacological therapies to postoperative sleep disorders. However, non-pharmacological management of postoperative sleep should be paid more attention in the future.

Quality Improvement Protocol: Improving the Use of Nonpharmacological Pain Management Strategies within the Inpatient Hospital Setting.

Background: There are many nonpharmacological pain management services available to hospitalized youth; however, not all youth are offered these services. Lack of knowledge about resources, difficulty with the referral process, and lack of understanding about nonpharmacological pain management services and when to refer patients are among the main reasons for lack of utilization. Quality improvement (QI) initiatives have grown within hospital settings and can serve to create change in fast-paced environments. Methods: The current QI project aimed to pilot an educational program to increase the use of nonpharmacological pain management interventions. Staff located on one floor of a pediatric hospital on the East Coast were selected because of the wide range of patient presentations and likelihood that these youth may present with pain during the hospitalization. Following several incremental changes and multiple PDSA cycles, utilization of nonpharmacological pain management services was assessed. Results: Education only did not result in increases in nonpharmacological pain management services ordered. A best practice alert for nursing staff, implemented within the electronic medical record, led to a 50% increase in services ordered. Conclusions: These results suggest that to improve use of nonpharmacological pain management strategies, hospital systems may need to consider more than education.

Prescriber Acceptability of a Direct-to-Patient Intervention for Benzodiazepine Receptor Agonist Deprescribing and Behavioural Management of Insomnia in Older Adults.

Behavioural treatments are recommended first-line for insomnia, but long-term benzodiazepine receptor agonist (BZRA) use remains common and engaging patients in a deprescribing consultation is challenging. Few deprescribing interventions directly target patients. Prescribers' support of patient-targeted interventions may facilitate their uptake. Recently assessed in the Your Answers When Needing Sleep in New Brunswick (YAWNS NB) study, Sleepwell (mysleepwell.ca) was developed as a direct-to-patient behaviour change intervention promoting BZRA deprescribing and non-pharmacological insomnia management. BZRA prescribers of YAWNS NB participants were invited to complete an online survey assessing the acceptability of Sleepwell as a direct-to-patient intervention. The survey was developed using the seven construct components of the theoretical framework of acceptability (TFA) framework. Respondents (40/250, 17.2%) indicated high acceptability, with positive responses per TFA construct averaging 32.3/40 (80.7%). Perceived as an ethical, credible, and useful tool, Sleepwell also promoted prescriber-patient BZRA deprescribing engagements (11/19, 58%). Prescribers were accepting of Sleepwell and supported its application as a direct-to-patient intervention.

Pain and the Non-Pharmacological Management of Pain in People with Parkinson's Disease.

Pain is a distressing and universal experience, yet everyone's pain experience is influenced by a complex array of biological, psychological, and social factors. For people with Parkinson's disease (PwP), these biopsychosocial factors include neurodegeneration and the psychological and social factors that accompany living with a chronic, neurodegenerative condition in addition to the factors experienced by those in the general population (e.g., living with co-morbidities such as osteoarthritis). The way these factors influence each individual is likely to determine which pain management strategies are optimal for them. This review first describes pain and the biopsychosocial model of pain. It explores how pain is classified in Parkinson's disease (PD) and describes the three main types of pain: nociceptive, neuropathic, and nociplastic pain. This background provides context for a discussion of non-pharmacological pain management strategies that may aid in the management of pain in PwP; exercise, psychological strategies, acupuncture and massage. While there is little PD-specific research to inform the non-pharmacological management of pain, findings from current PD research are combined with that from chronic pain research to present recommendations for clinical practice. Recommendations include assessment that incorporates potential biopsychosocial contributors to pain that will then guide a holistic, multi-modal approach to management. As exercise provides overall benefits for PwP, those with chronic pain should be carefully monitored with exercise prescribed and adjusted accordingly. Research is needed to develop and evaluate multi-modal approaches to pain management that are delivered in a biopsychosocial framework.

The Development and Implementation of the Fast-Pace Assessment Framework and Tiered Analgesic Orders for Opioid Optimization

BackgroundWithin the context of the opioid epidemic, changes needed to be made in the prescription and administration of analgesics. The purpose of this paper is to describe the development and implementation of a project that utilized a holistic pain assessment framework and introduced new order sets to guide the integration of nonopioid, opioid, and co-analgesics in a quaternary care medical center. MethodsAn interdisciplinary team updated policies and procedures for pain assessment and opioid administration and created new analgesic order sets for both adult and pediatric patients. Following requisite approvals, these order sets were integrated into the electronic health record. Education of clinicians, patients, and caregivers was provided to facilitate implementation of these new clinical practices. ResultsPrescribers’ levels of adherence with the use of the pain order sets ranged from 80% to 90% and no adverse effects were reported. Education of nursing staff was incorporated into hospital orientation. Ongoing evaluations are providing insights into how the new policies and procedures can be optimized to ensure reliable, safe, and effective pain management. ConclusionsSince the implementation of the opioid optimization project, adherence with the tiered, multimodal approach to analgesic prescribing is high. Next steps include both qualitative and quantitative evaluations of the benefits and challenges associated with this practice change. For example, systems will be developed to monitor nurses’ adherence with the implementation of the pain order sets and the use of both pharmacologic and nonpharmacologic pain management interventions.

Estimulación del ganglio de Gasser para dolor neuropático del trigémino refractario

Background and objectivePainful trigeminal neuropathy is a complex clinical entity due to its severity and refractoriness to pharmacological and interventional management. We describe our experience in treating refractory painful trigeminal neuropathy (RPTN) with Gasserian ganglion stimulation (GGS). Materials and methodsSix patients with RPTN were treated with GGS in our unit between 2019 and 2022. The following data were collected: socio-demographic characteristics, triggering event, duration of the disease and treatment received prior to surgery, pre- and post-intervention visual analogue scale score, follow-up time, and pre- and post-intervention functionality and quality of life. ResultsAll patients were women who had received aggressive first-, second-, and third-line pharmacological, non-pharmacological, and interventional management before being referred for GGS. Patients reported a 50-72% decrease in pain on visual analogue scale and improved functionality during follow-up. ConclusionsGGS is a promising therapeutic alternative for patients with RPTN. Although the initial outcomes and experience are encouraging, RPTN is recommended on the basis of safety, reproducibility, and trends observed in clinical practice.

Electric massage chairs reduce labor pain in nulliparous patients: a randomized crossover trial

BACKGROUND: Labor pain varies significantly among pregnant women, ranging from mild to extremely distressing. Non-pharmacologic pain relief methods during vaginal birth are increasingly popular, either as a complement to pharmacologic agents or at times as the primary method of pain relief. Multiple trials have reported that manual or by-hand massage reduces labor pain. The effectiveness of full-body mechanical massage using electric massage chairs on labor pain remains unexplored.OBJECTIVE: To evaluate mechanical massage using electric massage chair on labor pain in nulliparous women.STUDY DESIGN: A randomized counterbalanced crossover trial was conducted in a university hospital in Malaysia from August 2022 to February 2023. Eligible nulliparas in labor with a minimum labor pain score of 5 (0-10 numerical rating scale) were enrolled. Participants were randomized to 30 minutes on the massage chair with mechanical massage followed by 30 minutes on the massage chair without mechanical massage, or the other way around in massage sequence. The primary outcome was change in pain score comparing pain with and without mechanical massage as a paired comparison for the entire trial participants. Secondary outcomes were across arms analyses of maternal and neonatal outcomes. The paired t-test, t test, Mann- Whitney U test, Chi square test and Fisher exact test were used as appropriate for the data.RESULTS: 208 women were randomized; 104 to each intervention. Data was available from 204 participants (103 randomized to massage first and 101 to no massage first). The primary outcome of change in labor pain score (0-10 Numerical Rating Scale, NRS) after massage and no massage (all participants included after crossover, paired t-test analysis) was mean±standard deviation 4.51±2.3 vs 5.38±2.1 mean difference - 0.87 (95% CI -1.14 to -0.59), p<0.001, a significant reduction in pain score after electric chair mechanical massage compared to no massage. On the across randomized arms secondary analyses, labor pain score after their first massage chair session was 4.35±2.52 (randomized to massage first, received massage as initial intervention) vs 5.66±1.73 p<0.001 (randomized to no massage first, received no massage as initial intervention) mean difference -1.31 (95% CI -1.91 to -0.748), a significant reduction after mechanical massage. Other distal maternal outcomes (mode of delivery, labor analgesia, duration of labor and maternal agreement that mechanical massage is effective for labor pain) and neonatal outcomes (Apgar score at 1 and 5 minutes, cord artery blood pH and base excess, and neonatal admission) were not different across randomized arms.CONCLUSION: Mechanical massage using an electric massage chair significantly reduces labor pain, offering a potential non-pharmacologic pain management option during labor.

Treatment-emergent sexual dysfunctions due to antidepressants: A primer on assessment and management strategies

Antidepressants (ADs) are among the most commonly prescribed drugs worldwide. Persons with mental illness taking ADs commonly report sexual dysfunction (SD) related to treatment. A brief discussion on the neurobiology of sexual functioning and mechanism of treatment-emergent SD (TESD) was performed. The incidence of prevalence of TESD in various studies has been reviewed. TESD impacts patients as it frequently leads to nonadherence, while psychiatrists have challenges in proceeding forward with treatment in such patients. Assessment of patients with suspected TESD is described with a focus on practical tips for clinicians. Five strategies (watchful waiting, drug holiday, downward titration, switching, and add-on therapy) to manage TESD have been extensively discussed with evidence in the literature. Each strategy comes with its own bag of advantages and drawbacks, which have been pointed out for simplicity. A detailed discussion on individual pharmacological strategies is given, and options for non-pharmacological management that can be tried are enlisted. Common clinical case scenarios have been discussed to incorporate the implementation of this literature.

Efforts to Reduce Headache in Grade II Tuberculosis Meningitis Patients: A Case Study

Tuberculous meningitis is a life-threatening disease and can cause severe manifestations and neurological disorders. Headache is one of the symptoms that occurs in patients with tuberculosis meningitis. An 18-year-old woman was admitted with complaints of unilateral headache in the holocranial region with a description of throbbing pain on a scale of 6 (0-10), which decreases when she closes her eyes and sleeps. The pain is felt continuously and slightly interferes with activities. This case study aim to describe intervention that can reduce headache in Grade II Tuburculosis Meningitis. Nursing actions are given to minimize the pain experienced by patients with tuberculosis meningitis, namely carrying out pharmacological and non-pharmacological pain management by collaborating in giving paracetamol 500 mg and teaching non-pharmacological pain management by facilitating patient rest, teaching deep breathing relaxation. In addition, immediate treatment is needed by administering anti-tuberculosis drugs (OAT) and corticosteroids. Corticosteroids are given to minimize complications and death rates by suppressing the inflammatory response in the subarachnoid space. After being given care, the problem of acute pain is partially resolved so that further treatment is needed with participation of the patient and family for the success of nursing care. It is necessary to improve pain management in treating patients with TB meningitis headaches.

Effectiveness of slow deep breathing therapy on lowering blood pressure in hypertensive patients: A case study

Introduction: Hypertension is a cerebral vascular disorder in the form of narrowing of cerebral blood vessels, resulting in reduced oxygen and nutrient supply to the brain. It is characterized by an increase in systolic blood pressure &gt;140 mmHg and diastolic pressure &gt;90 mmHg. Non-pharmacological management is needed to be applied in lowering blood pressure. Slow deep breathing therapy exercises are done by breathing long and deep breaths slowly can stimulate the secretion of endorphins neurotransmitters in the autonomic nervous system which has an effect on decreasing the work of sympathetic nerves, increasing the work of parasympathetic nerves whose effects can affect heart rate to be slow and also vasodilation occurs in blood vessels. Objective: To lower blood pressure in hypertensive patients by using slow deep breathing exercises. Methods: The method used in this study used a case study with pre and post intervention, patients were given slow deep breathing exercises by breathing in through the nose for 3 seconds until they felt that the stomach expanded then held their breath for 3 seconds, then exhaled slowly through the mouth for 6 seconds, and repeated all steps for 15 minutes. Results: Obtained results of a decrease in blood pressure in patients after being given slow deep breathing exercises. Conclusion: Slow deep breathing therapy exercises with appropriate methods and procedures can be an alternative to lower blood pressure in hypertensive patients

Reducing Dysmenorrhea In School-Aged Teenagers By Practising Yoga: A Literature Review

Dysmenorrhea is the term used to describe lower abdominal pain that women feel during their menstrual cycle. Teens suffering from menstrual pain typically have lower abdominal cramps and other symptoms that interfere with day-to-day activities. An alternative to medication for treating menstruation discomfort is yoga. This study aimed to ascertain whether yoga may lessen dysmenorrhea in teenagers enrolled in school. This approach uses the MEDLINE/PubMed, Scopus, and Google Scholar databases to review literature. The PRISMA approach utilized for this literature review was adhered to during the article selection process. The research's selection criteria comprised works published within the last five years, specifically from 2018 to 2023. Yoga was employed to lessen dysmenorrhea discomfort in the research population, consisting of young women with monthly pain. Between 2018 and 2023, 666 studies were discovered to have satisfied the publication selection requirements. Fifteen journals that fit the requirements for this study were identified through the PRISMA route search. According to the data, yoga has been shown to have a calming effect on teenage menstrual discomfort in 15 journals. Thus, yoga is a successful non-pharmacological management strategy for lowering dysmenorrhea in school-age teenagers. This is because yoga may be calming, encouraging the body to release endorphins, which function as organic painkillers. Yoga is a mild activity that helps the body avoid stiffness, pressure, pain, and tiredness while increasing flexibility safely. It enhances lung capacity when breathing, improves blood circulation, eases physical and emotional stress, and lessens pain. Additionally, practising yoga helps women with PMS feel more at ease by reducing dangerous inflammatory secretions. Key Words: Yoga; Dysmenorrhea; Menstrual; Teenagers

Laporan Kasus : Penanganan Pada Klien Lanjut Usia Dengan Gangguan Pola Tidur Menggunakan Terapi Benson

Introduction; Sleep pattern disturbances are often experienced by individuals who experience a decline in health conditions both physically and psychologically. Sleep pattern disorders in the elderly can refer to health conditions that require further treatment through pharmacological and non-pharmacological management such as Benson therapy. Objective; to describe the effectiveness of providing Benson therapy to elderly people who experience sleep pattern disorders. Method; The implementation of this case study uses a nursing process approach through five stages, namely assessment, establishing a nursing diagnosis, developing interventions, implementing nursing plans and evaluating the results of actions. Results; After applying Benson therapy seven times, elderly people who had disturbed sleep patterns experienced an improvement in their condition. Conclusion; The evaluation results after implementing action on elderly people with sleep pattern disorders showed that the nursing problem was resolved.