Non-pharmacological Strategies Research Articles

Core competencies in palliative care among oncology nurses: An observational study

BACKGROUND: Palliative care requires a collaborative approach from a multidisciplinary team, incorporating nurses with ethical, clinical, communicative-relational, psychosocial, and teamwork skills. However, many professionals feel unprepared to face end-of-life challenges, highlighting a lack of skills, especially regarding psychosocial and spiritual aspects. AIM: The purpose of this study is to explore nurses' self-perception of competencies in palliative care. METHODS: A single-center descriptive observational study was conducted among palliative and non-palliative care nurses at the Fondazione IRCCS Istituto Nazionale dei Tumori in Milan (INT), using the short Italian version of the Professional Competence Scale (PCSQ). The Kruskal-Wallis test was used along with multivariate ANOVA for statistical analysis. RESULTS: 122 nurses participated (response rate: 52%), predominantly women (78%), aged 25-34 (50%), with a degree (46%) and over 10 years of experience (41%). The majority had no experience (71%) in palliative care, while 16% were currently working in this field. Statistical analysis revealed no significant correlations between educational level and responses. The Kruskal-Wallis test showed that experience in palliative care significantly influenced self-assessment scores, such as in activating non-pharmacological management strategies (p=0.004). CONCLUSIONS: Nurses perceive high competence in ethical and clinical decision-making in palliative care, influenced more by experience than by training. Addressing patients' subjective needs and using non-pharmacological interventions remain a challenge for nurses not working in palliative care settings.

Medical Therapy for Peripheral Artery Disease.

Patients with lower extremity peripheral artery disease (PAD) are at high risk for major adverse cardiovascular events (MACE) and major adverse limb events (MALE). This manuscript will review the current evidence for medical therapy in patients with PAD according to different clinical features and the overall cardiovascular (CV) risk. The management of PAD encompasses non-pharmacologic strategies, including lifestyle modification such as smoking cessation, supervised exercise, Mediterranean diet and weight loss as well as pharmacologic interventions, particularly for high risk patients. Benefits for reduction of CV and limb outcomes have been demonstrated for new therapies, including antithrombotic therapy (i.e., low-dose rivaroxaban plus aspirin), lipid lowering therapy (i.e., proprotein convertase subtilisin/kexin type 9inhibitors), and glucose lowering therapy (i.e., sodium-glucose cotransporter-2inhibitors and glucagon-like peptide-1receptor agonists). However, the adoption of these therapies in PAD remains suboptimal in practice. Implementation science studies have recently shown promising results in PAD patients. Comprehensive medical and non-medical management of PAD patients is crucial to improving patient outcomes, mitigating symptoms, and reducing the risk of MACE and MALE. A personalized approach, considering the patient's overall risk profile and preference, is essential for optimizing medical management of PAD.

Non-Pharmacological Strategies for Managing Sarcopenia in Chronic Diseases.

This article focuses on a range of non-pharmacological strategies for managing sarcopenia in chronic diseases, including exercise, dietary supplements, traditional Chinese exercise, intestinal microecology, and rehabilitation therapies for individuals with limited limb movement. By analyzing multiple studies, the article aims to summarize the available evidence to manage sarcopenia in individuals with chronic diseases. The results strongly emphasize the role of resistance training in addressing chronic diseases and secondary sarcopenia. Maintaining the appropriate frequency and intensity of resistance training can help prevent muscle atrophy and effectively reduce inflammation. Although aerobic exercise has limited ability to improve skeletal muscle mass, it does have some positive effects on physical function. Building upon this, the article explores the potential benefits of combined training approaches, highlighting their helpfulness for overall quality of life. Additionally, the article also highlights the importance of dietary supplements in combating muscle atrophy in chronic diseases. It focuses on the importance of protein intake, supplements rich in essential amino acids and omega-3, as well as sufficient vitamin D to prevent muscle atrophy. Combining exercise with dietary supplements appears to be an effective strategy for preventing sarcopenia, although the optimal dosage and type of supplement remain unclear. Furthermore, the article explores the potential benefits of intestinal microecology in sarcopenia. Probiotics, prebiotics, and bacterial products are suggested as new treatment options for sarcopenia. Additionally, emerging therapies such as whole body vibration training, blood flow restriction, and electrical stimulation show promise in treating sarcopenia with limited limb movement. Overall, this article provides valuable insights into non-pharmacological strategies for managing sarcopenia in individuals with chronic diseases. It emphasizes the importance of a holistic and integrated approach that incorporates exercise, nutrition, and multidisciplinary interventions, which have the potential to promote health in the elderly population. Future research should prioritize high-quality randomized controlled trials and utilize wearable devices, smartphone applications, and other advanced surveillance methods to investigate the most effective intervention strategies for sarcopenia associated with different chronic diseases.

Application Of Pbm-Nir Therapy For Postpartum Mother's Discomfort In Maternity Nursing Care

Normal post partum is post partum discomfort due to uterine involution. Uterine involution in patients can cause pain in the uterus called afterpains. Discomfort caused by uterine involution requires various treatments to minimize the pain felt by the mother so that the mother's comfort can return. This can be overcome with non-pharmacological pain management strategies through innovative near infrared phototherapy or near infrared photobiomodulation (PBM NIR). The aim of this research is to analyze the results of implementing pain management with non-pharmacological PBM NIR therapy in normal post-partum mothers with post-partum discomfort nursing problems. Case study that focuses on the implementation of non-pharmacological nursing pain management techniques with PBM NIR therapy. The case study subjects were 3 normal post-partum maternal patients with the same problem, namely post-partum discomfort in the obstetrics room at the Muhammadiyah Hospital in Palembang. The results of the study showed that the implementation of non-pharmacological pain management techniques with PBM NIR therapy had an effective effect on dealing with post-partum discomfort with complaints of decreased discomfort, decreased moaning, and strong uterine contractions. Implementation of pain management can improve the comfort status of normal postpartum mothers. This study makes an important contribution to understanding of the role of nonpharmacological techniques in postpartum pain management, as well as highlighting the importance of implementing innovative therapies for labor, as well as highlighting the importance of implementing innovative therapies to improve the quality of care in postpartum mothers.

Non-pharmacological Treatment for Nontuberculous Mycobacterial Pulmonary Disease.

Nontuberculous mycobacterial pulmonary disease (NTM-PD) arises from the exposure of susceptible hosts to a diverse group of environmental mycobacteria. The emphasis on non-pharmacological strategies is motivated by widespread presence of nontuberculous mycobacteria (NTM) in various environments and the inconsistent success rates of pharmacological treatments. Modifiable factors contributing to NTM-PD development include impaired airway clearance, low body mass index, gastroesophageal reflux disease, and exposure to NTM habitats. This suggests that lifestyle and environmental modifications could affect disease development and progression. The review highlights several modalities that can modify the risk factors. Airway clearance techniques, informed by the "gel-on-brush" model of the bronchial epithelium, aims at enhancing mucociliary clearance and have potential in alleviating symptoms and potentially improving lung function. The impact of nutritional status is also examined, with a lower body mass index linked to an increased risk and progression of NTM-PD, indicating the importance of targeted nutritional support. Additionally, the theoretical and epidemiological links between gastroesophageal reflux disease and NTM-PD advocates for careful management of reflux episodes. Understanding the risk of NTM transmission through environmental exposure to contaminated water and soil is also crucial. Strategies to mitigate this risk, including effective water management and minimizing soil contact, are presented as vital preventive measures. In conclusion, the review supports the inclusion of non-pharmacological treatments within a comprehensive NTM-PD management strategy, alongside conventional pharmacological therapies. This integrated approach seeks to improve the overall understanding and handling of NTM-PD.

The comparison of the effect of non-pharmacological pain relief and pharmacological analgesia with remifentanil on fear of childbirth and postpartum depression: a randomized controlled clinical trial

IntroductionChildbirth may be associated with psychological, social, and emotional effects and provide the background for women’s health or illness throughout their life. This research aimed at comparing the impact of non-pharmacological pain relief and pharmacological analgesia with remifentanil on childbirth fear and postpartum depression.Materials and methodThis randomized clinical trial with two parallel arms was conducted on 66 women with term pregnancy referred to Taleghani Hospital in Tabriz for vaginal delivery during September 2022 to September 2023. First, all of the eligible participants were selected through Convenience Sampling. Then, they were randomly assigned into two groups of pharmacological analgesia with remifentanil and non-pharmacological analgesia with a ratio of 1:1 using stratified block randomization based on the number of births. Before the intervention, fear of childbirth (FOC) was measured using Delivery Fear Scale (DFS) between 4 and 6 cm cervical dilatation. Pain and fear during labor in dilatation of 8 cm were measured in both groups using VAS and DFS. After delivery, FOC was assessed using Delivery Fear Scale (W DEQ Version B) and postpartum depression using the Edinburgh’s postpartum depression scale (EPDS). Significance level was considered 0.05. Mean difference (MD) was compared with Independent T-test and ANCOVA pre and post intervention.ResultsThe mean score of FOC in the non-pharmacological analgesia group was significantly lower than that in the pharmacological analgesia group after the intervention by controlling the effect of the baseline score (MD: -6.33, 95%, Confidence Interval (CI): -12.79 to -0.12, p = 0.04). In the postpartum period, the mean score of FOC in the non-pharmacological analgesia group was significantly lower than that in the pharmacological analgesia group after controlling the effect of the baseline score (MD: -21.89; 95% CI: -35.12 to -8.66; p = 0.002). The mean score of postpartum depression in the non-pharmacological analgesia group was significantly lower than that in the pharmacological analgesia group (MD: -1.93, 95% CI: -3.48 to -0.37, p = 0.01). Trial registration: Iranian Registry of Clinical Trials (IRCT): IRCT20170506033834N10. Date of registration: 05/07/2022 Date of first registration: 05/07/2022. URL: https://www.irct.ir/trial/61030; Date of recruitment start date05/07/2022.ConclusionThe study results indicated a reduction in FOC and postpartum depression among parturient women receiving non-pharmacological strategies with active participation in childbirth compared to women receiving pharmacological analgesia. Owing to the possible side effects of pharmacological methods for mother and fetus, non-pharmacological strategies with active participation of the mother in childbirth are recommended to reduce the FOC and postpartum depression.

Advancing Postoperative Pain Management in Oral Cancer Patients: A Systematic Review.

The goal of this review is to shed light on the management of orofacial discomfort after a cancer diagnosis in the head and neck region. A search was conducted on PubMed, Scopus, and Web of Science to identify studies on postoperative pain control in oral cancer. The review included open-access research, investigations into pain management, randomized clinical trials, retrospective studies, case-control studies, prospective studies, English-written studies, and full-text publications. Exclusion criteria included animal studies; in vitro studies; off-topic studies; reviews, case reports, letters, or comments; and non-English language. Three reviewers independently accessed databases and assigned a quality rating to the chosen articles. The review explores postoperative pain management in oral cancer patients; highlighting persistent opioid use; the efficacy of adjuvant drugs, such as gabapentin; and a multimodal approach. It emphasizes the need for personalized pain management, recognizing individual pain perception and tailoring interventions. Integrating pharmacological and non-pharmacological strategies is crucial for comprehensive pain management. The review also serves as a guide for future research, emphasizing the need for standardized methodologies and diverse participant populations.

A Randomized Controlled Trial to Assess the Effectiveness of Warm Foot Soak Therapy on Reduction of Blood Pressure among Hypertensive Patients

Introduction : Hypertension is known as the “silent killer” because of its uncertain symptom. Therefore, early detection efforts are needed such as regular blood pressure check and effective management. Both Pharmacological and Non-pharmacological management strategies for hypertension. This study aimed to determine the effectiveness of one of the non-pharmacological management : “warm water foot soak therapy” in reduction of blood pressure among hypertensive patients. Method : Experimental study design - Randomized Controlled Trial was conducted among 60 hypertensive patients using convenient sampling technique. Participants were randomly and equally allocated into Experimental and Control group with the help of computer generated randomization list. Sequentially Numbered Opaque Sealed Envelope (SNOSE) were used for allocation concealment. Experimental group received “Warm foot soak therapy” of both feet for 10-15 cm above ankle in warm water of temperature 37-40 degree Celsius for 15 minutes, once a day for 3 consecutive days. Before and after intervention blood pressure assessment were taken in both groups. Data were analyzed using SPSS ver. 27 Result : Homogenity of socio-demographic, clinical and pre-intervention blood pressure among both groups were statistically established using chi-square test (p> 0.05). Paired t test concluded that, warm foot soak therapy were having statistically significant effect on blood pressure ( p < 0.05) and there was a significant reduction in blood pressure among hypertensive patients (p=0.01). The study also discovered that there is no significant association between selected sociodemographic & clinical variables with pre-interventional change in blood pressure except for the dietary pattern (Veg) in both groups & presence of comorbidity (DM) in experimental group among hypertensive patients at level of significance 0.05. Conclusion : The study demonstrated that warm foot soak therapy have an effect on reduction of blood pressure among hypertensive patients.

Optimizing breathlessness management in amyotrophic lateral sclerosis: insights from a comprehensive systematic review

BackgroundBreathlessness is a prevalent symptom affecting the quality of life (QOL) of Amyotrophic Lateral Sclerosis (ALS) patients. This systematic review explored the interventions for controlling breathlessness in ALS patients, emphasizing palliative care (PALC), non-invasive ventilation (NIV), opioids, and non-pharmacological strategies.MethodsA comprehensive search of PubMed, Cochrane Library, and Web of Science databases was conducted. Eligibility criteria encompassed adults with ALS or motor neuron disease experiencing breathlessness. Outcomes included QOL and symptom control. Study designs comprised qualitative studies, cohort studies, and randomized controlled trials.ResultsEight studies were included, most exhibiting low bias risk, comprising one randomized controlled trial, three cohort studies, two comparative retrospective studies, and two qualitative studies (interviews). Most studies originated from Europe, with one from the United States of America. The participants totaled 3423, with ALS patients constituting 95.6%. PALC consultations significantly improved symptom assessment, advance care planning, and discussions about goals of care. NIV demonstrated efficacy in managing breathlessness, with considerations for device limitations. Opioids were effective, though predominantly studied in non-ALS patients. Non-pharmacological strategies varied in efficacy among patients.ConclusionThe findings underscore the need for individualized approaches in managing breathlessness in ALS. PALC, NIV, opioids, and non-pharmacological strategies each play a role, with unique considerations. Further research, especially ALS-specific self-management studies, is warranted.

Development and feasibility of a mindfulness-based dance/movement therapy intervention for chronic low back pain.

Responding to the need for innovative, multi-modal, non-pharmacological strategies in chronic low back pain (cLBP) care, this article presents the development and a mixed methods feasibility trial of a manualized Mindfulness-based Dance/Movement Therapy (M-DMT) program for cLBP. The 12-week program is designed as a group therapy, integrating mindfulness principles, creative/expressive dance and movement, and psychoeducational content focused on cLBP management. This holistic program seeks to cultivate nonjudgmental awareness of pain experiences, challenge maladaptive pain-related beliefs, enhance emotional well-being, foster social support, and promote effective coping strategies for the daily challenges associated with cLBP. The 12-week M-DMT intervention was administered to individuals with non-specific cLBP (N = 18, aged 51.7 ± 13.9 years, 72% female, 55% Black and 39% White). We assessed feasibility and acceptability through monitoring enrollment and retention rates, attendance, and adverse events. Moreover, we measured the intervention's credibility/expectancy, participants' perception of changes, and overall satisfaction. Additionally, we collected qualitative data, capturing participants' perspectives on the intervention's usefulness and perceived benefits. Specific benchmarks were established to gauge the successful feasibility and acceptability of the program. The adherence rate stood at 80%, with a perfect retention rate of 100%. The study successfully met the benchmarks for treatment acceptability and satisfaction criteria, with 61% of participants reporting "feeling better" or a "great deal better" after the intervention. No adverse events were observed. Participants found the intervention enjoyable and reported that it provided effective tools for cLBP and related symptoms. Notably, participants reported a decrease in fear-avoidance behaviors, increased motivation for physical activity, and a boost in self-efficacy for pain management. These encouraging findings establish a strong basis for considering the M-DMT intervention as a promising approach for cLBP management, warranting further investigation in larger-scale studies.

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.

Diet and Physical Activity in Fabry Disease: A Narrative Review.

Fabry disease (FD) is caused by mutations in the galactosidase alpha (GLA) gene which lead to the accumulation of globotriaosylceramide (Gb-3). Enzyme replacement therapy (ERT) and oral chaperone therapy are the current pharmacological treatments for this condition. However, in the literature, there is a growing emphasis on exploring non-pharmacological therapeutic strategies to improve the quality of life of patients with FD. In particular, the nutritional approach to FD has been marginally addressed in the scientific literature, although specific dietary interventions may be useful for the management of nephropathy and gastrointestinal complications, which are often present in patients with FD. Especially in cases of confirmed diagnosis of irritable bowel syndrome (IBS), a low-FODMAP diet can represent an effective approach to improving intestinal manifestations. Furthermore, it is known that some food components, such as polyphenols, may be able to modulate some pathogenetic mechanisms underlying the disease, such as inflammation and oxidative stress. Therefore, the use of healthy dietary patterns should be encouraged in this patient group. Sports practice can be useful for patients with multi-organ involvement, particularly in cardiovascular, renal, and neurological aspects. Therefore, the aim of this review is to summarize current knowledge on the role of nutrition and physical activity in FD patients.

Effects of resistance training on sleep quality and disorders among individuals diagnosed with cancer: A systematic review and meta-analysis of randomized controlled trials.

Sleep disorders are often complained by cancer patients and can last years after the end of therapies, leading to different negative consequences. Non-pharmacological strategies such as exercise interventions may be considered to counteract this phenomenon. The literature supports the beneficial effects of aerobic training (AT), while evidence on resistance training (RT) is scarce. Accordingly, our systematic review aims to investigate the potential novel effect of RT on sleep outcomes in cancer survivors. The literature search was conducted on MEDLINE (Pubmed), Web of Science, Scopus, and Cochrane Central Register of Controlled Trials databases, including only randomized controlled trials (RCTs). The screening procedure was conducted using the web-based software COVIDENCE. Sleep outcomes assessed through self-reported questionnaires or objective sleep measurements were extracted from RCTs recruiting cancer survivors of any age and gender, on or off treatment. The risk of bias (RoB) for each study was assessed using the Cochrane RoB 2 tool for RCTs. Meta-analytic syntheses were performed on sleep quality and insomnia. A total of 21 studies were included in the review. Considering the mean percentage differences of all studies combined, promising positive results were found after combined aerobic and resistance exercise program (COMB) for sleep quality (-19%) and sleep disturbance (-17.3%). The meta-analysis results showed significant improvement for both sleep quality and insomnia (d = 0.28, SE: 0.11, Z = 2.51, p < 0.01, 95% CI: 0.07-0.49 and d = 0.43, SE: 0.20, Z = 2.18, p = 0.029, 95% CI: 0.07-0.49, respectively). RT interventions of 60 minutes per session, performed 2-3 times a week for 12 weeks, with exercise intensity ranging from 60% to 80% of one-repetition maximum can be administered to cancer survivors, aiming to improve sleep outcomes.

Therapeutic Procedures and Care of a Child Nursing Considerations

As pediatric nurses, our mission is atraumatic care i.e. to shield children from needless trauma and pain caused by medical procedures. Child's preparation prior to the procedure includes need based assessment of the procedure and readiness for procedure, building trust and establishing rapport as well as clustering multiple procedures to minimize trauma. Prior to procedure informed consent is necessary whenever required. It is essential to follow family centred care and educate the child and family as family is the integral part of child’s life. Preparation of child according to age, utilization of age appropriate equipment and age specific techniques, keen observation of child and surrounding are important aspect of childcare. Pharmacological, non-pharmacological and psychological strategies, involvement of loved one’s aid for minimizing the pain fear anxiety and distress. The physical and psychological safety of child should be of prime concern while performing a nursing procedure on child, the aim should be to successfully complete the procedure minimizing the negative effects of the same. Therefore, it is vital that any medical procedure is ended in a positive manner.

Development of New Resolvin D1 Analogues for Osteoarthritis Therapy: Acellular and Computational Approaches to Study Their Antioxidant Activities.

In osteoarthritis (OA), oxidative stress plays a crucial role in maintaining and sustaining cartilage degradation. Current OA management requires a combination of pharmaceutical and non-pharmacological strategies, including intraarticular injections of hyaluronic acid (HA). However, several lines of evidence reported that HA oxidation by reactive oxygen species (ROS) is linked with HA cleavage and fragmentation, resulting in reduced HA viscosity. Resolvin D1 (RvD1) is a lipid mediator that is biosynthesized from omega-3 polyunsaturated fatty acids and is a good candidate with the potential to regulate a panoply of biological processes, including tissue repair, inflammation, oxidative stress, and cell death in OA. Herein, newly designed and synthesized imidazole-derived RvD1 analogues were introduced to compare their potential antioxidant properties with commercially available RvD1. Their antioxidant capacities were investigated by several in vitro chemical assays including oxygen radical absorbance capacity, 2,2-diphenyl-1-picrylhydrazyl radical scavenging, ferric ion reducing antioxidant power, hydroxyl radical scavenging, and HA fragmentation assay. All results proved that imidazole-derived RvD1 analogues showed excellent antioxidant performance compared to RvD1 due to their structural modifications. Interestingly, they scavenged the formed reactive oxygen species (ROS) and protected HA from degradation, as verified by agarose gel electrophoresis and gel permission chromatography. A computational study using Gaussian 09 with DFT calculations and a B3LYP/6-31 G (d, p) basis set was also employed to study the relationship between the antioxidant properties and chemical structures as well as calculation of the molecular structures, frontier orbital energy, molecular electrostatic potential, and bond length. The results showed that the antioxidant activity of our analogues was higher than that of RvD1. In conclusion, the findings suggest that imidazole-derived RvD1 analogues can be good candidates as antioxidant molecules for the treatment of oxidative stress-related diseases like OA. Therefore, they can prolong the longevity of HA in the knee and thus may improve the mobility of the articulation.

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 &lt;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.

Post-Traumatic Stress Disorder In Children And Non-Pharmacological Therapies Strategies In Iran: A Review Study

Purpose and Background: Post-traumatic stress disorder (PTSD) is a set of symptoms that appear after a severe traumatic stress. Children and adolescents experience an increase in potentially traumatic experiences. Many children subsequently develop mental health problems. Method: A broad search was conducted in scientific databases and search engines such as Science Direct, PubMed, Cochrane, Medline, SID, Scopus, CINAHL, OVID, Iran Doc, and Magiran with Using the keywords “post-traumatic stress disorder”, “non-pharmacological coping strategies”, “children” alone or in combination with each other and their English equivalent was done. Articles that were published between 2000 and 2023 and were more related to the main focus of the research topic were selected.After a comprehensive review, nine studies that met the purpose of this study were selected. Findings: The most important non-pharmacological treatment strategies in children included relaxation and hypnosis, acupuncture, neurofeedback, saikokeishikankyoto (a herbal preparation) and exercise (yoga). Conclusion: Therefore, the use of non-pharmacological methods as one of the effective methods in the treatment of these children’s disorders can improve the quality of life of the family of these patients and the patient himself, as a result, administrators should encourage the patients’ families by using non-pharmacological methods.

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.

Brain–gut photobiomodulation restores cognitive alterations in chronically stressed mice through the regulation of Sirt1 and neuroinflammation

BackgroundChronic stress is an important risk factor for the development of major depressive disorder (MDD). Recent studies have shown microbiome dysbiosis as one of the pathogenic mechanisms associated with MDD. Thus, it is important to find novel non-pharmacological therapeutic strategies that can modulate gut microbiota and brain activity. One such strategy is photobiomodulation (PBM), which involves the non-invasive use of light. Objective/hypothesisBrain-gut PBM could have a synergistic beneficial effect on the alterations induced by chronic stress. MethodsWe employed the chronic unpredictable mild stress (CUMS) protocol to induce a depressive-like state in mice. Subsequently, we administered brain-gut PBM for 6 min per day over a period of 3 weeks. Following PBM treatment, we examined behavioral, structural, molecular, and cellular alterations induced by CUMS. ResultsWe observed that the CUMS protocol induces profound behavioral alterations and an increase of sirtuin1 (Sirt1) levels in the hippocampus. We then combined the stress protocol with PBM and found that tissue-combined PBM was able to rescue cognitive alterations induced by CUMS. This rescue was accompanied by a restoration of hippocampal Sirt1 levels, prevention of spine density loss in the CA1 of the hippocampus, and the modulation of the gut microbiome. PBM was also effective in reducing neuroinflammation and modulating the morphology of Iba1-positive microglia. LimitationsThe molecular mechanisms behind the beneficial effects of tissue-combined PBM are not fully understood. ConclusionsOur results suggest that non-invasive photobiomodulation of both the brain and the gut microbiome could be beneficial in the context of stress-induced MDD.

RUQYAH: LISTENING TO QURANIC VERSES, A DISEASE TREATMENT STRATEGY

The global Muslim population has surpassed two million, and Islamic principles emphasize accepting teachings from the Holy Quran and Sunnah for theoretical and practical guidance. Among these teachings is the recommendation to seek healing through reciting the Quran, known as 'Ruqyah Shar'iyya.' Despite its significance, medical professionals in Muslim-majority countries often need more awareness of Ruqyah, leading to an overreliance on pharmacological treatments with potential side effects. This study aims to increase awareness among healthcare providers about authentic and updated knowledge regarding Islamic teachings related to disease treatment through listening to the Quran and supplications. Through a descriptive literature review, the research explores critical terms such as Ruqyah, shifa (healing), treatment by Quran, spiritual treatment, Islamic treatment, and supplication in various sources, including the Quran, Hadith books, Google Scholar, and PubMed. While pharmacological treatments remain the primary approach for many diseases, this study suggests that non-pharmacological strategies, such as Quran recitation (Ruqyah) and specific supplications, align with the recommendations of Prophet Mohammad (ﷺ). Training doctors, nurses, and healthcare providers in the Muslim community to incorporate Ruqyah into their practice or involving Ruqyah professionals for Muslim patients can offer additional treatment options. This approach promotes healing without side effects and enhances patients' patience, satisfaction, and overall well-being. Such practices improve quality of life and foster trust in the doctor-patient relationship.