Non-pharmacological Techniques Research Articles

Health advisory: melatonin use in children.

Free AccessLetters to the EditorHealth advisory: melatonin use in children Muhammad Adeel Rishi, MD, Seema Khosla, MD, Shannon S. Sullivan, MD, for the Public Safety and the Public Awareness Advisory Committees of the American Academy of Sleep Medicine Muhammad Adeel Rishi, MD Address correspondence to: Muhammad Adeel Rishi, MD, Indiana University School of Medicine, 340 W. 10th St, Indianapolis, IN 46077; Email: E-mail Address: [email protected] Indiana University School of Medicine, Indianapolis, Indiana; Search for more papers by this author , Seema Khosla, MD North Dakota Center for Sleep, Fargo, North Dakota; Search for more papers by this author , Shannon S. Sullivan, MD Division of Pulmonary, Asthma, and Sleep Medicine, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California Search for more papers by this author , for the Public Safety and the Public Awareness Advisory Committees of the American Academy of Sleep Medicine Search for more papers by this author Published Online:February 1, 2023https://doi.org/10.5664/jcsm.10332SectionsPDF ShareShare onFacebookTwitterLinkedInRedditEmail ToolsAdd to favoritesDownload CitationsTrack Citations AboutINTRODUCTIONAmong US adults and children, melatonin supplement consumption significantly increased from 1999 to 2020.1,2 The growing use of melatonin in children has occurred despite incomplete safety and efficacy data, reports demonstrating inconsistent dose labeling, and an increase in accidental pediatric melatonin ingestions.2,3While the perception may be that melatonin is natural and therefore safe, a recent analysis published in Morbidity and Mortality Weekly Report indicates that the annual pediatric ingestions of melatonin have risen from 8,000 in 2012 to more than 52,000 in 2021, and 15% of children with overdoses were hospitalized.2Adding to the misperception of safety, melatonin is marketed as a dietary supplement, with reduced regulatory oversight compared with pharmaceuticals.4 Variation in melatonin content is reported to be −83% to +478% of labeled content,5 with the most variability found in chewable tablets, such as those in pediatric formulations. Additionally, these supplements may be candy-like and colorful, appealing to children in particular. Melatonin is also relatively inexpensive and widely available, from grocery stores to warehouse stores where it may be sold in large quantities.With this background, the Public Safety Committee and Public Awareness Advisory Committee of the American Academy of Sleep Medicine developed a health advisory addressing the use of melatonin in children.6 The Academy advises that melatonin should be handled as any other medication and kept out of reach of children, and importantly, before starting melatonin or any supplement for their children, that parents discuss this with a pediatric health care professional to assess whether behavioral strategies may be more appropriate. Finally, if melatonin is used, a practical suggestion is to look for products with the US Pharmacopeia verified (USP verified) mark, which indicates that product was produced in a facility following Good Manufacturing Practice (GMP) standards.As the use and misuse of melatonin increases, it is important to emphasize that nonpharmacologic management techniques have been well studied and are considered safe and effective for pediatric insomnia.7 We also call for ongoing public and provider education about the appropriate role for melatonin use, and we encourage health care providers to engage with their patients about usage of melatonin.DISCLOSURE STATEMENTAll authors have seen and approved this manuscript. The authors report no conflicts of interest.REFERENCES1. Li J, Somers VK, Xu H, Lopez-Jimenez F, Covassin N. Trends in use of melatonin supplements among US adults, 1999–2018. JAMA. 2022;327(5):483–485 . CrossrefGoogle Scholar2. Lelak K, Vohra V, Neuman MI, Toce MS, Sethuraman U. Pediatric melatonin ingestions—United States, 2012–2021. MMWR Morb Mortal Wkly Rep. 2022;71(22):725–729 . CrossrefGoogle Scholar3. Lelak KA, Vohra V, Neuman MI, Farooqi A, Toce MS, Sethuraman U. COVID-19 and pediatric ingestions. Pediatrics. 2021;148(1):e2021051001 . CrossrefGoogle Scholar4. Grigg-Damberger MM, Ianakieva D. Poor quality control of over-the-counter melatonin: what they say is often not what you get. J Clin Sleep Med. 2017;13(2):163–165 . LinkGoogle Scholar5. Erland LA, Saxena PK. Melatonin natural health products and supplements: presence of serotonin and significant variability of melatonin content. J Clin Sleep Med. 2017;13(2):275–281 . LinkGoogle Scholar6. American Academy of Sleep Medicine. Health Advisory: Melatonin Use in Children and Adolescents. Adopted September 9, 2022. https://aasm.org/advocacy/position-statements/melatonin-use-in-children-and-adolescents-health-advisory/. Accessed September 20, 2022. Google Scholar7. Mindell JA, Emslie G, Blumer J, et al.. Pharmacologic management of insomnia in children and adolescents: consensus statement. Pediatrics. 2006;117(6):e1223–e1232 . CrossrefGoogle Scholar Previous article Next article FiguresReferencesRelatedDetails Volume 19 • Issue 2 • February 1, 2023ISSN (print): 1550-9389ISSN (online): 1550-9397Frequency: Monthly Metrics History Submitted for publicationSeptember 22, 2022Submitted in final revised formSeptember 30, 2022Accepted for publicationOctober 3, 2022Published onlineFebruary 1, 2023 Information© 2023 American Academy of Sleep MedicinePDF download

The Therapeutic Benefits of Yoga: A Comprehensive analysis of its effects on mental health and well-being

The roots of the word “health” are “heal” and “thy” (self), implying self-healing. As healers of the self, doctors, we must understand what the self is. There are often two categories of self: The ego-created self, also referred to as the taught exterior self of the body, mind, and social self. the real you, the spiritual you, the one who is watching or witnessing. Now that we have a better understanding of the self, let’s explore the characteristics of health. We may think that because we are practicing physicians, the body can heal itself. We do not consider undergraduate medical education to include instruction in psychology or psychiatry. According to this concept, the aim of health systems is the welfare of individuals. We know how the mind develops, how it is disrupted, and the various strategies utilized by pharmaceutical and nonpharmacological techniques to restore this troubled mind because we are behavioral specialists. You can learn more about the numerous ways that yoga can enhance your mental and physical health by reading about this topic. You can look at the research that demonstrates yoga’s efficacy as a supplemental therapy for illnesses like anxiety, sadness, stress, and post-traumatic stress disorder (PTSD). You might also look into the ways that yoga improves mental health, such as how it affects neuroplasticity, self-awareness, mindfulness, and stress levels.

The Effect of an Acupressure Training Program for Pediatric Nurses Caring for Children Undergoing Chemotherapy.

Acupressure is a nonpharmacological technique that can be used to control chemotherapy-induced nausea and vomiting (CINV) in children with cancer. To use acupressure as a strategy for managing CINV, oncology nurses must have adequate knowledge and skills to implement the technique in clinical practice. Our study aimed to evaluate the effect of an acupressure training program for pediatric nurses caring for children undergoing chemotherapy. We used a quasi-experimental design. Our sample populations included a convenience sample of 36 pediatric nurses and a purposive sample of 45 children undergoing chemotherapy. We used four tools for data collection: (1) a structured questionnaire comprising two parts: (a) characteristics of nurses and children and (b) assessment of nurses' knowledge; (2) an observational checklist for application of acupressure technique; (3) the Baxter Animated Retching Faces (BARF) scale; and (4) a vomiting assessment sheet. We found that after the training intervention, 94.4% ( n = 34) of nurses had a good level of knowledge and skill implementing the acupressure technique. There was a statistically significant difference in the knowledge and skill of the nurses before and after the training intervention, χ 2 (35, N = 36) = 19.113, p = .000. We concluded that the training program significantly improved the nurses' level of knowledge and skill when caring for children undergoing chemotherapy. We also found that after implementing the training intervention, the frequency and severity of CINV decreased among the children we studied. We therefore recommend that acupressure (in combination with antiemetic medication) be included as part of a protocol for chemotherapy administration in children.

Giving Warm Compresses with Progressive Muscle Relaxation Techniques Can Reduce Pain Intensity in Dysmenorrhea

Background: Dysmenorrhea is a menstrual disorder in the form of severe pain or tenderness in the lower abdomen caused by the activity of prostaglandins, during menstruation the damaged uterine lining is expelled by new compounds called prostaglandins. Intervention in adolescent girls who experience dysmenorrhea can be done by non-pharmacological techniques, namely by warm compresses and progressive muscle relaxation. Objectives: To determine the effectiveness of giving compressed warm with progressive muscle relaxation techniques to intense pain in dysmenorrhea. Methods: This study used a quasi-experimental with a pre-posttest approach, and a non-equivalent control group design. The research instrument used on the compress variable warm with progressive muscle relaxation techniques, namely SOP (Standard Operational Procedure) and pain intensity variable, namely using the NRS (Numeric Rating Scale). The population in this study found 95 female students, the samples were taken using purposive sampling, and samples in research this group collects 54 female students who are calculated using the formula slovin and drop out a formula. Results: Based on the results of statistical tests, namely the Mann Withney. Test obtained p-value 0.187>0.05. Conclusion: In this study, there were no significant differences between the warm compress intervention and the technique of progressive muscle relaxation or both have an effect on a decrease in pain intensity in the incidences of dysmenorrhea.

Pengaruh Senam Disminore Terhadap Skala Nyeri Disminore pada Remaja Putri Di Dusun Kenayan Wedomartani, Ngemplak, Sleman DIY

Background : One of the problems often faced by young women is menstrual pain (dysmenorrhea). The rate of dysmenorrhea in the world is very large, on average more than 50% of women in every country experience dysmenorrhea. In Indonesia, the incidence of dysmenorrhea is found as much 64.25%, most commonly found in adolescents. Altough generally harmless, it can interfere with daily activities. In addition to using pharmacology, dysmenorrhea can be overcome with non-pharmacological techniques, namely by doing dysmenorrhea exercises.
 Objective : To determine the effect of dysmenorrhea exercise on pain scale during dysmenorrhea in adolescent girls in Kenayan Hamlet, Wedomartani, Ngemplak, Sleman DIY.
 Methods : The research design used a quasi-experimental design with pre-test and post-test design without control. The subjects of the study were the young women of the village of Kenayan who experienced dysmenorrhea as many as 38 respondents. Pain scale is measured by NRS. Statistical test using T-Tes Pired Test.
 Results : The pain scale before the dysmenorrhea exercise is done 5,00 ±1727 (1-9) and after the dysmenorrhea exercise is done it is 2,00±1,109 (0-4). Based on the Paired T-Test, it is known that the p-value = 0,000.
 Conclusion : There is an effect of dysmenorrhea exercise on the scale of dysmenorrhea in young women in the village of Kenayan.
 Keywords : Dysmenorrhea Gymnastics,Pain, Youth

MANAJEMEN MUAL DAN MUNTAH PADA PASIEN KANKER PARU-PARU

Cancer is a disease that occurs due to abnormal reproduction of cells in the body. Chemotherapy is a type of modality therapy in cancer patients which is often done in addition to surgery, radiotherapy, hormone therapy and immunotherapy. Nausea and vomiting are the most common and disturbing effects of cancer patients undergoing chemotherapy. Management of nausea and vomiting needs to be done appropriately and in accordance with the problems experienced in order to reduce the incidence of nausea and vomiting. The purpose of this study was to describe the management of nausea and vomiting in lung cancer patients. This research uses descriptive research method. The descriptive method in this study uses a literature review design (Library Study). The search strategy method to find journals using the keywords “Cancer OR Cancer AND Lung Cancer OR Lung Cancer AND Management OR Intervention OR Management OR Intervention AND Nausea and Vomiting OR Nausea OR Vomiting OR Nausea and Vomiting AND Management of Nausea and Vomiting OR Nausea and Vomiting Management AND quantitative study ". The results of the literature review are known from 7 journals, it can be concluded that 3 journals show management of nausea and vomiting in lung cancer patients using non-pharmacologic techniques in the form of acupressure or acupuncture

Cuproptosis patterns and tumor microenvironment in endometrial cancer.

Cuproptosis is the most recently discovered mode of cell death. It could affect the metabolism of cancer cells and surrounding infiltrating immune cells. In recent years, many studies have also shown that the tumor microenvironment (TME) plays a critical role in tumor growth and development. Mounting evidence suggests that Cuproptosis would bring unique insights into the development of pharmacological and nonpharmacological therapeutic techniques for cancer prevention and therapy. However, no study has been done on the combination of cuproptosis and TME in any cancer. Herein, we investigated the relationship between cuproptosis-related genes (CRGs), TME, and the prognosis of patients with Uterine Corpus Endometrial Carcinoma (UCEC). We identified three CRGs clusters based on 10 CRGs and three CRGs gene clusters based on 600 differentially expressed genes (DEGs) with significant prognostic differences. Following that, the CRGs score based on DEGs with significant prognostic differences was established to evaluate the prognosis and immunotherapeutic efficacy of UCEC patients. The CRGs score was shown to be useful in predicting clinical outcomes. Patients with a low CRGs score seemed to have a better prognosis, a better immunotherapeutic response, and a higher tumor mutation burden (TMB). In conclusion, our study explored the influence of cuproptosis patterns and TME on the prognosis of cancer patients, thereby improving their prognosis.

Lemon Aromatherapy Intervention to Reduce Nausea and Vomiting in Gastritis Patients

Objective: To present care with lemon aromatherapy intervention as an effort to overcome nausea and vomiting in gastritis patients. Methods: The method used is descriptive and uses nursing care that refers to the IDHS and SIKI books. The subject of this study was 1 patient with a nursing diagnosis of nausea and vomiting in gastritis patients who were treated in the Dahlia Room, Banjar City Hospital. Data collection includes interviews, observations, physical examinations and documentation. Results: The results of the case studies conducted showed a change after the non-pharmacological technique of lemon aromatherapy was proven by the final results, namely the evaluation carried out by the patient not feeling nauseated, the INVR scale 3. Conclusion: The conclusion from the results of the lemon aromatherapy intervention was considered effective for reducing nausea and vomiting with a decreased INVR scale. with the results of the final evaluation of the INVR 3 scale, the client said that nausea was reduced.

Hypnosis for pain and anxiety management in cognitively impaired older adults undergoing scheduled lumbar punctures: a randomized controlled pilot study

BackgroundCore cerebrospinal fluid (CSF) amyloid and tau biomarker assessment has been recommended to refine the diagnostic accuracy of Alzheimer’s disease. Lumbar punctures (LP) are invasive procedures that might induce anxiety and pain. The use of non-pharmacological techniques must be considered to reduce the patient’s discomfort, in this setting. The objective of this study was to examine the efficacy of hypnosis on anxiety and pain associated with LP.MethodsA monocentric interventional randomized-controlled pilot study is conducted in a university geriatric day hospital. Cognitively impaired patients aged over 70 were referred for scheduled LP for the diagnostic purpose (CSF biomarkers). The participants were randomly assigned either to a hypnosis intervention group or usual care. Pain and anxiety were both self-assessed by the patient and hetero-evaluated by the operator.ResultsWe included 50 cognitively impaired elderly outpatients (women 54%, mean age 77.2 ± 5.0, mean Mini-Mental State Examination score 23.2 ± 3.5). Hypnosis was significantly associated with reduced self-assessed (p < 0.05) and hetero-assessed anxiety (p < 0.01). Hetero-evaluated pain was significantly lower in the hypnosis group (p < 0.05). The overall perception of hypnosis was safe, well-accepted, and feasible in all the participants of the intervention group with 68% perceiving the procedure as better or much better than expected.ConclusionsThis pilot study suggested that hypnosis was feasible and may be used to reduce the symptoms of discomfort due to invasive procedures in older cognitively impaired patients. Our results also confirmed the overall good acceptance of LP in this population, despite the usual negative perception.Trial registrationClinicalTrials.gov NCT04368572. Registered on April 30, 2020.

Hypnosis associated with 3D immersive virtual reality technology during bronchoscopy under local anesthesia.

BackgroundPatients undergoing flexible bronchoscopy under local anesthesia usually experience anxiety before and during the procedure. Different non-pharmacological techniques, including music and hypnosis, are used to distract patients’ attention, and to reduce anxiety. The new technique “virtual reality hypnosis (VRH)”, defined as a hypnotic induction suggestion delivered by personalized virtual reality software, can generate a simulation of a lifelike environment. No study has described the use of VRH during bronchoscopy. The objective is to investigate the anxiety reducing effect and the satisfaction of patients, physicians, and nurses using VRH during bronchoscopy.MethodsVRH was proposed to all patients who experienced anxiety before undergoing flexible bronchoscopy under local anesthesia. Local anesthesia was performed using 5% lidocaine spray only. No sedation was used. After the procedure, patients, physicians and nurses filled a standardized satisfaction form.ResultsTwenty consecutive patients who reported pre-procedure anxiety were included. The sex ratio was 16 women/4 men, the median age was 65 years. Eight patients (40%) had undergone a previous bronchoscopy under local anesthesia. The median duration of the procedure was 10 minutes, and all procedures were completed. The median level of anxiety of patients decreased from 9/10 before the procedure to 4/10 during the procedure. The median satisfaction rate regarding the use of VRH was 10/10. All patients agreed to use VRH again in case of a new bronchoscopy procedure.ConclusionsThis preliminary report has shown that VRH was useful to reduce patients’ anxiety during bronchoscopy under local anesthesia. VRH was easily implemented in the routine practice.

A study to assess the effectiveness of conventional methods along with balloon inflation vs conventional methods only in reduction of pain and fear during venipuncture in children age group of 5-12 years admitted in paediatric wards of GGSMC &amp;amp; H, Faridkot, Punjab

Introduction: Children are vulnerable to all kinds of illness. Illness and hospitalization are the first crisis that children face. Venipuncture is one of the most painful invasive procedures. Distraction has shown to be an effective non-pharmacological pain management technique. Aim: The study was intended to assess the effectiveness of conventional methods along with balloon inflation vs conventional methods only in reduction of pain and fear during venipuncture in children age group of 5-12 years admitted in pediatric wards of GGSMC&H, Faridkot, Punjab.Methods: A quantitative research approach and experimental research design was used to conduct the study. Total 80 patients (5-12 years) were selected who were admitted in the pediatric wards on the basis of inclusion and exclusion criteria and randomly allocated into experimental and conventional group through computerized block design method. Socio demographic data sheet was used to collect baseline information, Wong-Baker Faces Pain Rating Scale and Children’s Fear Scale were used to assess the pain and fear level.Results: Study found that the median of pain score in experimental group was 8 in conventional group was 10. Median of fear score in experimental group was 3 and in conventional group was 4. Mann-Whitney U test was applied for statistical analysis and p value was <0.001 which was statistically highly significant.Conclusions: This study concluded that conventional methods along with balloon inflation was effective as a non-pharmacological method of reduction/management of pain and fear during venipuncture.

Evidence-Based Guideline on Prevention and Management of Shivering After Spinal Anesthesia in Resource-Limited Settings: Review Article

BackgroundPerioperative shivering is a common problem faced in anesthesia practice. Unless it is properly managed and prevented, it causes discomfort and devastating problems, especially in patients with cardiorespiratory problems. Surgery, anesthesia, exposure of skin in a cool operating theater, and administration of unwarmed fluids are some of the major causes for the development of shivering among surgical patients. Currently, a variety of non-pharmacological and pharmacological techniques are available to prevent and manage this problem. The available options to prevent and treat shivering include but are not limited to pre-warming the patient for 15 minutes before anesthesia administration, administration of low dose ketamine, dexamethasone, pethidine, clonidine, dexmedetomidine, tramadol, and magnesium sulfate.ObjectiveTo develop evidence-based recommendations for the prevention and management of shivering after spinal anesthesia in a resource-limited settings.MethodsThe kinds of literature are searched from Google Scholar, PubMed, Cochrane library, and HINARI databases to get access to current and update evidence on the prevention and management of shivering after spinal anesthesia. The keywords for the literature search were (shivering or prevention) AND (shivering or management) AND (anesthesia or shivering).ConclusionPre-warming the patient with cotton, blanket, gown warming, and administering warm IV fluid 15 minutes before spinal anesthesia are possible non-pharmacologic options for the prevention of shivering. Furthermore, pharmacological medications like low dose ketamine, dexamethasone, magnesium sulfate, ad tramadol can be used as alternative options for the prevention and management strategies for shivering of different degrees in resource-limited areas.

Effect of bibliotherapy on reducing anxiety among pre-operative patients in Gujarat, India.

Numerous studies have shown that patients can have preoperative anxiety in mild, moderate, or severe forms. A supplemental tool to a disease's clinical treatment is bibliotherapy. This approach includes the core ideas of cognitive behavioral therapy and offers exercises meant to assist readers in overcoming unpleasant emotions. Therefore, it is of interest to evaluate how well bibliotherapy reduced pre-operative patients' anxiety. For the experimental group (30) and control group (30), a sample of 60 preoperative patients who had been determined to have considerable levels of anxiety was chosen. The Hamilton Anxiety Rating Scale is used to measure patient anxiety. Prior to surgery, bibliotherapy was given to the experimental group's sample twice daily for around 20 minutes. No intervention was given to the control group. The study's findings showed that the experimental group's mean percentage anxiety score at the pre-test was 80.10 percent, whereas the control group's mean percentage anxiety score was 85.66 percent. After the test, the experimental group's mean anxiety score was 50.66 percent, while the control group's mean anxiety score was 83.20 percent. It is evident that bibliotherapy was successful in lowering pre-operative patients' anxiety levels. Nurses can utilize this non-pharmacological technique to help patients feel less anxious about surgery and experience fewer post-operative problems.

Identifying barriers and enablers for benzodiazepine (de)prescription: a qualitative study with patients and healthcare professionals.

There has been a steadily growing trend in prescribing benzodiazepines over last decade. Spain is one of the countries where this class of drugs is most extensively prescribed by primary healthcare physicians. The aim of this study is to identify factors that might be acting as barriers and enablers for benzodiazepine (de)prescription from patient and professional perspectives. Qualitative study through semi-structured interviews with medical practitioners (n=17) and patients (n=27), and a nominal group with medical practitioners (n=19). Interviews were audio-recorded, transcribed and analyzed using thematic analysis. The analysis revealed key themes and was organized around barriers and enablers connected to three interrelated dimen-sions: the social and community context of prescription; the structure, organization and/or management of the health system, and the doctor-patient relationship. The excessive workload of professionals was widely cited as influencing over-prescription. (De)prescription of benzodiazepine was facilitated by encouraging the social prescription of health assets or developing strategies to therapeutic alliance processes and better doctor-patient communication. Our findings suggest that there is a role for the salutogenic approach and the health asset model in the development of a more person-centred clinical care. This study considers the importance of encouraging the use of non-pharmacological methods and techniques in the health system and promoting the creation of multidisciplinary teams, therapeutic alliance processes and better doctor-patient communication by giving professionals training in psychosocial skills.

METODE DZIKIR DALAM PENURUNAN TINGKAT KECEMASAN PADA PASIEN GAGAL GINJAL KRONIK TERHADAP TERAPI HEMODIALISA

One the most common psychological problems found in chronic kidney failure patients urdergoing hemodialisys is anxiety. Anxiety that cannot be overcome can have a negative impact on patient. One of the non-pharmacological techniques to reduce anxiety experienced by patients with chronic kidney failure undergoing hemodialysis is the dhikr method. The research method we use here is a literature review using electronic database through international and national journals such as google scholer, science direct. Pro-quet, jstor with the keyword dhikr method in reducing anxiety levels in patients wiyh chronic kidney failur againts hemodialysis therapi criteria. The inclusion used by the author is to limit the articles or journals published in the last five years starting from 2017to 2021. This literature riview uses 20 articles that meet the criteria. Conclusion regarding the result of the literature review above, one of the methods for reducing anxiety in chronic kidney failure patients undergoing hemodialysis is relaxation techniques such as dhikr.

Variation in the Use of Basic Behavioral Management Techniques in General and Pediatric Dental Practice: A Cross-sectional Study

Aim: Basic guidance on nonpharmacological behavioral management techniques in dental practice is fundamental for the effective treatment of pediatric patients. The aim of this study was to compare the use of basic nonpharmacological behavior guidance in general and specialist pediatric dentists and to evaluate the perceived difference in their effectiveness across hospital clinics in Jeddah, Saudi Arabia. Material and Methods: A cross-sectional study with a nonpurposive sample of 179 registered general and pediatric dentists in the Saudi Dental Society based in Jeddah in 2019. Participants were contacted and asked to complete a validated questionnaire. The first section of the questionnaire comprised questions on demographic data and the second section investigated the frequency of the use of various behavioral management techniques. Descriptive statistics (frequency and percentages) and inferential statistics were used. Results: A total of 109 participants completed the survey; 52 were general dentists and 57 were pediatric dentists. The techniques tell–show–do ( P = .018), positive reinforcement ( P = .004), distraction ( P = .001), and nonverbal communication ( P = .001) were used more frequently by pediatric dentists than general dentists, and there were statistically significant differences. Also, pediatric dentists reported that the techniques tell–show–do ( P = 0.035), positive reinforcement ( P = .026), distraction ( P = .011), and nonverbal communication ( P = .007) were highly effective more often than general dentists did. Conclusions: Statistically significant differences were found between general and pediatric dentists in the use of basic behavioral management techniques. Broadly, general dentists used fewer behavior guidance techniques compared to pediatric dentists. More pediatric dentists reported that behavioral management techniques were effective in comparison to general dentists.

Nurses' improved provision of infants’ procedural pain assessment and management with non-pharmacological interventions following a training program in Jordan

This study aims to compare the frequency of nurses’ documented assessment and performance of non-pharmacologic interventions to relieve procedural pain in neonates before and after a training intervention. Forty neonatal nurses received knowledge and clinical training about procedural pain assessment and non-pharmacological management related to neonates.The charts of 70–80 Neonatal Intensive Care Units admissions were compared at three-time points: once before and twice after the training intervention. Nurses’ documentation of pain assessment and non-pharmacological pain management techniques demonstrated significantly higher frequencies one month after the training than baseline (p = .00) and three months after the training than after the first month (p = .00). The training positively affected the pain management practices of nurses and clinical practice showed progressive improvement over time; all of which emphasize the importance of nurses' in-service training in improving the application of pain assessment and non-pharmacologic pain reduction strategies in NICUs.

Nitrous Oxide Inhalation Sedation in Pediatric Dentistry: An overview of the available guidelines

Children with behavioral issues are usually inadequately treated using non-pharmacological behavior management techniques, making dental treatment a real clinical challenge for the practitioner. This leads to the indispensable need for advanced pharmacological techniques, such as inhalation sedation (IS). In pediatric dentistry, nitrous oxide sedation is considered the safest tool for a dental practitioner to use on uncooperative children, thus reducing the need for dental treatment under general anesthesia. To date, several sets of high-ranking evidence-based inhalation sedation guidelines are available,developed in the United States, United Kingdom, Europe, Australia, and New Zealand. This review summarizes the indications, contraindications, advantages, and disadvantages of using nitrous oxide sedation in children, and compares these in terms of inhalation sedation procedure and documentation. This review will assist the dental practitioner in developing appropriate practice regulations for safe and effective practice.

Management of Post-Traumatic Dental Care Anxiety in Pediatric Dental Practice-A Clinical Study.

Background: It is important to avoid giving children traumatic dental experiences that induce post-traumatic dental care anxiety (PTDA) in clinical dental practices. The aim of this study was to evaluate whether non-pharmacological behavior management procedures can effectively reduce the use of pharmacological behavior management in children who have PTDA and are referred for regular dental treatments under general anesthesia (GA) and sedation. Methods: This clinical study consisted of two groups. The treatment group involved 20 healthy children aged 4–14 with PTDA and also those referred by other institutions for dental treatment with/without GA. The control group was sampled retrospectively from the patient records and involved 20 healthy uncooperative children aged 4–14 with PTDA who had been treated under GA. Results: The number of multiple appointments was significantly higher in the treatment group than in the control group. Only 25% of children in the treatment group underwent GA and the rest (75%) were managed with non-pharmacological management techniques. Nine (60%) children who were treated with minimally invasive techniques did not require GA. Conclusions: It is important to treat children as much as possible without causing PTDA by using appropriate behavior management techniques. This study emphasizes the usefulness of thoroughly employing non-pharmacological behavior management methods before directing a child with PTDA for dental treatment under pharmacological behavior management, which can prevent the over-utilization of sedation and GA.

Implementation of Chest Physiotherapy in Children with Tuberculosis to Manage Ineffective Airway Clearance

Objective: This case study aims to describe the nursing care process and analyze the administration of chest physiotherapy to treat ineffective airway clearance in children diagnosed with tuberculosis. Method: This research is a case study research using random sampling technique for the sampling process. The samples used were children diagnosed with tuberculosis, being hospitalized, and experiencing ineffective airway clearance. The study was conducted in March 2022. Data collection used a nursing assessment format for children, a physical examination format, and an interview guide format. The nursing care process is carried out from the initial stage of assessment to evaluation. Result: The main complaint expressed was a fever that went up and down, often felt nauseated, coughed up phlegm that was difficult to expel. The data findings showed wheezing, cyanotic skin color, and an increase in respiratory rate and pulse. The patient experiences ineffective airway clearance. Effective chest and cough physiotherapy interventions were given for 3 days during the treatment period and showed that the results of walking clearance were not effectively resolved. This condition is seen from the phlegm that has come out, there are no additional breath sounds, the respiratory rate and pulse are within normal limits. Conclusion: The provision of effective chest physiotherapy and coughing interventions proved to be able to overcome ineffective airway clearance. Research recommendations to be able to combine alternative non-pharmacological techniques in overcoming ineffective airway clearance in children, especially with tuberculosis.