Non-pharmacological Techniques Research Articles

The Effect of Benson Relaxation on Anxiety Levels In Major Surgical Preoperative Patients in the Dahlia Room Mardi Waluyo Blitar Hospital

Surgery can cause excessive fear and anxiety and can lead to complications. To reduce anxiety, non-pharmacological techniques is Benson Relaxation Therapi which is carried out by deep breathing and accompanied by beliefs held by the patient to achieve a relaxed state. Population on this research is preoperative major surgery patients. Sampling technique with Purposive Sampling 22 respondent. This research method : Quasy Experimental with One Group Pre-Test Post-Test, using questionnaire sheets, Standard Operating Procedures of Benson’s Relaxations, and Wilcoxon Sign Rank Test analysis. The purpose of study to determine the effect of Benson’s Relaxations on anxiety levels in preoperative major surgery patients. The Results of the Study : Using the analysis with the results of p-value = 0.000 which means <0.005. Conclusion : There is an effect of Benson’s Relaxation on the anxiety levels of pre operative major surgery patients. With the result of this reseach be used as a reference for Mardi Waluyo Blitar District Hospital in publishing of SPO Benson’s Relaxation it can be used to treat anxiety non-pharmacologically. Beside that, of nurses are expected to be able and willing to implement of Benson’s Relaxation which is proven effective in treating anxiety patients in all patients who experience anxiety in general.Keywords : Surgery, Benson Relaxation Technique, Anxiety

EVALUATING THE EFFICIENCY OF NON-PHARMACOLOGICAL PAIN MANAGEMENT TECHNIQUES DURING LABOR AND DELIVERY

Labor and delivery is a natural procedure that causes women significant pain and discomfort. Many women choose pharmacological pain management techniques, yet there is growing interest in non-pharmacological pain management techniques, viewed as safer and more natural than pharmacological methods. This study aimed to assess the efficacy of non-pharmacological pain management techniques during labor and delivery. In a randomized controlled trial, we randomly assigned 246 expectant women to either a non-pharmacological intervention or a control group. During labor and delivery, the non-pharmacological intervention group received a combination of relaxation techniques, including massaging and physical therapy, aromatherapy, TENS, and mixed interventions. The control group received standard care devoid of non-pharmaceutical interventions. Pain levels were measured using a visual analog scale at 30-minute intervals. Additionally, the length of labor, delivery mode, and birth outcomes were recorded using the APGAR score system. The demographic characteristics of patients in both groups were comparable and non-significant in variations (p>0.05). Forty participants utilized each non-pharmacologic technique. Comparing VAS pain scale scores at 30-minute intervals, the distribution of pain intensity levels was comparable between the groups. The larger fraction of neonates in the non-pharmacological group had higher APGAR scores, indicating no need for immediate medical attention. Based on a reasonable comparison of the effectiveness of various interventions for managing labor pain and distress, it was found that 9 (22.5%) of 40 patients who received massaging therapy reported low efficacy in managing labor pain, 13 (32.5%) reported moderate efficacy, and 28 (70%) reported high efficacy. In the aromatherapy of 40 patients, 16 reported low efficacy, 21 reported moderate efficacy, and 13 reported high efficacy in managing labor pain. Ten patients (25%) reported low efficacy, 12 patients (30%) reported moderate efficacy, and 28 patients (70%) reported high efficacy in managing labor pain through TENS. It provided cost-effective and safe alternatives to pharmaceutical interventions during labor and delivery. When properly implemented, these techniques reduced pain intensity comparable to commercial medicines while significantly improving the birthing experience and potentially contributing to better maternal and neonatal outcomes.

Chairside oral prophylaxis for people with profound intellectual or multiple disabilities—a retrospective feasibility study

ObjectivesPeople with severe intellectual or multiple disabilities (PIMD) have been receiving dental care in a specialized unit offering special care dentistry. For most of these adult patients, the initial consultation is complaint driven. In addition, the limited ability to cooperate due to their disabilities often means that dental treatment for these patients is usually carried out under general anesthesia (GA). Chairside treatment attempts are the exception rather than the rule. This retrospective study evaluated whether consistent practice of behavioral management principles and techniques embedded in a specific dental environment enables successful dental treatment of PIMD.Materials and methodsThe feasibility of chairside dental prophylaxis in PIMD (n=36) was analyzed: specific behavioral management techniques were applied, and professional tooth cleaning (PTC) was performed in the dental chair. Clinical data obtained from medical records and a questionnaire were analyzed.ResultsAll patients had severe intellectual or multiple disabilities and had previously undergone at least one dental treatment under GA. Of these patients, 55.6% never had their teeth professionally cleaned before. Applying different behavioral techniques, all patients were compliant with receiving PTC in the dental chair.ConclusionsAn individualized and disability-specific treatment strategy using various noninvasive and nonpharmacological behavioral guidance techniques resulted in a higher compliance rate in PIMD, which allowed chairside PTC and reduced the need for treatment under GA.Clinical relevanceConsistent implementation of various behavioral guidance techniques and communication strategies in a supportive environment enabled all patients to receive chairside PTC and be involved in a lifelong recall program.

Comparison of the Effect of Aloe vera and Warm Compresses on Pain Due to Phlebitis in Hospitalized Children

Background: Phlebitis and pain are among intravenous injection's most common side effects. Different pharmacological and non-pharmacological techniques have been used to treat phlebitis. Aloe vera gel and warm compress are non-pharmacological nursing methods for phlebitis. Objectives: The present study compares the effect of Aloe vera and warm compress on pain due to phlebitis in children admitted to pediatric wards. Methods: This single-blind clinical trial study was conducted on 90 children with phlebitis. The participants were selected using convenience sampling and randomly assigned to three control, Aloe vera compress intervention, and warm compress intervention groups. The data in this study were collected using the patient demographic information questionnaire and Wong-Baker Faces Pain Rating Scale. The pain scores were evaluated in all three groups before the intervention. The intervention for the children in the warm compress group was a warm compress for 20 minutes twice daily (once every 12 hours). The intervention for the Aloe vera compress group was 5 cc of Aloe vera gel applied twice daily (once every 12 hours) for three days. Pain intensity was recorded and assessed in the pre-intervention stage for the children in all three groups. It was also measured for the warm compress group half an hour after the intervention and for the Aloe vera group at the beginning of the intervention. Pain intensity was also measured and evaluated for the children in the control group. Data analysis was performed with SPSS-22 software at a significance level of less than 0.05 (P < 0.05) using the chi-square test, independent samples t-test, one-way analysis of variance (ANOVA), and Fisher’s exact test. Results: The ANOVA results showed that there was no statistically significant difference between the three groups (P > 0.05) in the average pain intensity scores before the intervention and the first day after the intervention, but the average pain intensity scores in the three groups on the second day (P = 0.04) and the third day (P = 0.002) showed a statistically significant difference after the intervention. On the third day, the difference in the pain intensity scores was significant between the two intervention groups (P = 0.03) and the control group. Moreover, the pain intensity score for the children in the Aloe vera group decreased more significantly compared to the warm compress group (P = 0.001). Conclusions: The results showed that applying both Aloe vera and warm compresses effectively reduced the pain induced by phlebitis, but Aloe vera reduced the pain caused by phlebitis more than warm compress. Thus, the Aloe vera compress can be used as an easy and simple method to reduce the pain caused by phlebitis.

Beyond Fear: Unveiling the Relationship Between Fear of Childbirth and Pharmacological Pain Relief

BackgroundPharmacological analgesia is the dominant method for pain relief in labor. Fear of childbirth (FOC) may significantly affect women's preferences for and usage of pharmacological analgesia. AimThis study aimed to investigate the relationship between FOC in late pregnancy and preferences for, as well as actual use of, pharmacological analgesia among nulliparous and multiparous women, accounting for confounding factors. MethodsA total of 1,300 women participated in the study, completing questionnaires assessing preferences for pharmacological analgesia, FOC, perception of labor pain, social support, coping styles, and demographic variables. The actual use of pharmacological analgesia was followed up. The data were analyzed using univariate and multivariate regression analyses. ResultsUnivariate analysis revealed that women with moderate to severe FOC had a stronger preference for pharmacological analgesia compared to those with none to mild FOC. However, multivariate analysis showed no direct association between FOC and actual usage of pharmacological analgesia. Instead, a stronger preference for pharmacological analgesia increased the likelihood of its actual usage during labor. ConclusionsOur study underscores the effect of FOC on preferences for pharmacological analgesia and its potential influence on actual usage during labor. Healthcare providers should consider women's FOC and preferences when evaluating pain management options. Targeted interventions focusing on promoting non-pharmacological techniques should be implemented to optimize labor pain management for women, particularly nulliparous women.

The Effect of Pianika Blow Therapy on the Respiratory Rate Values of Child Patients with Pneumonia at Prikasih Hospital

Background: Pneumonia is inflammation of the lung parenchyma in the alveoli and interstitial tissue caused by bacteria. The incidence of pneumonia in children <5 years in developing countries is higher when compared with developed countries, namely 10-20 cases/100 children per year, causing more than 5 million deaths per year in toddlers. Non-pharmacological techniques are currently in the spotlight as additional interventions for nursing care to overcome shortness of breath. Objective: To determine the effect of pursed breathing lips therapy or blowing a piano on the respiratory rate of pediatric patients with pneumonia Method: The research design used was a pre-experiment design, one group pre-test and post-test. This design involves one group being given a pre-test (O), given treatment (X) and given a post-test. Treatment success is determined by comparing pre-test scores and post-test scores. The research population and sample were 30 respondents, 15 control groups and 15 intervention groups. The research instrument uses a questionnaire. Statistical analysis uses a Paired Sample T-Test. Results: Respiratory results before therapy were given were abnormal >30x/minute (83.3%), the child blew the piano with the tone given for 17 seconds, rested for 2 minutes and carried out 3 attempts. The results with an average child respiratory rate of 34.53 before and 32.13, mean that there was a decrease in the RR value before and after the PLB technique, was carried out. The effect of PLB (pianika blowing) therapy on the RR value of preschool children with pneumonia at Prikasih Hospital. P-Value 0.043. Conclusion: Pursed Lips Breathing therapy is effective in increasing the RR value so this non-pharmacological therapy can be used as additional therapy for pneumonia patients. There is an effect of PLB (pianika blowing) therapy on the RR value of preschool-aged children with pneumonia at Prikasih Hospital.

Effectiveness of Audiovisual Distraction Technique and Filmed Modeling on Anxiety and Fear in Pediatric Dental Patients.

To evaluate the effectiveness of the audiovisual distraction (AVD) technique and filmed modeling (FM) on anxiety and fear in pediatric dental patients. This experimental in vivo study was conducted on 80 subjects of age-groups 5-8 years coming to the Department of Pediatric and Preventive Dentistry for their first dental visit. Study subjects were subjected to noninvasive restorative treatment under AVD in group I, FM in group II, and a combination of AVD and FM in groups III and IV (control 0). To assess the level of pre and postoperative anxiety and fear, various biological parameters like pulse rate, oxygen saturation, body temperature, respiratory rate, and salivary cortisol estimation along with facial image scale (FIS), and fear assessment picture scale (FAPS) were used. Group III (a combination of AVD and FM) came out to be better than other experimental groups and control groups in reducing dental anxiety and fear in pediatric dental patients. A combination of AVD and FM techniques can be recommended to be used as an effective behavior management technique. A child's disruptive behavior due to dental anxiety causes difficulty in delivering effective dental treatment. Thus, a child's behavior management is of paramount importance in the pediatric dental setup. Nonpharmacological behavior management techniques, that is, a combination of AVD and FM techniques can be recommended to be used as an effective behavior management technique to reduce dental anxiety and fear in pediatric dental patients. Jamil F, Khan SY, Jindal MK. Effectiveness of Audiovisual Distraction Technique and Filmed Modeling on Anxiety and Fear in Pediatric Dental Patients. Int J Clin Pediatr Dent 2023;16(4):598-602.

Comparative Evaluation of Low-level Diode Laser and Electrosurgical Pulpotomy in Primary Molars.

Considering the advantages of the nonpharmacotherapeutic techniques over the disadvantages of the pharmacotherapeutic agents, there is a need to evaluate clinically as well as radiographically various nonpharmacotherapeutic techniques to fortify them as replacements to the traditional pulpotomy. This study was conducted to evaluate and compare the clinical and radiographic outcomes of low-level diode laser (LLDL) and electrosurgical pulpotomy in primary molars. Seventy primary molars were allocated to group I (n = 35) and group II (n = 35), which underwent LLDL pulpotomy and electrosurgical pulpotomy, respectively. Clinical and radiographic analysis of all the teeth in the two groups was performed at 1, 3, 6, 9, and 12 months, respectively. Pearson's Chi-squared test was utilized to evaluate the success of both treatment procedures (p < 0.05). During the 12-month follow-up period, the differences between the groups pertaining to clinical and radiographical evaluation were statistically nonsignificant, although enhanced results were seen in the laser pulpotomy group. There was no significant difference in the success rate observed between the LLDL pulpotomy and electrosurgical pulpotomy group at the end of the 12-month follow-up period. The two pulpotomy techniques were found to be successful enough in strengthening the concept of a potent and safe nonpharmacotherapeutic approach in the management of pulpally involved primary molars. This study further establishes nonpharmacological pulpotomy techniques as a favorable alternative to traditional pulpotomy methods. Roy S, Garg N, Pathivada L, et al. Comparative Evaluation of Low-level Diode Laser and Electrosurgical Pulpotomy in Primary Molars. Int J Clin Pediatr Dent 2023;16(4):612-618.

Rehabilitation for non-motor symptoms for patients with Parkinson's disease from an α-synuclein perspective: a narrative review.

Parkinson's disease (PD) is a common neurodegenerative disorder affecting aged population around the world. PD is characterized by neuronal Lewy bodies present in the substantia nigra of the midbrain and the loss of dopaminergic neurons with various motor and non-motor symptoms associated with the disease. The protein α-synuclein has been extensively studied for its contribution to PD pathology, as α-synuclein aggregates form the major component of Lewy bodies, a hallmark of PD. In this narrative review, the authors first focus on a brief explanation of α-synuclein aggregation and circumstances under which aggregation can occur, then present a hypothesis for PD pathogenesis in the peripheral nervous system (PNS) and how PD can spread to the central nervous system from the PNS via the transport of α-synuclein aggregates. This article presents arguments both for and against this hypothesis. It also presents various non-pharmacological rehabilitation approaches and management techniques for both motor and non-motor symptoms of PD and the related pathology. This review seeks to examine a possible hypothesis of PD pathogenesis and points to a new research direction focus on rehabilitation therapy for patients with PD. As various non-motor symptoms of PD appear to occur earlier than motor symptoms, more focus on the treatment of non-motor symptoms as well as a better understanding of the biochemical mechanisms behind those non-motor symptoms may lead to better long-term outcomes for patients with PD.

Penerapan Rom Exercise Bola Karet Untuk Meningkatkan Kekuatan Otot Genggam Pasien Stroke Di RSUD Dr. Moewardi Surakarta

Background; Stroke is a blood circulation disorder in the brain which results in the death of brain tissue. Stroke patients who experience hemiparesis can result in functional impairment, impaired mobility, impaired daily activities and irreversible disability. Purpose: This study aims to determine the results of implementing rubber ball ROM exercise on muscle strength in non-hemorrhagic stroke patients. Methods: The application was carried out using a descriptive method with a case study design in non-hemorrhagic stroke patients who are at risk of experiencing muscle weakness. The application of the rubber ball rom exercise was carried out for 4 consecutive days by holding the rubber ball for 5 seconds and repeated 7 times. Results: There was an increase in muscle strength of 1 degree in both respondents after the rubber ball ROM exercise. Conclusion: The results of the application to the two respondents between before and after being given the rubber ball ROM exercise showed an increase in muscle strength. So that rubber ball ROM exercise can be used as a non-pharmacological technique to increase muscle strength in stroke patients.

Comparison of Animation Distraction Versus Local Anesthetic Application for Pain Alleviation in Children Undergoing Intravenous Cannulation: A Randomized Controlled Trial.

Background Medical procedures induce behavioral discomfort, fear, and worry in children and their families, worsening their agony. Reading, playing video games, and watching television lessen anxiety and discomfort. This study aims to compare the pain reduction in children using animation distraction and two percent lignocaine with the control group undergoing intravenous (IV) cannulation using the Visual Analogue Scale (VAS) at a tertiary care hospital inKolenchery, Kerala, South India, and to study the clinico-social factors influencing pain reduction in children undergoing IV cannulation. Materials and methods This is an open-label, randomized controlled trial study of 60 children admitted in a pediatric ward, Intensive Care Unit (ICU), or emergency department randomly assigned to either two percent lignocaine application, animation distraction, or control during intravenous cannulation. Children aged six to twelve years requiring IV cannulation for different illnesses were included. Twenty children were randomly assigned to the lignocaine group, twenty to the distraction group, and twenty to the control group. The visual analogue scale was used to measure the subjective pain intensity of the children during IV cannulation. We did statistical analysis using SPSS software version 21 (IBM Corp., Armonk, NY). Results Age, gender, previous history of cannulation, site, and size of the cannula were not significantly different between the groups. We did not relate the education of the mother to the VAS scores. The mean VAS score for pain at zero, one, and five minutes was lower in the distraction group compared to the lignocaine and control groups. The mean VAS score for pain at zero, one, and five minutes was not superior among the lignocaine group compared to the control group. Conclusion Based on the findings, animation distraction is preferable to lignocaine to alleviate pain in childrenrequiring IV cannulation for a variety of disorders.Distraction is one of the nonpharmacological techniques that seek to alleviate pain by encouraging the patient to focus on something other than the current procedure. In addition to reducing pain and anxiety during excruciating invasive interventions, distraction techniques reduce the number of interventions required and allow for the completion of interventions in less time.

Effectiveness of distraction intervention to overcome pain and associated distress during painful procedures in children

If procedures like injections and vaccinations are made free from pain, overall opinion about hospitalization will change. Nonpharmacological techniques like distraction allows focus of client to be diverted away from pain. This part of preliminary study aimed to evaluate the effectiveness of distraction in preventing or minimizing pain and behavioural distress among children while undergoing invasive intravenous procedures. Purpose: To assess and evaluate the intensity of pain and behavioural distress among children during invasive intravenous procedures with and without distraction technique and to determine the association between the intensity of pain, behavioural distress in children undergoing invasive intravenous procedures and selected variables. Method: An experimental approach with post test only control group design was used for the study. The sample for the study comprised of 24 children with age group of 3 - 12 years; 12 children for each experimental group and control group selected by purposive sampling with random assignment. Pain and behavioural distress were assessed using Revised Faces Pain Scale and Behavioural Distress Scale respectively. Findings: The results of this preliminary study showed that using distraction technique during invasive intravenous procedures reduces pain and pain associated behavioural distress among children caused due to invasive intravenous procedures.

Penerapan Mobilisasi Dini terhadap Penurunan Intensitas Nyeri pada Ibu Post Sectio Caesarea

Sectio Caesarea is considered very risky to be carried out by mothers who are about to give birth, due to the method that requires opening the wall or in medical terms Trans Abdominal Uterine Incision with pain that will be felt by a mother, which is a stressor that will be felt by the mother biologically which is felt physically. psychological and physical. The non-pharmacological techniques that can be used to reduce postoperative pain is early mobilization techniques. Early mobilization techniques are effective in reducing pain through several mechanisms, including eliminating the patient's concentration at the location of the pain in the operating area, reducing the activity of chemical mediators in the inflammatory process which increases the pain response. and minimize pain nerve transmission to the central nervous system. This research aims to know the results of implementationEarly Mobilization of Reducing Pain Intensity in Post Sectio Caesarea Mothers. This study used a quasi-experimental design with the pretest-posttest Nonequivalent Control Group design methodwithcase study descriptive method to 2 respondentsPost Sectio Caesarea. Based on the results of the implementation that has been done there is a decrease in pain intensity in patientspost sectio caesarea after being given the application of early mobilization.

Development of Animated Videos Using Diary’s Virtual Reality as a Medium Of Distraction on The Anxiety

Background: Dental anxiety refers to anxiety about dental treatment procedures. Dental anxiety is common among pediatric patients because dental treatment procedures are usually a new experience. Therapy and desperate nonpharmacological techniques, which have already become widely used, can alleviate dental anxiety. Virtual reality is one of the various media considered to distract children during dental and oral treatment. Produce a viable Diary's Virtual Reality (VR) media model and its application effectively lowers the anxiety level of child patients upon deciduous tooth extraction action.&#x0D; Method: Experimental design pretest-posttest method with control group design. There were 64 respondents which were divided into; an intervention group given the treatment of watching Diary’s Virtual Reality video and a control group given the treatment of watching video using mobile phones. To assess the child’s level of anxiety when the deciduous tooth is extracted, an MDAS query was used. The test results data of the model were tested using wilcoxon paired test and a Mann-Whitney paired test.&#x0D; Result: The Expert Validation Test of Dary’s VR media earned an average feasibility score of 97,5% with excellent categories with p-value=0,000. The paired data effectiveness test results showed an intervention group p-value=0,000 and a control group=0,010. The test results of the effectiveness of unpaired variable data show that the p-value between the intervention group and the control group is p=0,000. The Diary’s VR model effectively lowers the anxiety level of child patients.&#x0D; Conclusion: Giving Intervention Diary’s VR lowers the anxiety level of child patients significantly compared to the control group.

Correlation of Visual Distraction Method Toward Pain Reduction in Preschool Children at The Emergency Installation

Child's reaction in overcoming the crisis is influenced by the level of age, experience of the process being sick and treated, the support system available, and coping skills in dealing with stress. Preschool-age children is very difficult to understand the invasive procedures that can cause pain such as during IV insertion. When a child is hospitalized usually the child will be given an infusion. The infusion is done in order to gets the fulfillment of nutrition, fluids, and medicines. Yet, when the infusion installed on children, they can feel pain. The aims of study to determine the relationship between the visual distraction method and the reduction of pain in infusion preschool children. The population in this study was pre-school children who were treated at the Emergency Room. The sampling technique used Accidental Sampling with a total sample of 105 people. The research results obtained with a confidence level of 95% (α 0.05), it is known that the p value or Asymp value Sig. (2-sided) which is 0.001 means that the P value is 0.001 ≤ 0.05, this shows that there is a significant relationship between the Visual Distraction Method and the Pain Reduction Method in Infusion for Pre-School Children in the Emergency Room at Cut Meutia hospital of North Aceh. The use of nonpharmacological techniques has a significant impact on pain management in children. Various non-pharmacological measures that can be performed include using the distraction method. Audiovisual distraction therapy is thought to help release endorphins which have a function to reduce stress and pain.

A Multimodal Conservative Approach to Treating Migraine: A Physical Therapist's Perspective.

Migraine is common and interventions to treat or manage it vary. Physical therapists possess a varied skill set that can assess and treat limitations related to migraine and its symptoms. Conservative and non-pharmacological examination and treatment techniques for migraine and headache management are reviewed in terms of efficacy and relevance in order to describe the physical therapist's abilities and clinical reasoning process when confronting a patient with migraine symptoms. A thorough examination is necessary to detect red flags and will reveal a person with migraine's biopsychosocial limitations to manage their symptoms. Strength, endurance, cervical mobility, and visual deficits are common in those reporting headaches and examination techniques, along with patient-reported outcome measures, can elicit objective data for re-assessment during an episode of care. Exercise interventions, manual therapy, biofeedback techniques, and vestibular therapy have become viable and efficacious non-pharmacological interventions in recent years to assist the patient with managing and mitigating their migraine symptoms, along with mindfulness-based exercises. A case study, with individualized treatment approaches based on examination findings, current evidence, and accrued expertise, demonstrates the clinical applicability of a physical therapist's multimodal approach to treating migraine. Psychologically- informed physical therapy with mindfulness-based approaches and biofeedback can help a patient gain more control over their symptoms and their body's response to head pain, while exercise and vestibular therapy can assist the system with recovery and adaptation from deficits related to migraine symptoms. A thorough examination, with an individually- tailored rehabilitation plan incorporating movement and mindfulness-based therapies, is recommended.

Experiences of dentists and caregivers of patients with special care needs-A qualitative study.

Patients with special care needs (developmental disabilities) have unique and complex needs regarding their oral health and care. This qualitative study aimed to identify the experiences, preferences and challenges of dentists and caregivers regarding behavior guidance techniques for dental care in persons with special care needs. Relying on qualitative description as articulated by Sandelowski, we conducted telephone interviews with a purposeful sample of five special care dentists and seven caregivers. We analyzed the data using thematic analysis. Four themes were highlighted: (1) Neither pharmacological or non-pharmacological behavior guidance techniques was universally suitable, (2) A patient-centered approach was critical, (3) The dental environment triggered patients' behaviors and anxiety levels, (4) There was more demand for, than supply of, qualified dentists to treat patients with special care needs. Persons with special care needs are heterogeneous and respond to various behavioral techniques required to deliver their treatment. Behavior guidance planning should be negotiated carefully with patients and caregivers and then individualized based on patients' capabilities and needs for treatment. The necessity to manage complex behaviors has contributed to the limitation of access to dental care for persons with special care needs. Dentistry as a profession has the obligation to uphold the social contract and meet its responsibility to the dental care needs of this population.

A protocol for a wait list control trial of an intervention to improve pain and depressive symptoms among middle-aged and older African American women

BackgroundPain and depression frequently co-occur among older adults with comorbidities and can exacerbate one another. The intersection of race, gender and age puts older African American women at high risk of experiencing comorbid pain and depression. The purpose of this study is to test the feasibility and acceptability of a 12-week behavioral activation intervention called DAPPER (Depression and Pain Perseverance through Empowerment and Recovery) that uses non-pharmacological, tailored strategies to target pain and mood symptoms. We will measure pain intensity and depressive symptoms as outcomes, although we are not powered to test differences. MethodsWe describe the protocol for this study that uses a randomized waitlist control design to examine acceptability and feasibility of an intervention. The study population is comprised of self-identified African American women, 50 years of age or older with chronic pain and who self-report of depressive symptoms. Participants must also be pre-frail or frail and have an ADL or IADL limitation. The intervention consists of eight 1–2-h visits with a nurse interventionist via in-person or virtual telecommunication methods and two visits for non-invasive specimen collection. The primary outcomes include goal attainment, pain and depressive symptoms. Secondary outcomes include stress, frailty, and communication with providers. Follow-up qualitative interviews are conducted with participants to assess intervention acceptability. DiscussionFindings from this pilot study will provide further evidence supporting the use of non-pharmacological techniques to intervene in the cycle of pain and depression among an at-risk sub-population.

Pendidikan Kesehatan tentang Penatalaksanaan Non Farmakologi untuk Mengurangi Nyeri Persalinan

Labor is the process of expulsion of the fetus that occurs in full-term pregnancies born spontaneously with a rear-head presentation without complications to the mother and fetus. During childbirth, the mother feels pain that can interfere with comfort during contractions. Labor pain appears during the first stage of the active phase. Methods to reduce pain due to labor can be done with pharmacological and non-pharmacological methods. Non-pharmacological will not give side effects to the mother. Non-pharmacological techniques are usually deep breathing relaxation techniques, warm/cold compresses, music therapy, aromatherapy, and massage. Objective: to increase the knowledge of pregnant women about non-pharmacological management to reduce labor pain. Methods: counseling, discussion, question, and answer, as well as pretest and posttest. Result: there is an increase in knowledge of pregnant women who have good knowledge by 29,1%, namely from 62,5% increased to 91,6%. Conclusion: there is an increase in the knowledge of pregnant women about non-pharmacological management to reduce labor pain after receiving health education.

Pain Evaluation and Treatment in Children: A Practical Approach.

Pain is the most common complaint reported by children who access the emergency departments, but despite its frequency and the availability of many international guidelines, it often remains underreported and undertreated. Recently, the American Academy of Pediatrics and the American Pain Society have reiterated the importance of a multidisciplinary approach in order to eliminate pain in children. In all pediatric settings, an adequate assessment is the initial stage in a proper clinical approach to pain, especially in the emergency departments; therefore, an increasing number of age-related tools have been validated. A wide range of analgesic agents are currently available for pain management, and they should be tailored according to the patient's age, the drug's pharmacokinetics and the intensity of pain. In order to facilitate the choice of the appropriate drug, a treatment algorithm based on a ladder approach can be used. Moreover, non-pharmacological techniques should be considered to alleviate anxiety and distress in pediatric age. This review aims to offer a simple but intuitive description of the best strategies for pain relief in children, starting with the prompt recognition and quantification of pain through adequate assessment scales, and following with the identification of the most appropriate therapeutic choice among the ones available for pediatric age.