Non-pharmacological Methods Research Articles

Comparison of the Effect of Maternal Breast Milk Odor, Facilitated Tucking, and Nonnutritive Sucking Applied to Preterm Neonates During Heel Stick on Pain and Physiological Parameters: A Randomized Controlled Trial.

Background: Preterm infants in the neonatal intensive care unit (NICU) frequently undergo painful procedures, which can lead to both short-term and long-term complications, including potential mortality. Effective pain management is crucial in this context. Although numerous studies have explored non-pharmacological pain relief methods for preterm infants, no research has simultaneously compared the effects of maternal breast milk odor, facilitated tucking, and nonnutritive sucking. Aim: This study aims to comparatively investigate the efficacy of nonnutritive sucking, facilitated tucking, and maternal breast milk odor in reducing pain in preterm neonates during heel sticks. Methods: A randomized controlled trial was conducted in a tertiary-level NICU with 144 preterm neonates (gestational age 31-36 weeks) requiring heel sticks. The infants were randomly assigned to four groups: control, nonnutritive sucking, facilitated tucking, and maternal breast milk odor. Pain and physiological parameters were assessed through video recordings of the procedures and scored at 1-minute intervals using the Premature Infant Pain Profile and Data Evaluation Form. Data were collected at baseline and at 1, 2, and 3 minutes before, during, and after the heel stick. Results: The study found significant effects of the interventions on physiological parameters and pain (heart rate: F = 7.5, p < 0.001; oxygen saturation: F = 16.39, p < 0.001; respiratory rate: F = 6.56, p < 0.001; pain: F = 61.45, p < 0.001). Facilitated tucking resulted in significantly lower pain scores (6.61 ± 1.44) compared with the control group (14.22 ± 3.61), maternal breast milk odor (12.22 ± 3.08), and nonnutritive sucking (10.41 ± 1.71) (p < 0.001). Conclusions: All interventions demonstrated effectiveness in maintaining physiological stability and alleviating pain. Nevertheless, the intervention identified as most effective in reducing pain was facilitated tucking group.

The Effect of Acupressure on Pain Associated with Chest Tube Removal in Patients with Chest Trauma

Background: Inserting a chest tube is a life-saving procedure for patients with chest trauma, but it is often associated with significant pain. To alleviate this discomfort, non-pharmacological methods such as acupressure can be employed. Therefore, this study aimed to determine the effect of acupressure on pain during chest tube removal in patients with thoracic trauma. Methods: This quasi-experimental study involved the selection of 204 patients with chest tubes following chest trauma in Zahedan in 2022. The through patients were selected purposefully and Non-random allocation divided into two intervention and control groups of 102 people. The intervention group received acupressure treatment, while the control group did not. Pain levels of the patients were measured using a pain intensity scale on both the day of chest tube insertion and the day of removal. The data were analyzed using statistical test such as independent-t, paired-t and chi-square statistical tests within the SPSS 26 software. Results: The normality of the main variable was assessed using the Kolmogorov-Smirnov (KS) test. The significance level for the pain variable was found to be less than 0.05 (P&lt;0.001), indicating a non-normal distribution. Therefore, the Mann-Whitney U test was utilized for data analysis. The results of the Mann-Whitney test revealed that before the intervention, the mean pain scores were 9.46±0.69 in the intervention group and 9.47±0.65 in the control group. After the intervention, the mean pain scores were 7.11±0.98 in the intervention group and 9.39±0.90 in the control group. Based on the Mann-Whitney U value obtained from the comparison of the two groups before and after the intervention, it can be concluded that the intervention had a significant effect on reducing pain (Table 2). Conclusion: The insertion and removal of chest tube after trauma can be an extremely painful experiences for individuals. Considering the crucial role of nurses, non-pharmacological methods such as acupressure can be used to alleviate their pain. Acupressure is a cost-effective, accessible, and readily available approach that can be utilized in this context.

Effectiveness Of Ginger Transdermal Patch (Koyo Jahe) On Reducing The Intensity Of Labor Pain In Pregnant Women During The First Active Phase At TPMB K.B Pasuruan

One consequence of labor is pain, which can increase blood pressure, fetal heart rate, and maternal concentration. Mothers who are about to give birth can experience pain and discomfort due to uterine contractions, which begin the labor process. In most cases, pregnant women will experience pain during the labor process ((Utami &amp; Putri, 2020)). Handling and monitoring labor pain during labor is very important because it determines whether pregnant women can go into labor normally or through medical procedures. Nonpharmacological methods can help reduce pain during labor. The purpose of this study is to find out how effective ginger transdermal patch (koyo ginger) is to reduce the intensity of labor pain in pregnant women during the first active phase at TPMB Mrs. K.B Pasuruan. This study uses the quantitative method of Quasy Experiment, with the design of one group pretest-posttest. Koyo ginger is attached to the area of the mother's body that is in pain. Before and after 20-30 minutes of gluing, the intensity of pain is measured. The respondents of this study are mothers in the active labor phase. The analysis test uses the T-Test test. The results of the analysis showed that the intensity of labor pain in pregnant women during the first active phase before and after the administration of koyo ginger was reduced, with a sig value of 0.000 &lt; 0.05. Most women who are about to give birth need labor pain treatment, both pharmacological and non-pharmacological (Thomson et al., 2019). Ginger is one of the nonpharmacological methods to reduce labor pain (Joharmi et al., 2022). Ginger lowers pain and stops prostaglandins in a variety of ways, making it a safe and effective painkiller (Rondanelli et al., 2020).

Effects of White Noise and Therapeutic Touch on Pain and Comfort in Newborns during Heel Lance: A Randomized Controlled Study.

Nonpharmacological methods such as white noise and therapeutic touch can be used in pain management in neonates. This randomized controlled study evaluated the effects of white noise and therapeutic touch during heel lance procedures on pain, comfort levels, and physiological parameters in healthy neonates. This parallel, randomized controlled study was conducted in the Obstetrics and Gynecology Service of a regional hospital. The sample comprised 160 neonates with gestational ages of >35weeks randomly assigned to 4 groups (white noise [WN], therapeutic touch [TT], white noise+therapeutic touch [WT], and control [CG] group). Pain and comfort levels were evaluated according to the Neonatal Infant Pain Scale, and the COMFORTneo Scale. The primary outcomes were pain and comfort levels, and the secondary outcomes were heart rate and SpO2 levels. The Kruskal-Wallis test was used to compare the scale scores among groups. There were significant differences among groups in terms of Neonatal Infant Pain Scale and COMFORTneo scores (P <.05). The pain scores for the white noise, therapeutic touch, and white noise+therapeutic touch groups were 4.2±2.0, 5.2±1.6, and 3.3±1.7, respectively. There was a significant difference in average heart rate during the heel lance procedure among the groups (P <.05). Pain scores of the intervention groups were lower compared to the control group. The combination of white noise and therapeutic touch was more effective in reducing pain and increasing comfort levels. Nurses could reduce procedural pain by applying these pain relief methods.

Swiss Ball Exercise In Active Phase Of Labor: A Review Of Clinical Outcomes

Background: Childbirth is a transformative yet painful experience which impacts the mother physically and psychologically. Managing labor and pain is the crucial for the well-being of the mother and the neonates. There are two ways in which labor pain can be reduced namely pharmacological and non-pharmacological method such as birth ball which has been widely used for the better birthing experience. To evaluate the evidence-based insights of using Swiss ball exercises during the active phase of labor and to reviews its impact on pain intensity, duration of labor, maternal and neonatal outcomes. Materials and Methods: This review encompasses 12 studies conducted between 2011 and 2024, utilizing database like PubMed and Scopus to investigate the effectiveness of Swiss ball exercise during labor. Results: The findings indicated that Swiss ball exercises during labor offers significant benefits for mothers. It helped in alleviating the pain and shortening the first and second stage of labor making the labor less physically and emotionally tiring. It enhanced maternal satisfaction, and it helped in reduction in caesarean section risks and vulvar swelling and reduced the overall complications associated with childbirth. However, the uncertain neonatal outcome highlights a gap in knowledge and the need for further studies. Conclusion: Implementing a standardized Swiss ball exercise during labor has the potential to decrease pain, duration of labor and improved maternal satisfaction but there was no change in neonatal outcomes.

A Programmed Labour to Optimize Labour Outcome

Background: A Programmed labour following a protocol teaches the goal of safe motherhood. The present study on programmed labour protocol implemented to shorten the duration of labour, to optimise pain relief during labour, to monitor labour by partograph and to enhance vaginal birth. The prime objective of the study is to evaluate the effect of programmed labour on duration of labour and to assess efficiency of analgesics in reducing severity of labour pain. Materials and methods: Total 100 cases of low risk pregnant women both primi and multipara were included in this study. It was designed to low risk pregnant women with cephalic presentation without evidence of CPD- either with spontaneous onset of labour or waiting for induction of labour at 41+ wks pregnancy. Patient with labour pain allowed to move. Pain relief was done either by pharmacological or nonpharmacological method. Labour was monitored by partograph. Results: The duration were shortened in all stages of labour specially in active phase that was (Mean± SD- 3.08 hr ± 0.83), Significant paint relief in 76% cases (Mean SD of score 2.08 ± 0.62). The rate of vaginal delivery is more in programmed labour which is about 95% in this study. There is also significant reduction of maternal and fetal morbidity and mortality. Conclusion: The programmed labour is simple, easy, cheap and effective method of painless and safe vaginal delivery. Significant reduction of pain by programmed protocol avoid hyperventilation of mother, maintain circulation, thereby increase chance of vaginal delivery. Chatt Maa Shi Hosp Med Coll J; Vol.22 (2); July 2023; Page 72-74

Effect of Green Tea Supplementation on Blood Pressure Among Hypertensive People: A Community-based Randomized Control Trial

Background: A significant risk factor for cardiovascular disease, hypertension, affects more than a billion people globally. Numerous non-pharmacological methods work well to lower blood pressure. The objective of this study was to assess the short-term effect of green tea supplementation on blood pressure among people with hypertension. Methods: This community-based randomized controlled trial was conducted among people with hypertension recruited using a purposive sampling technique from the village of Lakhnaur, Mohali, Punjab, India. Sixty patients were randomly assigned to receive either supplementation with green tea beverage (one cup/day) or no intervention. The primary outcome measure was systolic and diastolic blood pressure. Blood pressure was measured at the baseline and 15 days after the intervention using a standard calibrated digital sphygmomanometer. Results: Post-intervention, the decrease in the mean systolic blood pressure was significantly greater (p &lt;) in the experimental group (129.83±6.497) than in the control group (135.0±6.433). Conclusion: Green tea supplementation significantly lowered the systolic blood pressure among study participants. Green tea may be included as part of a lifestyle intervention to manage and control systolic blood pressure in hypertensive patients.

Comprehensive Pain Management in Total Joint Arthroplasty: A Review of Contemporary Approaches.

Background: Total hip and knee arthroplasties are among the most effective and widely performed procedures in modern medicine, providing substantial benefits to patients with end-stage osteoarthritis. These surgeries have transformed the treatment of degenerative joint disease, significantly enhancing functionality and quality of life for patients. Despite considerable advancements in surgical techniques and postoperative care, managing postoperative pain remains a major challenge, impacting both clinical recovery and patient satisfaction. The persistence of postoperative pain as a barrier to recovery underscores the need for improved pain management strategies. Methods: A comprehensive narrative review of the literature was conducted, focusing on the physiological mechanisms underlying surgical pain, the role of anesthesia techniques, and the development of multimodal pain management approaches used in total joint arthroplasty. This review emphasizes the components of modern multimodal strategies, which combine multiple pharmacologic and non-pharmacologic methods to address the various mechanisms of postoperative pain. Results: Current pain management strategies employ a dynamic, multimodal approach that covers the perioperative period. These strategies aim to optimize pain control while minimizing side effects. They incorporate a range of methods, including nerve blocks, non-opioid analgesics, opioids, and non-pharmacologic techniques such as physical therapy. However, evidence regarding the efficacy and optimal combinations of these interventions varies widely across studies. Conclusions: This variation has led to inconsistent pain management practices across institutions. To standardize and improve care, this paper presents the authors' institutional pain management model, offering a potential framework for broader application and adaptation in the field of joint arthroplasty.

Abstract 4137905: The association between prehospital epinephrine administration and short-term outcomes in patients with shockable out-of-hospital cardiac arrest and extracorporeal cardiopulmonary resuscitation: a propensity matched analysis

Background: In out-of-hospital cardiac arrest (OHCA) patients with an initial shockable rhythm, epinephrine increases the likelihood of return of spontaneous circulation (ROSC), but its effect on neurological outcome remains uncertain. Epinephrine administered before extracorporeal resuscitation (ECPR), which is a non-pharmacological method to obtain ROSC, may have worsened neurological outcome. Aim: To evaluate the impact of prehospital epinephrine administration on the prognosis of OHCA patients undergoing ECPR. Methods: This is a retrospective analysis of a cohort study from a multicenter, prospective registry of 81234 OHCA patients between 2014 and 2021. After the application of exclusion criteria, 1061 OHCA patients with an initial shockable rhythm and who underwent ECPR were eligible for this study. The primary outcome was favorable neurological outcome at 30 days after the OHCA and the secondary outcome was ROSC during transfer. Patients who did and did not receive prehospital epinephrine were propensity score-matched on the basis of age, gender, witness arrest, bystander-initiated CPR, dispatcher-assisted CPR, advanced airway management, call-to-defibrillation interval, year and district. Results: Among 1061 eligible patients, 442 patients received epinephrine and 619 patients did not. Matching was successful in achieving covariate balance as shown by a standardized difference of &lt;10% for all variables (329 matched pairs). The proportion of patients with prehospital ROSC was significantly higher in those who received prehospital epinephrine than those who did not (36 [8%] vs 31 [5%]; adjusted odds ratio [OR] after propensity score-matching, 1.96 [95% CI 1.05-3.67], p=0.03). The proportion of patients with favorable neurological outcome at 30 days was not significantly lower in those who received prehospital epinephrine than those who did not (34 [8%] vs 78 [13%]; adjusted OR after propensity score-matching, 0.78 [95% CI 0.45-1.37], p=0.39). Conclusion: In patients with shockable OHCA and ECPR, prehospital epinephrine administration was significantly associated with increased ROSC before hospital arrival and not significantly with decreased favorable neurological outcome at 30 days.

The effect of eight weeks of circuit resistance training on Apo-B/A ratio and inflammatory status of sedentary postmenopausal women

Abstract Exercise can be an effective non-pharmacological method to reduce the complications of menopause. This study aimed to investigate the effect of 8 weeks of circuit resistance training (CRT) on the levels of C-reactive protein (CRP), intercellular adhesion molecule 1 (ICAM-1), apolipoprotein A (Apo-A), Apo-B, and their ratio in sedentary postmenopausal women. Thirty postmenopausal women (age 54 ± 3 years, body mass index 27.6 ± 1.97 kg/m2) without any serious diseases and no hormone therapy volunteered to participate in the research. The subjects were randomly divided into two groups: circuit resistance training (n = 15, CRT) and Control (n = 15) groups. Resistance training was performed for 8 weeks, 3 days a week, including 12 stations for the whole body in 3 sets and 8-12 repetitions. The exercises started at 40% of one repetition maximum (1RM) and gradually reached 75% of 1RM in the last week. Blood samples were taken before and 48 hours after the end of both interventions to measure CRP, ICAM-1, Apo-A-I, and Apo-B. To analyse the data, a two-way analysis of variance test was used. The CRT intervention by reducing Apo-B (−8.9% vs −0.1%; change percentage relative to pre-to-post values in each group) and increasing Apo-A1 (+4.7% vs −0.1%) led to a significant increase in the Apo-B/A ratio (−13.0% vs −0.08%) compared to the Control group. In addition, a substantial decrease in the inflammatory levels of CRP (−21.0% vs +6.3%) and ICAM-1 (−22.7% vs +1.6%) was observed after 8 weeks of CRT compared to the Control group. The observed changes were consistent with a reduction in body mass and an improvement in the waist-hip ratio (WHR). The findings indicated that CRT could reduce the complications of menopause by reducing inflammatory markers and improving the lipid profile.

Comparison of the effectiveness of drug therapy and non-drug technology of post-COVID rehabilitation of workers with intensive computer load

Currently, there is sufficient evidence of the importance and clinical effectiveness of non-drug therapy. The scientific discussion on the priority of the clinical application of pharmacological and non-pharmacological methods of rehabilitation of patients with mononeuropathies has acquired particular importance against the background of neurological post-COVID complications in patients with COVID-19. The study aims to compare the effectiveness of drug therapy and non–drug technology of post-covid rehabilitation of workers with intensive computer workload based on the study of clinical and laboratory parameters. Scientists have conducted a survey of two groups of workers with intensive computer workload who underwent rehabilitation after COVID-19 with the use of drug therapy and non-drug technologies, including balneotherapy, drinking narcotherapy, aerosol inhalations, low-frequency magnetic therapy. The authors have evaluated the effectiveness of therapy based on the results of studies of asthenization, degree of fatigue, latent coronary insufficiency, the state of the blood microcirculation system, immune status, the state of the POL-AOSIS system and endogenous intoxication of patients. Asthenization, the degree of fatigue, and latent coronary insufficiency decreased in the majority of the examined patients after post-COVID non-drug measures. Whereas in patients of the drug group, a decrease in these indicators was noted in a small number of examined patients. The indicators of the immune status of patients after non-drug therapy returned to normal, after drug therapy they only approached the limits of the norm, but did not reach it. After the treatment, the indicators of lipid peroxidation in the group of patients undergoing post-COVID rehabilitation using non-drug technologies decreased more significantly than in the group receiving drug treatment. The content of the antioxidant enzymes catalase and ceruloplasmin and the fat-soluble antioxidant α-tocopherol after treatment increases in both groups, but in the group of drug treatment they do not reach the lower limit of the reference intervals. The decrease in the content of medium-molecular peptides is more pronounced when using non-drug technologies. The application of the proposed non-drug technology for the rehabilitation of patients with post-COVID syndrome who are subjected to intense computer loads during work showed a significantly more pronounced normalization of asthenization, fatigue, latent coronary insufficiency and the state of the blood microcirculation system, immune status, the state of the POL-AOSIS system and endogenous intoxication of patients. The data obtained indicate a high therapeutic effect of the use of non-drug technology. Limitations. The surveyed groups included only persons permanently registered in Kislovodsk. Ethics. The research was conducted in accordance with the principles of biomedical ethics and approved by the local Ethics Committee of the Izmerov Research Institute of Occupation Health, Moscow (Protocol No. 4 dated 04/14/2021). Each participant of the study submitted a voluntary written informed consent signed by him after explaining to him the potential risks and benefits.

Patient Experiences of Long-term Pain and Pain Management Following Pelvic Exenteration for Locally Recurrent Rectal Cancer: A Qualitative Study.

Although pain may persist for patients who undergo pelvic exenteration for treatment of locally recurrent rectal cancer, studies exploring patient experience of postoperative pain and its management remains limited. This study aimed to explore patient experiences of postoperative chronic pain and management following pelvic exenteration. Qualitative cohort study of patients who have undergone pelvic exenteration for locally recurrent rectal cancer. The study was conducted through one-on-one semi-structured telephone interviews. Seventeen patients with locally recurrent rectal cancer who underwent pelvic exenteration between January 2018 and December 2020 were included. Semi-structured interviews explored participants' experiences of pain including its impact on life and management strategies at six and twelve months following exenteration. Interview transcripts were analyzed by two researchers using inductive thematic analysis. Participant experiences of pain following exenteration are reflected by three themes identified: 1) adapting to long-term consequences of pelvic exenteration including pain, 2) reluctance to take pain medications, 3) engaging multidisciplinary care team is essential to post-pelvic exenteration chronic pain management. Several participants reported ongoing intermittent pain following surgery that significantly affected various aspects of their lives. This prompted participants to adapt their lifestyle and explore alternative pain relief methods as some were hesitant to rely on analgesics. The small sample size from a single center whereby all patients underwent curative pelvic exenteration for lower recurrent rectal cancer with none undergoing the procedure for palliation limits the generalizability of the results of this study. While chronic pain following pelvic exenteration for locally recurrent rectal cancer interferes with patient's postoperative quality of life, analgesia use was influenced by pain habituation and fear of dependence on pain medications. Our findings emphasize the further need to investigate a multidisciplinary approach, including non-pharmacological methods, for optimization of pain outcomes following pelvic exenteration. See Video Abstract.

Perceived Access to HIV Prevention Services Amidst the COVID-19 Pandemic Among Men Who Have Sex with Men (MSM) and MSM Sex Workers in France, Russia, and Türkiye.

This study examined the association between self-identification as a sex worker (SW) and perceived access to pharmacologic and non-pharmacologic HIV prevention methods among MSM in France, Russia, and Türkiye amidst the COVID-19 pandemic. Globally, 17,250 MSM recruited through a geosocial networking smartphone application completed the COVID-19 disparities survey, which was administered between October and November 2020. Approximately 38% of survey respondents were identified as living in France (n = 1269), Russia (n = 3882), and Türkiye (n = 3141) at the time of survey completion. Given the diverse sociodemographic factors and attitudes toward both MSM behavior and commercial sex work in these countries, we conducted a secondary analysis of survey data exploring the relationship between SW status and perceived access to pharmacologic and non-pharmacologic HIV prevention methods during the COVID-19 pandemic. Among respondents in Russia and France, MSM SW status was associated with a reduction in perceived access to condoms/lubricants (p = .001 in Russia, p < .001 in France). MSM SW in France were less likely to report never using PrEP as compared to non-SW peers (RR = 0.40, p = .005). Our findings highlight the disparities in access to HIV prevention for MSM SW living in these three countries during the COVID-19 pandemic. Based on our findings, COVID-19 may have exacerbated pre-existing inequities in HIV prevention among populations experiencing intersecting stigmas.

Impact of Swimming Training on the Course and Symptoms of Bronchial Asthma and Respiratory System Function: A Literature Review

Introduction: Bronchial asthma is one of the most common inflammatory diseases among adults and children. It is characterized by the occurrence of bronchial obstruction, which is manifested, for instance, by a feeling of shortness of breath, wheezing, a feeling of tightness in the chest, a feeling of squeezing in the chest. In addition to pharmacological treatment, health behavior including sport is of great importance. In this publication, we will attempt to discuss the effects of swim training on asthma and respiratory system function. We will try to answer the question whether swimming is a safe form of exercise for patients with bronchial asthma.Material and methods: Review of the specialized literature in the field of pulmonology, guidelines for treatment of bronchial asthma and articles available on PubMed and Google Scholar database searching by the keywordsAim of the study: The aim of this publication is to review the available literature to answer the question of whether swimming training is a suitable form of exercise for asthmatic patients and what effect it has on respiratory functionConclusions: The treatment of bronchial asthma is based on the pharmacological treatment. In addition to medications, non-pharmacological methods and health behaviours are important. Appropriate physical activity for people with asthma may include swimming training, which has a beneficial effect on lung function and asthma symptoms management, especially in the paediatric population. There are studies that suggest that swimming carries a lower risk of causing bronchospasm than other sport activities, however, there are inconclusive reports on the effect of attending chlorinated swimming pools on the development of asthma and allergies. Studies on competitive and elite swimmers show that intensive swimming training, especially in chlorinated pools, can induce bronchial hyperresponsiveness and the risk of developing asthma, but this requires further research.

How are different traditional Chinese medicine modalities deployed by clinical practitioners in China? Findings from a national survey

ObjectiveTraditional Chinese medicine (TCM) incorporates traditional diagnostic methods and several major treatment modalities including Chinese herbal medicine, Chinese patent medicine, and non-pharmacological methods such as acupuncture and tuina. Even though TCM is used daily by more than 70,000 healthcare facilities and over 700,000 clinical practitioners in China, there is a poor understanding of the extent to which TCM diagnostic methods are used, how different treatment modalities are deployed in general, and what major factors may affect the integration of TCM and Western medicine. This study aimed to fill this void in the literature. MethodsIn the 2021 National Healthcare Improvement Evaluation Survey, we included three questions gauging the perception and practices of TCM amongst physicians working in TCM-related facilities, investigating the frequency of their deployment of TCM diagnostic methods, and predominant TCM treatment methods. Our empirical analysis included descriptive statistics, intergroup chi-square analysis, and binary logistic regression to examine the association between different types of facilities and individual characteristics and TCM utilization patterns. ResultsA total of 7618 clinical physicians comprised our study sample. Among them, 84.27% have integrated TCM and Western medicine in their clinical practice, and 80.77% of TCM practitioners used the 4 diagnostic methods as a tool in their clinical practice. Chinese herbal medicine was the most widely utilized modality by Chinese TCM physicians (used by 88.49% of respondents), compared with the Chinese patent medicine and non-pharmacological TCM methods, which were used by 73.14%, and 69.39%, respectively. Herbal tea as an out-of-pocket health-maintenance intervention is also a notable practice, recommended by 29.43% of physicians. Significant variations exist across certain institutions, departments, and individual practitioners. ConclusionGiven that most of the surveyed physicians integrated TCM with Western medicine in their clinical practices, the practice of “pure TCM” appears to be obsolete in China’s tertiary healthcare institutions. Notably, remarkable variation exists in the use of different TCM modalities across institutions and among individuals, which might be related to and thus limited by the practitioners’ experience. Future research focusing on the efficacy and safety of TCM interventions for specific diseases, the development of standardized clinical guidelines, and the enhancement of TCM education and training are called for to optimize TCM-Western medicine integration.

Clinical Management of Respiratory Diseases in Neurosurgical Settings

Respiratory diseases, such as chronic obstructive pulmonary disease(COPD)and asthma, are becoming increasingly prevalent in super-aging societies. In Japan, the estimated prevalence of COPD among individuals aged 40 years and above is 8.6%, while asthma affects about 10% of adults. These statistics highlight the similarities between COPD and asthma in clinical settings. Both diseases involve chronic airway inflammation and present with symptoms such as chronic cough, sputum production, wheezing, and dyspnea. Exacerbations of these symptoms and complications are critical concerns during the perioperative period. COPD, often caused by long-term smoking, leads to irreversible airway and lung damage, while asthma is characterized by episodic and reversible airway constriction due to chronic inflammation. COPD diagnosis involves spirometry and the exclusion of other diseases, with treatment goals focusing on symptom improvement and risk reduction through smoking cessation, pharmacotherapy(mainly bronchodilators), and non-pharmacological methods(such as pulmonary rehabilitation). Asthma management aims to control inflammation and prevent exacerbations using inhaled corticosteroids and bronchodilators as standard treatments. Perioperative management of both diseases involves improving respiratory function with pharmacotherapy, careful anesthesia selection, and early postoperative mobilization. Consultation with respiratory specialists is recommended for effective management, especially in complex cases.

Alleviating Active Labor Pain: The Impact of Virgin Coconut Oil (VCO) Back Massage During the First Stage of Labor

Labor pain is one of the most intense sensations experienced by women during childbirth, particularly during the first stage of labor. This study aimed to evaluate the effect of back massage with Virgin Coconut Oil (VCO) on the intensity of active labor pain during the first stage. The research employed a quantitative, pre-experimental one-group pretest-posttest design, involving 18 mothers in active phase labor at IMP Restu Bunda, West Tulang Bawang Regency. Pain levels were measured using the Visual Analog Scale (VAS) before and after the back massage with VCO. Results showed that the average labor pain intensity before the intervention was 7.0, and after the back massage with VCO, the average pain decreased to 5.2. Statistical analysis using the Wilcoxon test revealed a significant reduction in pain intensity (p-value = 0.000), indicating that back massage with VCO effectively reduced labor pain. Seventeen respondents reported a decrease in pain, while only one respondent experienced no change. The findings suggest that back massage with VCO is a viable non-pharmacological method for managing labor pain, with minimal side effects.

The Effectiveness of Acceptance and Commitment Therapy Method on the Life Expectancy of Patients with Various Diseases in Iran: A Literature Review Study

Context: Acceptance and commitment therapy (ACT) is a cognitive-behavioral psychotherapy method focusing on acceptance and commitment to life values. Objectives: This study aimed to evaluate the effectiveness of the ACT method on the life expectancy (LE) of patients with different diseases. Evidence Acquisition: The present study is a literature review that collects findings from past related studies in the last two decades. For this purpose, the essential and common Medical Subject Headings (MeSH) terms were first identified. Then, the desired MeSH terms were searched in the most reliable and essential international databases, including Google Scholar, Scopus, PubMed, Web of Science, and national databases, including Magiran, SID, Iran doc, etc. First, 265 articles were identified, and then 18 were selected as final studies considering the inclusion and exclusion criteria. Results: The findings of 18 studies were extracted for the present study. Some different types of patients, including those with rheumatoid arthritis, depression, multiple sclerosis, asthma, diabetes, liver transplants, chronic pain, cancer, physical-motor disabilities, drug addiction, and others, were shown to increase LE through the use of the ACT method. The main finding of the present study was that using the ACT method to increase LE in patients with various diseases has a significant effect, which was clearly highlighted in all the selected studies. Conclusions: Based on the findings, ACT is an effective and high-efficiency method in increasing patients' LE. Acceptance and commitment therapy can improve LE, resilience, quality of life, compliance with treatment, and other patient benefits, thus improving the speed of recovery for patients. Therefore, the ACT method, which is a non-pharmacological method, can be used by specialists and clinical psychology experts for different patients.

Complex therapy of musculoskeletal pain: the role of centrally acting muscle relaxants

Chronic pain is the main manifestation of musculoskeletal diseases (MSDs), leading to deterioration of quality of life and loss of ability to work. The importance of this problem is determined by the widespread prevalence of MSDs, osteoarthritis (OA), acute and chronic non-specific back pain (NBP), periarticular soft tissues lesions. Introduction of effective methods of treatment of musculoskeletal pain (MSP) into medical practice is one of the fundamental tasks of modern medicine.The pathogenesis of MSP includes mechanisms such as injury, inflammation, peripheral sensitization, biomechanical disorders, dysfunction of the nociceptive system and psychoemotional disorders. Painful muscle tension plays an important role in the development of MSP, especially in NBP. Given the complex pathogenesis of MSP, its treatment is based on the combined use of drugs with different mechanisms of action and nonpharmacological methods. Non-steroidal anti-inflammatory drugs (NSAIDs) have a central place in this context. However, they can cause serious adverse reactions (ARs), so when choosing NSAIDs, it is necessary to consider comorbid pathology and risk factors. One of the most acceptable NSAIDs with a pronounced analgesic effect and low incidence of ARs is aceclofenac, which is available in various dosage forms (tablets, sachets, topical cream for external use). This medication is characterized by proven efficacy and good tolerability.Centrally acting muscle relaxants (CM) play an important role in the treatment of MSP. They eliminate muscle spasm, enhance the effect of analgesics and reduce the need for NSAIDs. The effect of CM has been demonstrated in spasticity and NBP. However, the use of many drugs of this group can be associated with serious ARs, which limits their use.Tolperisone has the best combination of efficacy and favorable safety profile among CM. Its positive effect in the complex treatment of NBP has been confirmed in several well-organized, placebo-controlled trials. There are also studies demonstrating the efficacy of tolperisone in OA. An important advantage of this drug is virtually no sedative effect, and no negative impact on hemodynamics and on the ability to perform concentration-intensive work. Emergence of a new form of tolperisone – extended-release tablets (Mydocalm® Long 450 mg) – increases patient compliance with CM therapy and facilitates the physician's work.

Typical clinical practice of treating patients with chronic migraine

Currently, effective methods for the treatment of chronic migraine (CM) have been developed, but it remains unclear how they are used in real clinical practice and how often. The typical practice of treating patients with CM in our country has not been sufficiently investigated, which formed the basis for conducting this study.Objective: to evaluate the quality of treatment of patients with CM in real-life neurological practice.Material and methods. The study included 200 patients with CM (63 men and 137 women, mean age – 33.1±7.1 years) admitted to A.Ya. Kozhevnikov Clinic of Nervous Diseases (CND) of Sechenov University for frequent headaches, who were previously treated by neurologists in other medical institutions on an outpatient and/or inpatient basis. All patients were clinically interviewed to establish a diagnosis and analyze their previous treatment.Results. All patients had an experience of incorrect or inadequate treatment, including ineffective drug and non-drug methods. All patients were taking painkillers to relieve migraine, but less than half of them was satisfied with their effectiveness. Only 12 (8.5%) patients with medication overuse headache had previously received treatment for drug overuse. None of the patients who were admitted to CND had previously received cognitive-behavioral therapy and treatment with an interdisciplinary approach that included not only pharmacotherapy but also psychological and behavioral methods and kinesiotherapy.Conclusion. In real-life clinical practice, ineffective methods are often used to treat migraine, and an interdisciplinary approach that includes effective pharmacotherapy and non-pharmacological methods is lacking.