Non-pharmacological Therapies Research Articles

Therapeutic Controlled Release Strategies for Human Osteoarthritis.

Osteoarthritis is a progressive, irreversible debilitating whole joint disease that affects millions of people worldwide. Despite the availability of various options (non-pharmacological and pharmacological treatments and therapy, orthobiologics, and surgical interventions), none of them can definitively cure osteoarthritis in patients. Strategies based on the controlled release of therapeutic compounds via biocompatible materials may provide powerful tools to enhance the spatiotemporal delivery, expression, and activities of the candidate agents as a means to durably manage the pathological progression of osteoarthritis in the affected joints upon convenient intra-articular (injectable) delivery while reducing their clearance, dissemination, or side effects. The goal of this review is to describe the current knowledge and advancements of controlled release to treat osteoarthritis, from basic principles to applications in vivo using therapeutic recombinant molecules and drugs and more innovatively gene sequences, providing a degree of confidence to manage the disease in patients in a close future.

An update on the pharmacotherapy of postpartum depression.

Extensive research has been conducted on postpartum depression (PPD) over the past century, and yet no definitive answer regarding its etiopathogenesis, risk factors, genetic predilection, and treatment has been found. The few preclinical and clinical studies propose that maternal brain adaptations to the endocrinological, immunological, and behavioral changes and external sociodemographic risk factors in the perinatal period make women more vulnerable to anxiety and depression. Irrespective of the cause, a dilemma exists regarding the type of help to provide postpartum mothers. With very few treatment options at our disposal, deciding between psychotherapy, pharmacological, and non-pharmacological therapy on a case-by-case basis is unproductive because in developing countries infrastructure is limited and the availability of medications, especially for psychiatric illnesses, is still evolving. Hence, regardless of psychotherapy, antidepressants remain the first line of treatment with selective serotonin reuptake inhibitors (SSRIs); sertraline has the best efficacy and safety profile in breastfeeding women. As endocrine factors play a significant role in etiopathogenesis, hormonal therapy with oxytocin has been shown to be efficacious, and studies investigating the role of testosterone in treating PPD are also under way. In 2019, the US Food and Drug Administration (FDA) approved the first and only drug for the sole purpose of treating PPD, brexanolone. Zuranolone, a drug recently approved by the FDA, has a similar mechanism of action to brexanolone. For breastfeeding mothers reluctant to use pharmacotherapy, somatic therapy has been studied, including bright light therapy, vagal nerve stimulation, and newer noninvasive interventions. This article encompasses a short note on PPD, including its etiopathogenesis and clinical characteristics, and recapitulates the various available and evolving pharmacological and nonpharmacological therapies.

Multisensory healing: transformative service encounters in nonpharmacological therapies for cancer patients’ well-being

Purpose This study aims to explore the impact of nonpharmacological therapies on cancer patients’ daily illness management and long-term well-being. It focuses on the design and effects of immersive multisensory workshops, including therapies such as yoga, music therapy and visual imagery. By examining individuals’ experiences before, during and after the service experience, the study aims to provide comprehensive insights into the transformative effects of these immersive multisensorial experiences from the individuals’ perspectives. Design/methodology/approach From November 2021 to March 2023, the authors conducted 13 interviews and 3 focus groups (10 participants in total) among cancer patients. Thematic analysis of recorded interviews and focus groups revealed recurring patterns, key themes and meaningful insights from participants’ narratives. Findings The findings provide insights into individuals’ journey of service experiences among cancer patients from a user perspective. By framing the results within the service encounters model, individuals’ journey of this immersive multisensory experience is studied in three different periods: the pre-core, the core and the post-core service encounter. The pre-core service encounter includes activities such as information gathering to answer concerns and setting expectations, with the therapy. The core service encounter encompasses the immersive environmental experience, which includes multisensory integration and activity immersion, body-mind reconnection, as well as engaging interactive experiences with service providers, other patients and internal engagement. The post-core service encounter reflects the cognitive, psychological, behavioral and spiritual outcomes of the service. Originality/value This paper sheds light on the design of immersive multisensory workshops as nonpharmacological therapy. Adopting a user-focused approach using the service encounters framework helps clarify various aspects of this therapy and its effects on patients’ reconnection with their bodies and well-being. This research offers valuable insights for designing effective multisensory therapeutic environments for chronic patients to improve the quality of health-care services.

Perceived health and working life in caregivers from nursing homes that used or did not use nighttime personalized non-pharmacological therapies to address residents’ behavioral and psychological symptoms of dementia

Dementia is frequent in nursing home (NH), affecting between 40 and 50 % of the residents and is associated in 90 % of the cases with behavioral and psychological symptoms (BPSD) which are detrimental to caregivers’ working life and perceived health. We compared perceived health and working life between NHs that used or did not use nighttime personalized non-pharmacological therapies (PNPT) to address BPSD. This anonymous survey included 96 caregivers from 25 NHs which used (n = 69) or not (n = 27) nighttime PNPT. Perceived health, nursing and medical care, quality of care and internal motivation were significantly higher, stress symptoms and workload were significantly lower and there was a tendency to enhanced satisfaction with work in caregivers from NHs which used nighttime PNPT. Our present data open a new window on the benefits of PNPT.

The effect of administration of green coconut (Cocos nucifera Linn Viridis Variety) water on reducing dysmenorrhea primary for teenage women in class X at State High School 1 Deli Tua Year 2024

Primary Dysmenorrhea is menstrual pain that occurs in teenagers, which is usually not associated with other diseases. According to WHO, in 2018 the incidence of primary dysmenorrhoea was very high in the world. On average, more than 50% of women in each country experience primary dysmenorrhoea. One way to treat primary dysmenorrhoea is non-pharmacological therapy, namely using green coconut water. Green coconut water contains calcium and magnesium which can reduce muscle tension. Vitamin C, which is a natural anti-inflammatory, relieves menstrual pain by inhibiting the cyclooxygenase enzyme which plays a role in the process of forming prostaglandins. This study aims to determine the effect of giving green coconut water on reducing primary dysmenorrhoea in adolescent girls. The research will be carried out at SMA Negeri 1 Deli Tua starting in April-May 2024. The research design uses a quasi-experiment method with one group pretest -posttest design. The sample in this study consisted of 22 respondents who were given green coconut water using a purposive sampling technique. The primary data used in this research was an observation sheet on the primary dysmenorrhoea pain scale before and after being given green coconut water as a research instrument. Based on the results of bivariate analysis using the Chi Square test, it shows that the p-value is 0.000. So it can be concluded that p <0.005, which means there is an effect of giving green coconut water on reducing primary dysmenorrhoea in young women.

Effectiveness of Finger Hand Relaxation and Progressive Muscle Relaxation Techniques on Anxiety in Pre-Operative Sectio Caesarea Patients

Background: Anxiety is a common thing that occurs in patients who will undergo surgery. The anxiety that occurs in preoperative patients can be felt from the time they are scheduled for surgery until the time of surgery arrives. Anxiety management can be done using pharmacological and non-pharmacological therapy. Purpose: The aim of this research is to analyze the effectiveness of finger grip relaxation techniques and progressive muscle relaxation on anxiety in pre-caesarean section surgery patients in the Kediri Regency Regional General Hospital. Method: This study used a Quasy-experiment With Pretest Posttest to determine the effect of finger grip and progressive muscle relaxation techniques. The sample selection in this study used a purposive sampling technique and a total of 56 patients were obtained who were divided into 2 groups, namely the finger grip intervention group and the progressive muscle intervention group. The pretest and posttest data for each group were then analyzed using the Wilcoxon Test to determine the effect and the Mann-Whitney Test to compare the posttest results of the 2 groups. Results: The results of the study showed that the Wilcoxon test in both intervention groups obtained a p-value < α (0.05), which means that before and after the intervention, both progressive muscle relaxation and finger grip relaxation had an influence on the anxiety level of pre-caesarean section patients. For the results of the Mann-Whitney test, the p-value was 0.063 or p-value > α (0.05), which means there was no significant difference between changes in anxiety whether those given progressive muscle relaxation intervention or finger grip relaxation. Conclusion: Finger grip relaxation techniques and progressive muscle relaxation techniques are both effective in reducing anxiety levels in pre-caesarean section surgery patients. So this non- pharmacological therapy can be an option for patients in dealing with anxiety problems before caesarean section surgery.

The Application of Dhikr Spiritual Therapy to Reduce Signs of Risk of Violent Behavior in the Mawar Room at dr. Radjiman Wediodiningrat Hospital

The risk of violent behavior is a condition when an individual will endanger the safety of himself, others, family, community, because of his aggressive behavior. Spiritual dhikr therapy is a therapy that can help reduce signs and symptoms of the risk of violent behavior because when patients listen to reading the Al-Qur’an it can reduce stress hormones, increase feelings of relaxation and divert attention from fear, anxiety and tension. This study aims to apply how to apply spiritual dhikr killing treatment therapy in patients at risk of violent behavior. The method employed is through a case study research design using 5 nursing processes. The patients accept the implementation of nursing strategies to cotrol violent behavior using physical, drug, verbal and spiritual means. Interventions for clients with a risk of violent behavior are adjusted to violent behavior implementation strategies (SP) and then receive additional non-pharmacological therapy in the form of spiritual dhikr therapy at each meeting. Spiritual dhikr therapy is carried out for 10 consscutive days, each meeting consisting of 5 sessions with reading tahlil, tasbih, tahmid, takbir, istighfar. Each session reads the dhikr sentence 33 times wtithin 5 minutes. Before giving dhikr, spiritual therapy there were 9 signs of violent behavior, whereas after giving therapy for 10 days there was a decrease to 2 signs of violent behavior. Spiritual dhikr therapy can reduce signs and symptoms of violent behavior because dhikr can purify the heart and soul, be grateful for what Allah has given, make the body healthy, and prevent oneself from the dangers of lust. Nursing strategies (controlling violent behavior physically, drugs, verbally and spiritually and spiritual dhikr intervention can effectively reduce signs of violent behavior. This can reduce stress hormones, increase feelings of relaxation and distraction of fear, anxiety.

Role of nonpharmacological concussion management in children: systematic review of randomized controlled trials.

Concussion is a global public health problem that affects many children worldwide. Most patients present with postconcussion syndrome and normal brain imaging find- ings. Despite the high incidence of concussion in children, published research on nonpharmacological management is lacking and much more often concerns pharmacological interventions. This systematic review aimed to evaluate the role of nonpharmacological interventions in managing concussion based on randomized controlled trials. The PubMed, Scopus, Web of Science, and Cochrane data- bases were extensively searched for articles published between January 2013 and July 2023. A modified patient intervention, comparison, and outcome framework was used to construct the search strategy and eligibility criteria. Risk of bias was assessed using the Risk of Bias-2 tool. A total of 16 studies conducted between January 2013 and July 2023 were analyzed. Three studies were conducted in an acute care setting (<24-hour postinjury) involving rest, computer time, and doing nothing, while the other 13 studies were conducted in a chronic care setting (>24-hour postinjury) and included aerobic exercise, collaborative care intervention, cervical spine rehabilitation, education by physiotherapists, a hyperbaric oxygen therapy protocol, family intervention therapy, virtual reality, traditional occupational therapy, virtual rehabilitation, oculomotor control exercises, vestibular rehabilitation, coordination exercises, and balance exercises. This systematic review highlights the importance of nonpharmacological therapy in pediatric concussion cases. Active rehabilitation may yield promising outcomes. Another interesting approach may be useful in pediatric concussion management. How- ever, this systematic review shows a lack of high-quality literature supporting nonpharmacological pediatric con- cussion treatments.

Analysis of the Application of Murottal Al-Quran to the Signs and Symptoms of Hearing Hallucinations

Schizophrenia is a serious mental health problem where one of the symptoms is hallucinations. Signs and symptoms of hallucinations include feeling more comfortable with their situation, the client is seen laughing and talking to himself or expressing things that are not actually real, so pharmacological and non-pharmacological therapy management is needed. One of them is by providing Murottal Al-Qur'an therapy. The aim of this research is to explain nursing care and determine the analysis of Al-Quran murottal therapy on reducing the signs and symptoms of auditory hallucinations experienced by patients. This research design uses descriptive research with a case study method. Therapy is given for 7 days for 15 minutes by listening to the chanting of holy verses from the Koran, one of which is Surah Ar-Rahman and Surah Al-Jinn. The results of the research were a decrease in the signs and symptoms of hallucinations in clients and the ability to control their hallucinations by carrying out positive activities, conversing with people around them and murottalizing the Koran. Providing Al-Quran murottal therapy can reduce the client's signs and symptoms of hallucinations, namely daydreaming, isolating himself, smiling, talking to himself, lack of eye contact and hearing voices that are not real.

Transcutaneous auricular vagus nerve stimulation mitigates gouty inflammation by reducing neutrophil infiltration in BALB/c mice

Gouty inflammation, caused by uric acid crystal deposition, primarily affects tissues around the toe joints and triggers potent inflammatory responses. Current treatments focus on alleviating inflammation and pain using pharmaceutical agents, which can lead to side effects and complications. This has generated interest in non-pharmacological interventions, such as non-invasive vagus nerve stimulation (VNS). In this study, we explored the anti-inflammatory mechanisms of transcutaneous auricular vagus nerve stimulation (taVNS) in a mouse model of acute gout. Gouty inflammation was induced by injecting monosodium urate (MSU) crystals into the ankle joints of BALB/c mice. The effects of taVNS on the expression of inflammatory cytokines and chemokines in the ankle joint tissue were assessed using real-time quantitative PCR (qPCR), western blotting, histological assessments (H&E staining), and immunohistochemistry (IHC). The role of α7 nicotinic acetylcholine receptors (α7nAChR) was also evaluated by signal blocking. Our findings revealed that MSU significantly elevated gout-associated inflammatory cascades and mediators in the ankle joint. Notably, taVNS at 200 µA and 25 Hz effectively reduced these inflammatory responses, decreasing neutrophil infiltration and chemoattraction within the tissue. taVNS showed significant anti-inflammatory properties by suppressing neutrophil activity, offering a novel therapeutic approach for gout beyond conventional pharmacological methods. Additionally, taVNS holds potential for managing various chronic joint diseases. These results highlight taVNS as a promising non-pharmacological therapy for chronic inflammation.

Unmet Needs in Spondyloarthritis: Pathogenesis, Clinical Trial Design, and Nonpharmacologic Therapy.

A program focused on pathogenesis, clinical trial design, and nonpharmacologic mind-body therapy for of spondyloarthritis (SpA) was presented at the Spondylitis Association of America Unmet Needs Conference IV. SpA pathogenesis is incompletely understood but involves a complex set of drivers, including genetics, biomechanical stress, and microbial factors. Affected tissues may include axial and peripheral joints, entheses, skin, uvea, and intestines. The specific role of key cytokines like interleukin (IL)-23, IL-17, and tumor necrosis factor in the phases of this inflammatory process remains unclear. New insights into pathogenesis will continue to generate targets for novel therapeutics. How to optimally evaluate those therapeutics in clinical trials, and for the various manifestations of SpA, remains less clear. Future trials need better generalizability, robust subgroup analyses to assess differential responses for distinct disease manifestations, a focus on comparative efficacy, and outcomes relevant to the clinician and the patient. Additionally, study designs need to leverage available technology to facilitate subject participation in trials. In view of the interplay between biologic, physical, and psychological aspects of disease, there is increasing attention to nonpharmacologic agents, with the aim of maximizing long-term health-related quality of life through the control of symptoms and inflammation. Recent studies provide encouraging evidence that mind-body interventions such as tai chi, qigong, yoga, and meditation have benefits for patients with SpA, particularly those with pain. The advances in our understanding of pathogenesis, novel therapeutics, and nonpharmacologic interventions have revolutionized the management of SpA, but numerous questions around optimal management remain.

Daily high-frequency transcranial random noise stimulation (hf-tRNS) for sleep disturbances and cognitive dysfunction in patients with mild vascular cognitive impairments: A study protocol for a pilot randomized controlled trial.

Poor sleep quality is increasingly considered to be an underlying cause of cerebrovascular diseases. This is a slowly progressing condition that gradually leads to vascular cognitive impairment and stroke during ageing. At present, randomized clinical trials examining the non-pharmacological therapies in the management of this comorbidity are very limited. Transcranial current stimulation (tCS) is a non-invasive technology for promoting cognitive function and treating brain disorders. As advanced modalities of tCS, transcranial random noise stimulation (tRNS) and transcranial alternating current stimulation (tACS), could deliver frequency-specific waveforms of currents that can modulate brain activities in a more specific manner. Chinese individuals between the ages of 60 and 90 years, who are right-handed and have mild vascular cognitive impairment (VCI) with sleep disturbances, will participate in a randomized study. They will undergo a 2-week intervention period where they will be randomly assigned to one of three groups: high-frequency (hf)-tRNS, 40 Hz tACS, or sham tCS. Each group will consist of 15 participants. Before the intervention, high-resolution magnetic resonance imaging (MRI) data will be used to create a computational head model for each participant. This will help identify the treatment target of left inferior parietal lobe (IPL). Throughout the study, comprehensive assessments will be conducted at multiple time points, including baseline, 2nd week, 6th week, and 12th week. These assessments will evaluate various factors such as sleep quality, domain-specific cognitive performance, and actigraphic records. In addition, the participants' adherence to the program and any potential adverse effects will be closely monitored throughout the duration of the intervention. The primary objective of this study is to examine the safety, feasibility, and effectiveness of hf-tRNS and 40 Hz tACS interventions targeting left IPL in individuals with mild vascular cognitive impairment (VCI) who experience sleep disturbances and cognitive dysfunction. Additionally, the study seeks to evaluate the program's adherence, tolerability, and any potential adverse effects associated with frequency-specific transcranial current stimulation (tCS). The findings from this research will contribute to a deeper understanding of the intricate relationship between oscillation, sleep, and cognition. Furthermore, the results will provide valuable insights to guide future investigations in the field of sleep medicine and neurodegenerative diseases. ClinicalTrials.gov Identifier: NCT06169254.

Therapy strategies for repetitive vocalizations in dementia : Asystematic review

Vocalizations in dementia patients are repetitive verbal expressions that, due to their volume, frequency, and/or social inappropriateness, cause negative effects on patients and other individuals present. The prevalence ranges up to 30%. Given the increasing global incidence of dementia and the limited number of randomized controlled trials about treating repetitive vocalizations, this systematic review provides asummary of existing works on the effectiveness of potential pharmacotherapeutic and nonpharmacological therapies. The systematic review follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and was registered on the International Prospective Register of Systematic Reviews (PROSPERO) registration page (registration number: CRD42023486344). Literature search was conducted in PubMed and Embase databases. Due to insufficient data, case reports were also included. Of 2635 articles, 25studies were included in the review. Efficacy was demonstrated for selective serotonin reuptake inhibitors (SSRIs), pregabalin, gabapentin, and the antipsychotics haloperidol and risperidone based on afew case reports, albeit with associated side effects. Nonpharmacological interventions also showed efficacy. Both pharmacological and nonpharmacological interventions are effective treatment approaches for repetitive vocalizations in dementia patients. Due to the fact that there are hardly any randomized controlled studies available, the results of this systematic review must be interpreted with caution. The results of this review show that randomized controlled trials are required for many interventions.

The Management and Prevention of Delirium in Elderly Patients Hospitalised in Intensive Care Units: A Systematic Review.

Delirium or an acute confusional state (ACS) is characterised as being a frequent and complex hospital complication in older adult patients, which can affect their level of independence and increase patient morbidity and mortality. Critically ill patients in the intensive care unit (ICU) frequently develop ICU delirium, leading to longer hospital and ICU stays, increased mortality and long-term impairment. This review aims to assess existing evidence of interventions that can be considered effective for the management and prevention of delirium in ICUs, reducing short-term morbidity and mortality, ICU and hospital admission times and the occurrence of other long-term complications. For this systematic review, we searched Medline, PubMed, Cochrane Library, CINHAL, LILACS, SciELO and Dialnet from January 2018 to August 2024, in English, Spanish and French. MeSH descriptors were adjusted to search the different databases. We also checked Prospero for ongoing systematic reviews. The electronic search yielded a total of 2656 studies, of which 14 trials met the eligibility criteria, with a total of 14,711 participants. We included eight randomised clinical trial (RCTs), four cohort analyses, one systematic review and one observational trial, including participants over 65 years admitted to the ICU. Ten of these studies were based on pharmacological interventions, three of them examined non-pharmacological interventions and the remaining study examined mixed (pharmacological and non-pharmacological) interventions. Six placebo RCTs were included, plus four reported comparisons between different drugs. Regarding non-pharmacological interventions, nursing programmes focused on optimising modifiable risk factors or the use of therapies such as bright light are emerging. Regarding mixed interventions, we found the combination of invasive techniques and with sedoanalgesia. Due to its satisfactory level of sedation, dexmedetomidine is presented as a viable option because, although olanzapine offers safer results, postoperative administration angiotensin inhibitor systems significantly reduced the incidence of delirium. As for propofol, no significant differences were found. Among the non-pharmacological and mixed therapies, bright light therapy was able to reduce the incidence of delirium, and the combination of epidural/general anaesthesia was effective in all subtypes of delirium. Concerning the remaining interventions, the scientific evidence is still insufficient to provide a definitive recommendation.

Effectiveness of Isometric Handgrip Exercise on Blood Pressure in Hypertensive Patients in Tenajar Lor Village, Kertasemaya District, Indramayu Regency

Uncontrolled hypertension may result in numerous consequences; effective management is essential to regulate blood pressure in hypertensive individuals by both pharmacological and non-pharmacological interventions. Isometric handgrip exercise is a non-pharmacological therapy. This study sought to assess the impact of isometric handgrip exercise on blood pressure in hypertensive individuals in Tenajar Lor Village, Kertasemaya District, Indramayu Regency. This research design employs a quasi-experimental framework featuring a two-group pre- and post-test methodology alongside a control group design. The study sample comprised 30 respondents, categorized into intervention and control groups. The isometric handgrip exercise intervention was conducted daily for five successive days. The Wilcoxon test results indicated that the intervention group had an average systolic mean rank of 8.00 with a p-value of 0.000, and a diastolic mean rank of 7.50 with a p-value of 0.000. The control group exhibited a mean rank of 2.00 for systolic measurements with a p-value of 0.083, and a mean rank of 3.13 for diastolic measurements with a p-value of 0.157. The Mann-Whitney test yielded the average blood pressure disparity between the intervention and control groups. The p-values obtained were 0.001 for systolic blood pressure and 0.006 for diastolic blood pressure (p &lt; 0.05). This study concludes that isometric handgrip exercise influences blood pressure in hypertensive patients. Individuals with hypertension are advised to perform isometric handgrip exercises autonomously at home. Healthcare professionals, particularly nurses, implement isometric handgrip exercises to regulate blood pressure in individuals with hypertension.

Resistance physical exercise modulates metabolic adipokines, decreases body weight, and improves glomerular filtration in patients with chronic kidney disease in hemodialysis.

Chronic kidney disease (CKD) is a condition characterized by abnormalities in kidney structure and function that persist for more than 3months. It is estimated that more than 800 million people in the world have a diagnosis of CKD. To remove the harmful metabolic substances from the body, people with CKD need to perform hemodialysis. Due to their beneficial effects against a wide range of clinical conditions, physical exercise is considered a non-pharmacological therapy. This study aimed to evaluate the beneficial effects of resistance exercise during hemodialysis on metabolic adipokines, myokines, body weight, and glomerular filtration rate in patients living with CKD. Briefly, the blood samples were collected in two moments: immediately before the start of the resistance exercise protocol and 1week after the end of the protocol. Resistance exercise protocol was performed thrice a week for 12weeks and applied during hemodialysis sessions. Here, resistance exercise increases the circulating irisin (14.56%; p = 0.0112), handgrip strength (5.70%; p = 0.0036), glomerular filtration rate (25.9%; p = 0.022) and significantly decreases adiponectin (- 55.7%; p = 0.0044), body weight (- 3.7%; p = 0.0001), glucose (- 22%; p = 0.009), and albumin levels (- 9.55%; p = 0.0001). Conversely, leptin levels (- 10.9%; p = 0.38), iron (3.05%; p = 0.705), ferritin (3.24%; p = 0.880), hemoglobin (- 0.52%; p = 0.75), total cholesterol (7.9%; p = 0.19), LDL (- 9.99%; p = 0.15) and HDL (- 4.8%; p = 0.45), did not change after resistance exercise. Interestingly, 1,25 hydroxyvitamin D levels were significantly increased (14.5%; p = 0.01) following resistance exercise. Considering the effect of sex (males vs. females), we found that irisin levels increased in females but not in males after the resistance exercise protocol. Furthermore, handgrip strength and body weight were different, indicating that males had the highest strength and weight. We demonstrated that both males and females had lower albumin levels after the resistance exercise protocol. In conclusion, we suggest that resistance exercise has beneficial effects in the CKD population by modulating adipokines and metabolic myokines and therefore can be used as a non-pharmacological adjunctive therapy in CKD patients undergoing HD.

Referral to pulmonary rehabilitation and palliative care services in people with idiopathic pulmonary fibrosis in England, 2010–2019

The benefits of pulmonary rehabilitation (PR) and palliative care (PC) as non-pharmacological therapies for people with idiopathic pulmonary fibrosis (IPF) are increasingly being recognised but in the UK the proportion of people with this life-limiting condition who are referred to such services is thought to be low. This retrospective cohort study aimed to describe trends in referrals to PR and PC services among people with IPF over a 10-year period and to identify factors associated with non-referral. Our study cohort was drawn from the UK’s pseudonymised Clinical Practice Research Datalink (CPRD) Aurum primary care database and comprised 17,071 individuals diagnosed with IPF between 2010 and 2019. While 12.0% of IPF patients were offered a referral to PR, less than 2% completed a PR programme. Around a fifth (19.4%) received a referral to generic PC support services; however, this is well below reported PC referral rates for lung cancer patients. Moreover, the majority of PC referrals occurred late; among those who died, 31% were referred within a month and 70% within 6 months of death. Referrals to PR and PC had however increased (by around 2–fold and 4-fold, respectively) over the course of the study period. Factors associated with non-referral to PR included female sex, older age and co-diagnosis of dementia; barriers to PC referral included being female or of Asian or Black ethnicity. We also found evidence of regional differences in referrals. These findings confirm that PR and PC service provision for people with IPF across England is suboptimal.

Characteristics and prognosis of patients with cardiac sarcoidosis presenting with atrioventricular block and ventricular arrhythmias

Cardiac sarcoidosis (CS) may initially present with life-threatening arrhythmias such as atrioventricular block (AVB) and ventricular arrhythmia (VA), including ventricular tachycardia and ventricular fibrillation. Diagnosing CS is challenging due to subtle or absent findings in routine tests and the low sensitivity of the definitive diagnostic tool, endomyocardial biopsy. CS can also mimic other cardiac conditions such as dilated cardiomyopathy or arrhythmogenic right ventricular cardiomyopathy, and it may occur without any systemic involvement. Consequently, delays in presentation, accurate diagnosis, and initiation of appropriate treatment are frequent. Greater awareness of the condition could improve outcomes for patients with CS. Non-invasive advanced imaging techniques, such as 18F-fluorodeoxyglucose positron emission tomography and cardiac magnetic resonance imaging are essential for diagnosis, although they may not be accessible in all clinical settings. Management of arrhythmias in CS involves conventional therapies in the utilization of antiarrhythmics and non-pharmacological therapy (e.g., implantable devices), but with notable divergences in the use of immunosuppression and a preference for implantable cardioverter defibrillators over permanent pacemakers. This narrative review aimed to outline the clinical features of patients with CS presenting with AVB or VA and examine diagnostic investigations, imaging techniques, treatment approaches, and prognosis based on current research and international guidelines.

A bioabsorbable mechanoelectric fiber as electrical stimulation suture.

In surgical medicine, suturing is the standard treatment for large incisions, yet traditional sutures are limited in functionality. Electrical stimulation is a non-pharmacological therapy that promotes wound healing. In this context, we designed a passive and biodegradable mechanoelectric suture. The suture consists of multi-layer coaxial structure composed of (poly(lactic-co-glycolic acid), polycaprolactone) and magnesium to allow safe degradation. In addition to the excellent mechanical properties, the mechanoelectrical nature of the suture grants the generation of electric fields in response to movement and stretching. This is shown to speed up wound healing by 50% and reduce the risk of infection. This work presents an evolution of the conventional wound closure procedures, using a safe and degradable device ready to be translated into clinical practice.

Penerapan Teknik Relaksasi Benson Untuk Menurunkan Nyeri Pada Pasien Post Sectio Caesarea di RSUD dr. R Goeteng Taroenadibrata Purbalingga

Introduction: The number of SC deliveries in recent times has increased tremendously. This is a variable phenomenon related to social, economic and cultural levels SC has become a very safe procedure in many parts of the world so it is considered almost perfect. Procedures, operations may cause discomfort and alter tissue continuity. (Number, 2022). Objective: Based on this PkM, namely to determine the results of the application of benson therapy to reduce pain levels in post SC patients. Methods: The upcoming PKM method applies the benson relaxation technique as a nursing care approach to post SC surgery patients who experience pain. After being given benson relaxation therapy there was a decrease in the pain scale from 6 to scale 3. Community service activities are carried out by implementing directly by applying the Benson Relaxation technique. The target audience of this PkM is pregnant women who have undergone labor through the SC technique at RSUD dr. R Goeteng Taroenadibrata Purbalingga. Results: The results that have been carried out participants experienced an increase in pain before being given the application of benson relaxation techniques as many as 27 participants (90%) experienced moderate pain (4-7), after being given benson relaxation participants experienced a decrease in pain levels, namely 25 participants (83%) experienced a decrease to mild pain (&lt;4). Outputs: The output of the activity used is a publication article that is expected to be able to hunt down Objective: This community service activity aims to help reduce post-SC pain with benson relaxation, patients can overcome it with non-pharmacological therapy independently. Method: This community service activity is carried out directly by providing the application of the benson relaxation technique, then continuing to evaluate so that the giver of the application of the benson relaxation technique can find out whether the target has decreased pain or not. The activity of applying the benson relaxation technique was carried out for 1 day for 10-15 minutes in the afternoon. The activity measures the patient's pain intensity using the VAS (Visual Analog Scale) measuring instrument. this activity is implemented directly to reduce pain in post SC patients at Dr. R Goeteng Taroenadibrata Purbalingga Hospital in the Bougenvile Room from July 15-28, 2024. Result: Participants experienced an increase in pain before being given the application of benson relaxation techniques as many as 27 participants (90%) experienced moderate pain (4-7), after being given benson relaxation participants experienced a decrease in pain levels, namely 25 participants (83%) experienced a decrease to mild pain (&lt;4). Conclusion: Community Service participants in the application of benson relaxation techniques to reduce pain in SC patients in the Bougenvile Ward Room of RSUD dr. R Goeteng Taroenadibrata Purbalingga as a whole amounted to 30 participants, most in the age range 21-35 as many as 22 participants (73%), and the highest level of education is high school education as many as 14 participants (46.7%), with the most history of previous operations there has never been a history of previous operations as many as 21 participants (70%). Participants experienced increased pain before being given the application of benson relaxation techniques as many as 27 participants (90%) experienced moderate pain (4-7), after being given benson relaxation participants experienced a decrease in pain levels, namely 25 participants (83%) experienced a decrease to mild pain (&lt;4).