Painful Procedures Research Articles

Photodynamic therapy light’: An enhanced treatment protocol for actinic keratoses with minimal pain and optimal clinical outcome by combining laser-assisted low irradiance PDT with shortened daylight PDT

BackgroundBetween 2003 and 2016, 546 patients in our clinic discontinued outpatient treatment for actinic keratoses (AKs) using conventional photodynamic therapy (PDT) because of intolerable pain, thereby necessitating the use of a less painful procedure. Therefore, we developed a novel off-label PDT protocol: ‘PDT light’. MethodsLaser-assisted low irradiance PDT (li-PDT) was performed beginning in 2014. The dosage was gradually lowered to 8-12 J/cm² in 2018, so that we achieved considerable pain reduction while maintaining comparable therapeutic efficacy. A further considerable reduction in pain was achieved from 2018 onwards by combining the advantages of li-PDT with daylight PDT (DLPDT), thereby resulting in 2018 in the new technique ‘PDT light’. Patients with AK Olsen grades 1 or 2 and field cancerization initially received a mild-fractionated CO2 laser pretreatment prior to MAL-incubation (methyl aminolaevulinate, Metvix ®) under occlusion for 1.5-3 h. Then, patients were illuminated on average for 1.02 min with the Aktilite-LED and, after application of an UV-screen on the illuminated area, sent out into daylight for 1 h. ResultsBetween March and November 2019, we successfully treated 152 cases using the enhanced ‘PDT light’ procedure, with 137 cases achieving at follow-up 1 (on average after 8.14 months) good-to-excellent clearance rates (CLA and CLB together 90%) and minimal adverse effects. ConclusionsThe novel ‘PDT light’ protocol proved to be an excellent and nearly painless method with an average visual-analogue scale (VAS) score of 1.19. Additional advantages included reduced illumination time, shorter outpatient stays in the clinic, fewer adverse effects, and better patient compliance than with DLPDT alone.

Comparison of Butorphanol-Azaperone-Medetomidine and Nalbuphine-Medetomidine-Azaperone in Free-Ranging Elk (Cervus canadensis) in Pennsylvania, USA.

Chemical immobilization is commonly used to capture and handle free-ranging elk (Cervus canadensis). Butorphanol-azaperone-medetomidine (BAM) and nalbuphine-medetomidine-azaperone (NalMed-A) are compounded drug combinations that are lower-scheduled in the US than drugs historically used for elk immobilizations. We compared BAM and NalMed-A for immobilization of free-ranging elk using free-darting and Clover trapping. From January 2020 to April 2022, 196 female elk were immobilized in Pennsylvania, USA. We report vital rates, induction and recovery times, and the need for supplemental drugs. We built mixed-effects logistic regression models to describe differences between drug choice based on induction and recovery times, capture method, and individual variation. Several models were competing, including our null model, which suggests that BAM and NalMed-A are comparable based on the parameters we evaluated. Supplemental drug administration was more frequently needed in NalMed-A immobilizations (21.2%) than in BAM immobilizations (9.0%). Overall, we found minor differences between BAM and NalMed-A, both of which appear to be effective for immobilizing elk in both free-darting and Clover trapping scenarios when performing moderately invasive, minimally painful procedures on free-ranging elk.

Efficacy of facilitated tucking position and Reiki given to preterm infants during orogastric tube insertion: A randomised controlled trial.

This research was conducted to evaluate the effects of Reiki and facilitated tucking position on pain, stress and physiologic parameters in preterm infants during orogastric tube (OGT) insertion. The study used a single-blind, parallel-group randomised controlled experimental design. It was carried out in the neonatal intensive care unit of a hospital in Niğde/Turkey between February 2022 and January 2023. A total of 45 preterm infants, who met the study criteria and whose sample size was determined according to power analysis, were randomly divided into three groups. As an intervention, the facilitated tucking position was applied to the first group, and Reiki was applied to the second group during OGT insertion. Routine application continued in the control group. The Infant Introductory Information Form, Physiological Parameter Follow-up Chart, Infant Stress Scale (ISS) and Premature Infant Pain Profile Scale-Revised (PIPP-R) were used for data collection. Significance was accepted as P < 0.05 in the statistical analysis. It was determined that the infants were homogeneously distributed between the experimental and control groups (P > 0.05). Infants who received the facilitated tucking position and Reiki intervention had better physiological stability compared to the control group (P < 0.05). The group with the lowest average stress (1.53 ± 0.99) and pain scores (4.06 ± 1.22) during OGT insertion was the facilitated tucking group (P < 0.001). After the procedure, stress and pain scores in both the facilitated tucking group and the Reiki group were found to be significantly lower than those in the control group (P < 0.001). The results of the study showed that the facilitated tucking position during OGT insertion was especially effective in reducing the pain and stress of infants. Both the facilitated tucking position and Reiki were determined to be effective interventions in reducing the pain and stress of infants more quickly after the procedure. The results of study contribute to the recommendation that NICU nurses should include non-pharmacological methods to decrease the pain of preterm infants during procedural pain.

Pain in recessive dystrophic epidermolysis bullosa (RDEB): findings of the Prospective Epidermolysis Bullosa Longitudinal Evaluation Study (PEBLES)

BackgroundPain is common in the genetic skin fragility disorder epidermolysis bullosa (EB), from skin and mucosal injury and inflammation as well as extra-mucocutaneous sites. Individuals living with EB have identified pain as a priority for better treatments.ObjectivesThe Prospective EB Longitudinal Evaluation Study (PEBLES) is a prospective register study exploring the natural history of RDEB across all ages from birth to death. Here, we investigated the characteristics and treatment of pain in different RDEB subtypes.MethodsInformation was collected from individuals with different RDEB subtypes over an 8-year period. Data included visual analogue scale (VAS) ratings of background and procedural pain, its location, intensity and impact on sleep, as well as pain medication. Disease severity scores and quality of life measures were correlated to pain scores.ResultsSixty-one participants (13 children, 48 adults) completed a total of 361 reviews. Pain was common, experienced by 93% of participants at index review, with 80% suffering both background and procedural pain. Across all RDEB patients, the median VAS for background pain was 40 (out of 100) [interquartile range 20,60] and for those having regular dressing changes, median procedural pain was 52 [40,80]. Severe (RDEB-S) and pruriginosa (RDEB-Pru) groups had the greatest increase in procedural compared to background pain of 20 and 22 VAS points, respectively. Correlations between disease severity and quality of life impairment were observed across most groups, particularly RDEB-S. Over half of those studied experienced pain frequently or constantly, and in one third pain disturbed sleep at least 4 nights per week. Skin was the commonest source of pain in all subtypes except inversa RDEB where the mouth was the main site. Despite frequent and severe pain, one third of participants used no medication for pain and, in those that did, pain levels remained high suggesting ineffectiveness of current pain management approaches and a significant unmet need in RDEB.ConclusionThe frequency, severity, and impact of pain in all RDEB patients is significant, particularly in RDEB-S and RDEB-Pru. Our findings highlight that current RDEB pain management is poorly effective and that further research is needed to address this symptom.

The Effect of the Parent's Presence during the Dressing Process on the Severity of the Child's Pain

Objective: This research was carried out to determine the effect of the parent's presence near the child during the dressing process on the severity of pain caused by the dressing. Method: The sample of the descriptive comparative study consisted of 60 children. Ethics committee and study permission were obtained from the relevant institutions. Data were collected by observation and face-to-face interviews using the “Individual Characteristics Form” and the YBATT (facial expression, legs, activity, crying, and being able to be consoled) pain assessment scale Results: It was determined that the effect of the parent's presence with the child during the dressing on the severity of pain and behavioral pain symptoms was not statistically significant. In addition, it was determined that the gender (X2=0.071; p=0.500&gt;0.05) and age (X2=6.133; p=0.105&gt;0.05) of the children did not affect the perceived pain intensity in the presence or absence of parents. In the examination of the way parents support their children during the painful procedure, it was observed that 13 (43.4%) of them had a remote monitoring approach. Conclusion: In this study, it was seen that the presence of the parent with the child during the dressing did not affect the severity of the pain, the presence of the parent extended the dressing time, and the parents were in the approach of remote monitoring as a way of supporting the child during the procedure.

Pharmacology of spinal interventions: review of agents used in spine pain procedures.

Spine procedures are commonly performed to diagnose and treat various spinal conditions, ranging from degenerative disc disease to vertebral fractures. These procedures often involve the use of pharmaceutical agents to enhance the efficacy of the intervention and improve patient outcomes. This review provides an overview of the pharmaceuticals commonly utilized in spine procedures, including corticosteroids, anesthetics, antibiotics, radiographic contrast, neurolytic agents, and materials used in kyphoplasty and vertebroplasty. This review summarizes the utilization of these pharmaceutical agents in spine procedures in an effort to optimize patient outcomes. Understanding the pharmacological properties and appropriate uses of these pharmaceuticals is essential for interventionalist and healthcare providers involved in the care of patients undergoing spinal interventions.

Using self‐management strategies to improve toothbrushing for adults in supported community living

AbstractHygiene is an important area related to personal health and socialization. Regular toothbrushing can prevent painful procedures related to tooth decay and gum disease and reduce bad breath and plaque that may interfere with social and professional acceptance. Unfortunately, many individuals with disabilities do not engage in regular and thorough preventative dental hygiene, placing them at risk for oral disease. Using a multiple baseline design, three participants who independently brushed their teeth but did not brush frequently or thoroughly were taught to self‐evaluate and record using a self‐management (SM) checklist. The findings of this study suggest that SM may be a helpful method for improving the frequency and quality of toothbrushing. Outcomes regarding supporting individuals to achieve maximal independence in these essential life skills are discussed.

The role of environmental sensitivity, traumatic experiences, defense mechanisms and mental pain on central sensitivity: testing a path analysis model in chronic headache on quality of life.

Central pain sensitivity (CS) is defined as an increased responsiveness of nociceptive neurons in the central nervous system to normal or subthreshold inputs. The main aim of this paper is to investigate if and how specific psychological constructs are related with CS burden in patients with chronic headache (CH). Specifically, research question 1 explores the association of temperament, personality, childhood adversities, defense mechanisms and mental pain with CS burden. Research question 2 aims to test the role of the best predictors of CS burden in affecting the quality of life (QoL) using path analysis. A total of 508 women with CH completed a psycho-diagnostic survey. Results showed that higher levels of low sensory threshold (β = 0.200), bodily threat traumatic experiences (β = 0.156), neurotic defenses (β = 0.109) and mental pain (β = 0.343) emerged as the best predictors of higher CS burden. The model presented demonstrated a satisfactory fit (GFI = 0.984; NFI = 0.966; CFI = 0.979; RMSEA = 0.056 [95% CI 0.028-0.085]) with large and medium effect sizes on physical (-0.654) and psychological QoL (-0.246). The study showed a key role of psychological dimensions in CS burden levels and their relationships with QoL in CH patients. From a clinical perspective, these results suggest the importance of evaluating the level of CS burden during the clinical assessment for chronic pain conditions such as CH, since it may contribute to guide patients to tailored psychological and medical treatments, thereby saving time and costs on diagnostic procedures for chronic pain.

TARGETED TREATMENT OF CHRONIC CYSTITIS USING INTRAVESICAL INSTILLATION OF AN ENCAPSULATED FORM OF HYALURONIC ACID

Introduction. A new approach in the bladder diseases treatment is an intravesical instillation of drugs. However, the low therapeutic effectiveness and painfulness of the instillation procedure are significant limitations of this method. Often, therapy for chronic cystitis comes down to repeated drug instillation into the bladder, which can lead to irritation of the urethral canal and re-infection. Purpose of the study – an approach to the treatment of chronic cystitis by a combination of the local delivery  intravesical instillation, and advanced materials science technologies  emulsion microgels. Materials and methods. Hyaluronic acid (HA) was encapsulated in emulsion microgels based on whey protein isolate. To study the therapeutic effect, experimental animals were divided into 3 groups (5 pieces each): without therapy; with encapsulated HA therapy; with therapy of HA solution. Chronic cystitis modeling was carried out by intraperitoneal administration of a cyclophosphamide solution. For groups of the animals receiving therapy, intravesical instillation of HA in encapsulated and free forms was carried out four times on days 6, 10, 14 and 18 after the initiation of cystitis. The therapy effectiveness was assessed using classical histological analysis. Results. This work demonstrates the effectiveness of chronic cystitis therapy with hyaluronic acid immobilized in mucoadhesive carriers – emulsion microgels. Histological analysis confirmed a significant topical therapeutic effect in animals with intravesical administration of microgels with hyaluronic acid. Conclusions. The proposed strategy combines local delivery and the use of microcontainers containing a drug, which can be successfully used for local therapy of a wide range of bladder diseases.

Evaluation of propofol-based procedural sedation in pediatric hemato-oncological patients provided by physician assistants in anesthesia.

Procedural sedation and analgesia are required for painful hemato-oncological procedures such as lumbar and bone marrow punctures. At our institution, sedation with propofol and alfentanil is usually provided by Physician Assistants in Anesthesia. We evaluated the adverse events during the PSA program for children, provided by Physician Assistants in Anesthesia. We included pediatric patients meeting our criteria for deep sedation by a Physician Assistants in Anesthesia, scheduled for a hemato-oncological procedure at the Amalia Children's Hospital at the Radboudumc Nijmegen. The primary outcome was oxygen desaturation below 92% for more than 20 s. We prospectively collected data on demographics, current health problems, type of procedure, need for airway interventions, and hypotension. We collected data from 437 sedation sessions involving 71 patients. No oxygen desaturation below 92% lasting longer than 20 s occurred. In 2 cases, a jaw thrust was performed. No invasive airway techniques (oropharyngeal cannula, laryngeal mask, or intubation) were required. A significant drop in mean arterial pressure was seen in 2 out of 437 cases (0.5%). There was no occurrence of cardiopulmonary resuscitation or other adverse events such as aspiration or laryngeal spasm. Sedation and analgesia for short painful procedures in selected pediatric hemato-oncological units with a dedicated protocol may be safely provided by trained and certified Physician Assistants in Anesthesia.

Developing and Validating a Multimodal Dataset for Neonatal Pain Assessment to Improve AI Algorithms With Clinical Data.

Using Artificial Intelligence (AI) for neonatal pain assessment has great potential, but its effectiveness depends on accurate data labeling. Therefore, precise and reliable neonatal pain datasets are essential for managing neonatal pain. To develop and validate a comprehensive multimodal dataset with accurately labeled clinical data, enhancing AI algorithms for neonatal pain assessment. An assessment team randomly selected healthy neonates for assessment using the Neonatal Pain, Agitation, and Sedation Scale. During painful procedures, 2 cameras recorded neonates' pain reactions on site. After 2weeks, assessors labeled the processed pain data on the EasyDL platform in a single-anonymized setting. The pain scores from the 4 single-modal data types were compared to the total pain scores derived from multimodal data. The On-Site Neonatal Pain Assessment completed using paper quality scales is referred to as OS-NPA, while the modality-data neonatal pain labeling performed using labeling software is MD-NPL. The intraclass correlation coefficient among the 4 single-modal groups ranged from 0.938 to 0.969. The overall pain intraclass correlation coefficient score was 0.99, with a Kappa statistic for pain grade agreement of 0.899. The goodness-of-fit for the linear regression models comparing the OS-NPA and MD-NPL for each assessor was greater than 0.96. MD-NPL represents a productive alternative to OS-NPA for neonatal pain assessment, and the validity of the data labels within the Multimodality Dataset for Neonatal Acute Pain has been validating. These findings offer reliable validation for algorithms designed to assess neonatal pain.

Prospective, randomized, double-blind trial to validate the efficacy of an oral herbal gel on pain in the newborn during minor diagnostic-therapeutic procedures.

Term and preterm infants are frequently exposed to painful procedures and stimuli during hospitalization in the Neonatal Intensive Care Unit (NICU). Pain is widely recognized to cause short- and long-term effects in the newborn. In recent years there has been a growing medical interest and a strong demand from parents for phytotherapeutic drugs, but literature data are limited, and excellent methodological studies are necessary to evaluate the importance of phytotherapy in the neonatal period. We evaluated the use of an oral phytotherapeutic gel based on chamomile, angelica and oats in the management of full term and preterm infant pain caused by minor diagnostic or therapeutic procedures. We enrolled full term infants (>37 weeks gestational age [GA]) and preterm infants with higher GA than 28 weeks, weighing more than 1000 grams. Assessed painful procedures were minor diagnostic or therapeutic ones. Newborns were double-blind randomized into two groups (A and B) to orally receive the phytotherapeutic gel (solution A) and a gel of the same consistency and aroma (solution B) before the painful procedure. The group of newborns to whom solution A had been administered showed significantly lower scores in the Pain Scale (P<0.01) during painful procedure. This figure indicates that the herbal medicine has been effective in reducing pain experience in the population of examined newborns. To the best of our literature research, our work is the first scientific study highlighting the possibility of preventive beneficial effects of phytotherapeutic drugs on pain control.

Hip Surgery is Not More Painful Than Spine Surgery in Children With Cerebral Palsy.

Posterior spinal fusion (PSF) and hip reconstruction are commonly indicated surgeries in children with cerebral palsy (CP), particularly those functioning at GMFCS levels IV and V. These are large and often painful procedures, and previous literature suggests that hip surgery is more painful than spine surgery in this patient population. The purpose of this study is to investigate pain scores and opioid use following hip and spine surgery in a large cohort of children with CP, including many patients who have undergone both types of surgery. A retrospective chart review was performed to identify children with CP who underwent hip reconstruction and/or PSF at a tertiary children's hospital between 2004 and 2022. Charts were reviewed for demographic data, pain scores, pain medication usage, duration of hospital stay, and complications. Data were collected for 200 patients (101 male, 99 female) who met inclusion criteria. Eighty-seven patients underwent hip reconstruction, 62 spinal fusion, and 51 both hip and spine surgery asynchronously. Median (interquartile range) age at the time of surgery was significantly older for spinal fusion compared with hip surgery [13.1 (4.9) vs. 8.1 (5.7) y, P <0.0001]. Length of stay was significantly longer after PSF, with a median of 6 (4) days compared with 2 (1) days after hip surgery ( P <0.0001). Both maximum and average daily pain scores were similar following hip and spine surgery, with the exception that average pain scores for hip surgery were slightly higher on postoperative day 1, hip=1.73 vs. spine=1.0 ( P <0.0001). The amount of opioids used, expressed as morphine milligram equivalents (MME)/kg were similar in the hip and spine surgery groups; however, it was significantly lower in the hip surgery group on postoperative day 0, hip=0.06 versus spine=0.17 ( P <0.0001). For the 51 patients who underwent both hip and spine surgery, the amount of opioids used mirrored that for the entire group (similar MME/kg, though only statistically significantly less on POD 0 and 3), and pain scores were not significantly different between the 2 groups except in 2 circumstances. The 2 exceptions in these 51 patients both demonstrated lower pain scores in patients after hip surgery, including lower maximum pain scores on POD 1 ( P =0.041), and lower average pain scores on POD3 ( P =0.043). This is the largest series to date comparing postoperative pain in children with CP after hip and spine surgery, including 51 of 200 patients who underwent both types of surgery. The results of this study demonstrate that hip surgery is not more painful than spine surgery in children with CP, and conflict with the traditional belief that hip surgery is more painful. This is important information for health care providers when counseling patients and families regarding these surgeries in children with CP. Level 3.

Comparison of gum resin of Bombax malbaricum with Sucrose 24% for use in procedural pain in neonates

Comparison of gum resin of Bombax malbaricum with Sucrose 24% for use in procedural pain in neonates

Parental adjustment to a burn-injured child: how to support their needs in the aftermath of the injury.

The physical pain of a burn is immeasurable, but the pain of seeing a child suffer is indescribable. Childhood burns not only affect the child directly, but also have a significant impact on the parents and the rest of the family. During the acute phase of the burn, the child's main allies in recovery are their parents, so they face emotional turbulence, having to support their children while witnessing the painful procedures they go through. They often feel helpless and distressed because they are unable to protect their children from suffering and have difficulty managing everything they feel. In addition to the often-present feeling of guilt, they also experience sadness and worry, particularly when returning home. After hospital discharge, fears increase, as do the challenges. There is a need to readapt the entire family dynamic to respond to the needs of the burned child who returns home. This readaptation often generates stress and anxiety, interfering with the entire family structure. It is crucial to try to understand these parents and give them all the support they need. Only capable and well-adjusted parents can ensure resilient family environments with safer and calmer children, thus promoting family well-being. In this perspective paper, the authors underline the role of parents of burnt children during the long trajectory of child rehabilitation and recovery. By acknowledging their needs, feelings and challenges healthcare providers can engage and support suffering parents toward more family-centered approach.

Dry Liposculpture of the Calves and Ankles-A Novel Technique for Sculpting the Lower Legs.

Liposuction of the calves and ankles was historically described as a "taboo" procedure and linked with higher postoperative pain and unpleasing aesthetic results. This study presents a Novel technique for dry liposculpture of the calves and ankles using a tourniquet, as a safe and less painful procedure, which achieves better aesthetic results. This single surgeon, retrospective study included 70 women who underwent surgery based on the technique described. Details regarding the surgical outcomes and pain levels were collected, and patients completed 2 years of follow-up. A mean of 1395 cc fat was aspirated from both legs, combined, and the mean duration of surgery was 98 minutes. No major complications were observed, and postoperative pain levels were low. Pre- and post-surgery pictures were evaluated by 8 certified senior plastic surgeons for aesthetic results. The findings suggest that dry liposculpture is suitable for reshaping the calves and ankles. This technique is safe, with precise and satisfactory aesthetic results, low levels of postoperative pain, and may take less time to perform than wet liposuction. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Assessment of intermediate phase post anesthesia quality of recovery and its affecting factors

BackgroundRecovery after surgery and anesthesia is dependent on patient, surgical, and anesthetic characteristics, as well as the presence of any of numerous adverse sequelae. Postoperative recovery is a complex and multidimensional process that requires a holistic view of the recovery of capacities and homeostasis after anesthesia and surgery.ObjectiveTo assess the quality of recovery after anesthesia and its affecting factors at Wachamo University Nigist Eleni Mohamed Memorial Comprehensive Hospital.Methoda prospective observational study was conducted at Wachamo University Nigist Eleni Mohamed Memorial Comprehensive Hospital among 384 surgical patients who undergone under anesthesia. Quality of recovery was assessed by using Quality of Recovery 40. Student t-test and one-way ANOVA were utilized to compare the mean of Quality of recovery in different groups. Binary regression was used to find out the factors affecting Quality of recovery quality of recovery. SPSS 27 was used for analysis. A p-value of < 0.05 was considered statistically significant.ResultSex and smoking history were the factors that we failed to find an association with poor quality of recovery. Preoperative antiemetic administration; premedication with benzodiazepines and emergency procedures were the factors that show potential relation with poor quality of recovery after anesthesia and surgery. Procedures performed under general anesthesia; Patients who had coexisting diseases; post-anesthesia incidence of nausea and vomiting; Visual Analog Scale score >/= 7 during discharge and prolonged duration of surgery were the factors that had a significant association with poor quality of recovery.ConclusionThe magnitude of good quality of recovery was 65.6% whereas 34.4% scored poor quality of recovery. The predictors for the prevalence of poor quality of recovery were found to be orthopedic procedures; procedures undergone under general anesthesia; incidence of post-anesthesia nausea and vomiting; prolonged length of the procedure and severity of pain.

A Multicenter, Randomized, Double-Blind, Parallel-Grouped, Positive-Controlled, Non-Inferiority Clinical Study to Evaluate the Efficacy and Safety of Injectable Calcium Hydroxylapatite Microsphere Hydrogel Fillers in the Correction of Nasolabial Fold in Chinese Subjects.

Soft tissue fillers are used to improve the appearance of nasolabial folds (NLFs). This study aimed to compare the efficacy and safety of a new calcium hydroxylapatite microsphere hydrogel filler (Aphranel) versus Restylane for correcting NLFs. In this multicenter, randomized, double-blind, parallel-grouped, positive-controlled, non-inferiority trial, 210 subjects were randomized to bilateral NLF treatment with Aphranel and Restylane on either side of the NLF. NLF was assessed before and right after injection and at the first week, first month, third, sixth, and 12 months. The primary efficacy endpoint was the WSRS improvement rate for the NLF, defined as ≥ 1 point improvement at Week 24. The secondary efficacy endpoints include the WSRS score assessed by investigators and the independent review committee (IRC) and the Global Aesthetic Improvement Scale (GAIS) evaluated by the subjects, investigators, and IRC over time. Randomization was performed using a computer-generated randomization list. To ensure the double-blind nature of the study, neither the physicians administering the injections nor the patients receiving them were aware of the specific product being used. All syringes were identical in appearance, with labels coded instead of indicating the product name. The preparation of the injection products was handled by nurses who were not involved in the treatment process, thereby maintaining the blinding of both the physicians and the patients to the treatment assignment. A total of 188 subjects (168 women and 20 men) completed the 12-month follow-up. The investigator-evaluated improvement rates using WSRS at 24 weeks were 84.04% for Aphranel and 78.72% for Restylane. The IRC-evaluated improvement rates using WSRS at 24 weeks were 72.34% for Aphranel and 70.21% for Restylane. Aphranel was shown to be statistically non-inferior to Restylane (P>0.05). Both the investigator and IRC-assessed WSRS scores over time showed that the mean scores for Aphranel were non-inferior to the mean scores for Restylane (all P>0.05). There was no difference between the Aphranel and Restylane groups according to the subjects, investigators, and IRC-assessed GAIS score at any time point (all P>0.05). Both devices' most frequently reported adverse events were injection site swelling and procedural pain. This study confirms that Aphranel is an effective and safe treatment for correcting NLFs in Chinese subjects. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Patient Preferences and Expectations in Analgesia for First Trimester Surgical Abortion

&lt;i&gt;A central component of a patient’s abortion experience is pain perception and optimization of pain management choices. Yet, data on patients’ experience of pain and their preferences regarding pain strategies are limited and tend to utilize solely quantitative data. This study utilized a qualitative thematic analysis to identify patient priorities, preferences, and expectations for pain management during first-trimester surgical abortion with nitrous oxide or oral sedation. Thirty-one patients seeking a first-trimester surgical abortion, self-selecting inhaled nitrous oxide (NO) (16 patients), or oral sedation (PO) with oxycodone and Ativan (15 patients) enrolled in this prospective cohort study. Participants provided demographic data, rated procedure pain on a 10 cm visual analog scale (VAS), and participated in semi-structured interviews. We analyzed qualitative data using a content analysis approach. Pre-procedure participants wanted a positive experience. Participants endorsed an ideal analgesic as having a quick onset of action, minimal side effects, no addiction potential, and being effective at reducing pain. After the procedure, there we start differences between priorities in NO and PO participants. NO participants valued the resumption of everyday activities, while PO participants desired ongoing anxiolysis. Anticipatory counseling often mitigated higher procedure pain and more medication side effects than anticipated. Participants emphasized that positive interactions with providers/staff significantly improved their abortion experience. Preemptive comprehensive counseling about procedure and analgesic effectiveness, along with providing options for analgesia, will facilitate an affirmative and patient-centered abortion experience.&lt;/i&gt;

Barriers and facilitators of retention in care after cervical cancer screening: patients’ and healthcare providers’ perspectives

BackgroundCervical cancer continues to threaten women’s health, especially in low-resource settings. Regular follow-up after screening and treatment is an effective strategy for monitoring treatment outcomes. Consequently, understanding the factors contributing to patient non-attendance of scheduled follow-up visits is vital to providing high-quality care, reducing morbidity and mortality, and unnecessary healthcare costs in low-resource settings.MethodsA descriptive qualitative study was done among healthcare providers and patients who attended the cervical cancer screening clinic at Mbarara Regional Referral Hospital in southwestern Uganda. In-depth interviews were conducted using a semi-structured interview guide. Interviews were audio-recorded, transcribed verbatim, and thematically analysed in line with the social-ecological model to identify barriers and facilitators.ResultsWe conducted 23 in-depth interviews with 5 healthcare providers and 18 patients. Health system barriers included long waiting time at the facility, long turnaround time for laboratory results, congestion and lack of privacy affecting counselling, and healthcare provider training gaps. The most important interpersonal barrier among married women was lacking support from male partners. Individual-level barriers were lack of money for transport, fear of painful procedures, emotional distress, and illiteracy. Inadequate and inaccurate information was a cross-cutting barrier across the individual, interpersonal, and community levels of the socio-ecological model. The facilitators were social support, positive self-perception, and patient counselling.ConclusionsOur study revealed barriers to retention in care after cervical cancer screening, including lack of partner support, financial and educational constraints, and inadequate information. It also found facilitators that included social support, positive self-perception, and effective counselling.