Use Of Non-pharmacological Therapies Research Articles

Non-pharmacological therapies applied in pregnancy and labor: an integrative review.

To identify non-pharmacological therapies applied during pregnancy and labor. Integrative review conducted in the databases: PubMed, ScieLO and PEDro, searching for articles from 2008 in English, Spanish and Portuguese. The descriptors used were: pregnancy, childbirth, physiotherapy, alternative and complementary medicine, alternative therapy, non-pharmacological therapy, biomechanical therapy. Forty-one articles were analyzed and subdivided into ten categories of nonpharmacological therapies: massage, perineal massage, hot bath, supportive care, childbirth preparation group, breathing techniques, pelvic floor exercises, transcutaneous electrostimulation, Swiss ball and spontaneous pushing. Six articles (60%) showed a positive outcome for reduction of pain in labor and all of them had a positive outcome for different variables of labor, such as reduction of time, anxiety and pelvic floor laceration rates. The use of non-pharmacological therapies was efficient to reduce the effects of labor and childbirth, such as pain, duration of labor, anxiety, laceration and episiotomy.

Comparisons of the Effects of Watching Virtual Reality Videos and Chewing Gum on the Length of Delivery Stages and Maternal Childbirth Satisfaction: A Randomized Controlled Trial.

Background: Maternal childbirth satisfaction is one of the important indicators of the quality of the care provided. The use of non-pharmacological therapies can make the childbirth process a pleasurable event for the mother. This study aimed to compare the effects of watching virtual reality videos and chewing gum on the length of delivery stages and maternal satisfaction.Methods: This clinical trial study was performed on 93 women with first and second pregnancies, who were referred to Allameh Bohlool Hospital in Gonabad and Sajjadieh Hospital in Torbat-e-Jam, Iran, for childbirth between 2018 and 2019. Pregnant women were randomly assigned to three groups of chewing gum, virtual reality, and control. Interventions were performed twice: in the active (dilation of 4–5 cm) and second (dilation of 7–8 cm) phases of parturition for 20 minutes each. Data were collected using data-gathering forms, including a demographic characteristics form, a midwifery characteristics form, and the Mackey Childbirth Satisfaction Rating Scale. The data were analyzed using SPSS, version 22, via the Chi square tests, ANOVA, Kruskal–Wallis, and Tukey’s post hoc tests. Results: The difference in the mean maternal childbirth satisfaction score between the two intervention groups of virtual reality and chewing gum was not statistically significant (P=0.339), but the mean score in the intervention groups was higher than that of the control group (P<0.001(. There was no significant difference in the mean length of the active and second phases of parturition between the two intervention groups, but this value in the intervention groups was significantly lower than that of the control group.Conclusion: The thought divergence interventions of chewing gum and watching virtual reality videos enhanced childbirth satisfaction, and curtailed parturition stages in our sample of pregnant women. Trial Registration Number: IRCT20181214041963N1.

Nurses' experiences of providing nonpharmacological pain management in palliative care: A qualitative study.

To explore the experiences and views of nurses who provide nonpharmacological therapies for chronic pain management in palliative care. Nursing expertise in palliative care is essential in providing pain relief to patients with chronic diseases. Examinations of the use of nonpharmacological therapies for chronic pain management in palliative care have revealed what nonpharmacological therapies have been used, but there is insufficient knowledge regarding nurses' attitudes, views and experiences regarding pain therapies in this context. A qualitative descriptive design was chosen. Data were collected through individual interviews in a purposive sample with 15 nurses to ensure maximum variation. The data were analysed using qualitative content analysis. This study aligns with the consolidated criteria for reporting qualitative research (COREQ) checklist. The analysis yielded four categories, as follows: "building and sustaining favourable therapeutic relationships" involved the creation of trust and a solid relationship; in "recognising the diversity of patients' needs," person-centred care is expressed as being vital for individualised nonpharmacological pain management; "incorporating significant others" describes how nurses can help to ease the patient's pain by identifying positive encounters with family members or friends; and in "recognising the existence of barriers," nurses highlight vulnerable groups such as children, for whom nurses require special education to enable optimal nonpharmacological pain management. The unique knowledge that nurses gain about the patient through the nurse-patient relationship is central and crucial for successful nonpharmacological pain management. This study emphasises the need for nurses to get to know their patient and to be open and sensitive to patients' descriptions of their unique life situations, as this provides the necessary knowledge for optimal care and pain management. Nurses should be encouraged and given the opportunity to attend specialised training in palliative care and pain management.

Real-World Treatment Patterns and Characteristics Among Patients with Agitation and Dementia in the United States: Findings from a Large, Observational, Retrospective Chart Review.

Background:Few studies have examined patient characteristics and treatment patterns among patients with dementia and agitation in the United States (US).Objective:To examine real-world treatment patterns and characteristics of patients with agitation related to dementia who were treated with antipsychotics in US residential care and community-based settings.Methods:This retrospective chart review collected US physician-level data from patients 55 to 90 years old initiated on an antipsychotic medication for the treatment of agitation related to dementia from January 2018 to May 2018. Clinical characteristics and treatment patterns were assessed overall and stratified by residential care and community-based settings.Results:A total of 313 participating physicians, 59.5% of whom were primary care physicians, abstracted 801 patient charts (residential care: n = 312; community-based: n = 489). Of patients with agitation who were initiated on an antipsychotic, most patients (74.5%) were initiated within 3 months of the onset of their studied agitation episode, and 62.8% experienced multiple agitation episodes before initiation. While non-pharmacological therapies are recommended first-line approach for agitation in dementia, use of non-pharmacological therapy before initiation of antipsychotics was reported for only 37.8% of patients in residential care and 21.3% in community-based settings.Conclusion:Most patients were initiated on an antipsychotic treatment after multiple episodes of agitation and largely without initial non-pharmacological therapy, suggesting that current treatment guideline recommendations for first-line non-pharmacological intervention may not be adequately followed in clinical practice. Understanding the clinical burden and treatment patterns among dementia patients with agitation is imperative for effective disease management.

AxSpA patients who also meet criteria for fibromyalgia: identifying distinct patient clusters using data from a UK national register (BSRBR-AS)

BackgroundAround 1 in 8 patients with axial spondyloarthritis (axSpA) also meet criteria for fibromyalgia and such patients have considerable unmet need. Identifying effective therapy is important but to what extent fibromyalgia-like symptoms relate to axSpA disease severity has not been established. The aim of the current analysis was to determine whether distinct clusters of axSpA patients exist and if so to determine a) whether they differ in terms of prevalence of fibromyalgia and b) the features of patients in clusters with high prevalence.MethodsThe British Society for Rheumatology Biologics Register (BSRBR-AS) recruited axSpA patients from 83 centres 2012–2017. Clinical data, and information from patients was collected (including research criteria for fibromyalgia). Cluster analysis was undertaken using split samples for development and validation both in the whole population and the sub-group which met fibromyalgia criteria.ResultsOne thousand three hundred thirty-eight participants were included of whom 23% met research criteria for fibromyalgia. Four clusters were identified. Two exhibited very high disease activity, one which was primarily axial (n = 347) and a smaller cluster (n = 32) with axial and peripheral disease, and in both groups more than half of members met criteria for fibromyalgia. The remaining two clusters (n = 437, n = 462) had overall less severe disease however the one which showed greater disease activity and poorer quality of life had a higher proportion meeting fibromyalgia criteria (16% v. 4%). Within those meeting fibromyalgia criteria there were three clusters. The two main groups were defined by level of symptom severity with a smaller third cluster noted to have high average swollen and tender joint counts and high levels of comorbidity.ConclusionsThe major feature defining clusters with a high proportion of persons meeting criteria for fibromyalgia is high axSpA disease activity although clusters with features of fibromyalgia in the absence of high disease activity also show moderately high prevalence. Management may be most successful with pharmacologic therapy to target inflammation but enhanced by the concurrent use of non-pharmacologic therapy in such patients.

Stroke in atrial fibrillation: Review of risk stratification and preventive therapy

Atrial fibrillation (AF) is a leading preventable cause of ischemic stroke for which early detection and treatment are critical. The risk of stroke in people with AF can be stratified by the use of such validated prediction instruments such as CHADS2 or CHA2 DS2–VASc. The CHA2 DS2–VASc adds to the evaluation of the risk of stroke by reliably identifying patients at very low risk. Additional points are assigned for an additional age category of 65–74 years (1 point), female sex (1 point), and vascular disease other than cerebrovascular disease (1 point). Two points are awarded for age ≥75 years. The risk of stroke increases according to point score: 0.5% per year (0 points), 1.5% per year (1 point), 2.5% per year (2 points), 5% per year (3 points), 6% per year (4 points), and 7% per year (5–6 points). For decades, Vitamin K antagonists were the only class of oral anticoagulants available to clinicians for the prevention of stroke in AF. However, new oral anticoagulants (NOACs), such as apixaban, dabigatran, and rivaroxaban, are currently available and have proved to be safe and effective in preventing stroke in patients with nonvalvular AF. In addition, a nonpharmacologic procedure like left atrial appendage occlusion is a possible option in selected patients. In this article, we have reviewed the stratification of stroke risk in AF, prevention of stroke in nonvalvular AF, warfarin versus NOACs, weighting risk of bleeding versus stroke risk when deciding on the anticoagulation protocol in patients with AF, and the use of nonpharmacologic therapy for stroke prevention.

Oriental Medicine Technique in the Treatment of Stress and Quality of Life in Patients with Chronic Problems

Ear therapy has been increasing and has greater popularity in Brazil, because of the ease of the procedure and low cost and rapid response. The use of non-pharmacological therapies for pain management has been a promising medium in the care of patients with chronic pain. This study evaluated the effect of auriculotherapy on the level of stress and quality of life of patients with chronic pain. The study included 47 subjects with chronic pain that were treated once a week for 5 weeks. Evaluations were held before the first session and the fifth session. The results are presented with the comparison between the initial media and the fifth session. For the stress assessment, the inventory of stress symptoms for adults Lipp (ISSL) was used. This questionnaire assesses stress classifying it into 3 parts: alarm, resistance and exhaustion. The evaluation of quality of life was made by SF12.v2 questionnaire. Before starting the study participants signed the free clarification. After 5 sessions there was a reduction of the stress level in the alarm phase (U=838,00, Z=5,712, p=0,000, d=1,17), resistance phase (U=833,000, Z=-5,722, p=0,000, d=1,26) and exhaustion phase (U=1182,50, Z=−4,025, p=0,000, d=0,77). After 5 sessions there was an improvement in the components of quality of life: Physical Functioning (U=803,50, Z=−1,985, p=0,047, d=0,35), Role Physical (U=742,00, Z=−2,223, p=0,026, d=0,46), Bodily Pain (U=386,00, Z=−5,231, p=0,000, d=1,28), General Health (U= 774,50, Z=−2,12, p= 0,033, d=0,49), Vitality (U=944,00, Z=−,564, p=0,573, d=0,09), Social Functioning (U=750,00, Z=−2,267, p=0,023, d=0,60), Role Emotional (U=684,50, Z=−2,554, p=0,011, d=0,55), Mental Health (U=592,50, Z=−3,431, p=0,001, d=0,77). O PCS (U=485,00, Z=−4,138, p=0,000, d=0,67) e MCS (U=654,00, Z=−2,750, p=0,006, d=0,57). The ear therapy was effective to improve stress levels and most domains of quality of life. However, there was no improvement in vitality.

Use of electroanalgesia and laser therapies as alternatives to opioids for acute and chronic pain management.

The use of opioid analgesics for postoperative pain management has contributed to the global opioid epidemic. It was recently reported that prescription opioid analgesic use often continued after major joint replacement surgery even though patients were no longer experiencing joint pain. The use of epidural local analgesia for perioperative pain management was not found to be protective against persistent opioid use in a large cohort of opioid-naïve patients undergoing abdominal surgery. In a retrospective study involving over 390,000 outpatients more than 66 years of age who underwent minor ambulatory surgery procedures, patients receiving a prescription opioid analgesic within 7 days of discharge were 44% more likely to continue using opioids 1 year after surgery. In a review of 11 million patients undergoing elective surgery from 2002 to 2011, both opioid overdoses and opioid dependence were found to be increasing over time. Opioid-dependent surgical patients were more likely to experience postoperative pulmonary complications, require longer hospital stays, and increase costs to the health-care system. The Centers for Disease Control and Prevention emphasized the importance of finding alternatives to opioid medication for treating pain. In the new clinical practice guidelines for back pain, the authors endorsed the use of non-pharmacologic therapies. However, one of the more widely used non-pharmacologic treatments for chronic pain (namely radiofrequency ablation therapy) was recently reported to have no clinical benefit. Therefore, this clinical commentary will review evidence in the peer-reviewed literature supporting the use of electroanalgesia and laser therapies for treating acute pain, cervical (neck) pain, low back pain, persistent post-surgical pain after spine surgery (“failed back syndrome”), major joint replacements, and abdominal surgery as well as other common chronic pain syndromes (for example, myofascial pain, peripheral neuropathic pain, fibromyalgia, degenerative joint disease/osteoarthritis, and migraine headaches).

New Therapeutic Approaches in Obesity and Metabolic Syndrome Associated with Polycystic Ovary Syndrome.

Polycystic ovary syndrome (PCOS) is a pathophysiological disorder affecting reproductive and metabolic indices. PCOS is commonly associated with a high prevalence of insulin resistance and obesity; this association carries an increased risk of developing metabolic syndrome, type 2 diabetes mellitus (T2DM), and cardiovascular disease. Guidelines recommend lifestyle modification, metformin, hormonal contraceptives (HCs), and bariatric surgery as the main treatment options in obese patients with PCOS. Studies are being conducted to test the efficacy of existing treatment options as well as to discover new therapies. This review focuses on the most recent advances in this regard and highlights new hypotheses and emerging studies to give a picture of the latest therapeutic trends in the treatment of obese patients with PCOS. In this respect, much attention is given to the role of inositols, the mediators of insulin action. A deficiency of d-chiro-inositol containing inositol-phospho-glycans may be the basis of insulin resistance frequently seen in PCOS patients. Moreover, evidence suggests the use of statins in obese women with PCOS, but guidelines call for further research. Adiponectin, quercetin, vitamin D, and anti-obesity drugs have also been studied and seem to have a useful role in the treatment of obesity and metabolic syndrome in PCOS. Many trials have been conducted on the use of non-pharmacological therapies. Therapies including resveratrol, acupuncture, and berberine have favorable effects in overweight PCOS patients. However, more research is needed to reveal the clinical complexity of PCOS and develop more effective treatment options.

Randomized controlled trial on the effectiveness of a multicomponent intervention on migraine: A study protocol.

To describe a randomized controlled trial protocol that evaluates the effectiveness of a multicomponent intervention in improving the outcomes (quality of life, disability, intensity, frequency and duration) of patients with migraine. Migraine affects various facets of Quality of Life and results in moderate to high levels of disability among migraineurs. Migraine pain can be intense and unremitting that can interfere with the daily routine and reduce the ability to think and function normally. Many people can lower their risk of a migraine by simply avoiding stress, getting enough sleep, eating regularly and by avoiding triggers. Hence, the present study aims at evaluating the effectiveness of a multicomponent intervention in managing migraine headaches. The multicomponent intervention includes behavioural lifestyle modification program and sessions of pranayama (a form of yogic breathing exercise). The study is a prospective, randomized, controlled, single-blinded trial with parallel arms. The study participants are randomized to intervention and control arms. The participants randomized to the intervention arm would receive the specific multicomponent intervention based on the protocol. The participants in the control arm would receive routine care. They are followed up for 24weeks and the outcomes are assessed. Various studies report that non-pharmacological therapies and integrative therapies play a major role in the management of migraine headaches. The findings of the study are expected to open up new horizons in health care arena emphasizing the use of non-pharmacological therapy for less focused areas of primary care health problems such as migraine. The trial is registered with the Clinical Trials Registry India (CTRI). The CTRI India is one of the primary registries in the WHO registry network (Ctri.nic.in, ). CTRI reference ID: CTRI/2015/10/006282.

PERINEAL PAIN RELIEF THERAPIES AFTER POSTPARTUM

ABSTRACT Objective: identifying therapies for treating perineal pain after vaginal birth and to verify indication, technique and duration of local cooling. Method: an exploratory study (survey) conducted in 32 public maternity hospitals in the city of São Paulo (Brazil). A nurse or midwife who provided direct care to the woman was interviewed in each maternity ward. We investigated: institutional characterization, professional qualification, pain relief method, criterion for administration of therapies, indication, contraindication, method, local cooling technique and interval. A descriptive analysis was also carried out. Results: pharmacological and non-pharmacological methods were used for perineal pain relief, despite the use of non-pharmacological therapies not having protocols in these institutions. Among the pharmacological-based methods, analgesics and anti-inflammatories were the most common. Local cooling was the most used non-pharmacological method, and its main indication was perineal edema. Application time and local cooling interval ranged from 10-30 min and 3-8 h, respectively. Ice cubes in latex gloves were the main cooling technique. Conclusion: drug therapies predominated for control of perineal pain. Considering the advantages of non-pharmacological therapies, it is necessary to develop protocols to ensure their safe and effective use in maternity care.

Ефективність застосування препарату «Ноофен»® у дітей зі стабільною первинною артеріальною гіпертензією

Objective: to evaluate the efficacy and safety of Noofen® (γ-amino-β-fenil-butyric acid hydrochloride) in treatment of children with stable PH. Materials and methods. The study involved 45 children 12–17 years old with stable PH, which were divided in two groups. The main therapeutic group included 27 children who received non-pharmacological treatment, Noofen® and enalapril. 18 children of comparison group received the same treatment as the children of the main group, but without adding Noofen. Results. It was found that the Noofen® in combination with antihypertensive therapy by enalapril in children with PH improves the general condition and the reduction of office blood pressure. Noofen® potentiates the effect of enalapril, speeding term normalization of blood pressure and thus reducing the term antihypertensive therapy. The effectiveness of a combination of non-pharmacological therapy, enalapril and Noofen® in reducing average daily systolic BP in 1.33 times higher compared with the use of non-pharmacological therapy and enalapril without adding Noofen®. Combination therapy with enalapril and Noofen® in children with PH reduces energy expenditure during exercise and restoration of hart's functional reserves. The impact of Noofen® on GABA-ergic structure reduces influence of central nervous system on regulating heart rhythm in children with PH, reduces the activity of stress-realizing system through effects on cortisol levels, promotes the elimination of asthenic-neurotic symptoms, anxiety reduction and normalization of the night sleep. Concludions. The stable primary hypertension (PH) in children requires complex treatment with non-pharmacological therapy, antihypertensive drugs and correction of adaptation processes in the body. Key words: children, stable hypertension, antihypertensive therapy, Noofen®.

Efeitos do exercício físico no controle clínico da asma

&lt;p&gt;A asma é uma doença inflamatória crônica das vias aéreas cujo diagnóstico é clínico e o tratamento visa principalmente controlar os sintomas e diminuir os riscos de exacerbação. Mesmo sob tratamento clínico-medicamentoso adequado, os pacientes nem sempre atingem o controle clínico adequado. Por isso, recomenda-se o uso de terapias não farmacológicas, destacando-se o exercício físico (EF), que é, atualmente, reconhecido como parte fundamental do programa de reabilitação para asmáticos. A revisão que se segue objetivou explorar os aspectos relacionados à melhora do controle clínico da doença induzidos pelo EF em pacientes asmáticos. Para tanto, foram revisados artigos publicados na base de dados Pubmed e SciELO (de 1970 a 2015). Verificou-se que os primeiros estudos sugeririam que o EF, predominantemente aeróbio, melhora o condicionamento físico e a percepção de falta de ar (dispneia). Essa tendência foi mantida até os anos 90 e a partir de então surgiram estudos com maior rigor metodológico mostrando que o EF pode reduzir o broncoespasmo induzido pelo exercício (BIE), a responsividade brônquica bem como e a capacidade física aeróbia. Evidências mostrando que o EF melhora os fatores de saúde relacionados à qualidade de vida, o controle clínico da asma e a inflamação pulmonar passaram a ser melhor investigados apenas nos últimos 5 anos. Atualmente, considera-se a prática de EF como um componente fundamental no programa de tratamento para pacientes com asma moderada e grave, quando realizado com predominância aeróbia, em intensidade de baixa a moderada e feito pelo menos duas vezes por semana de forma individualizada. Portanto, o exercício físico parece potencializar o controle clínico da asma através da melhora do condicionamento físico, sendo importante sua indicação na prática clínica para os pacientes que estão em tratamento clínico-medicamentoso otimizado.&lt;/p&gt;

Nonpharmacological interventions aimed at modifying health and behavioural outcomes for adults with asthma: a critical review.

Evidence suggests that living with asthma is linked with psychological and behavioural factors including self-management and treatment adherence, and therefore, there is a reasonable hypothesis that nonpharmacological treatments may improve health outcomes in people living with this condition. A systematic review of randomized controlled trials (RCTs) of nonpharmacological interventions for adults with asthma was designed. Databases searched included The Cochrane Airways Group Register of trials, CENTRAL and Psychinfo. The literature search was conducted until May 2014. Twenty-three studies met the inclusion criteria and were organized into four groups: relaxation-based therapies (n=9); mindfulness (n=1), biofeedback techniques (n=3); cognitive behavioural therapies (CBT) (n=5); and multicomponent interventions (n=5). A variety of outcome measures were used, even when trials belonged to the same grouping, which limited the ability to conduct meaningful meta-analyses. Deficiencies in the current evidence base, notably trial heterogeneity, means that application to clinical practice is limited and clear guidelines regarding the use of nonpharmacological therapies in asthma is limited. Relaxation and CBT, however, appear to have a consistent positive effect on asthma-related quality of life and some psychological outcomes, and lung function (relaxation only). Future trials should be informed by previous work to harmonize the interventions under study and outcome measures used to determine their effectiveness; only then will meaningful meta-analyses inform clinical practice.

Perfil dos medicamentos prescritos para idosos em uma Unidade Básica de Saúde do município de Ijuí-RS

Buscou-se identificar os medicamentos utilizados pelos idosos atendidos numa Unidade Básica de Saúde do município de Ijuí-RS e entre estes, os medicamentos potencialmente inapropriados para esta faixa etária, além de verificar as potenciais interações envolvendo esses medicamentos. Realizou-se estudo transversal e documental, a partir de 429 prescrições aviadas de janeiro a novembro de 2010, para 286 idosos. A maioria dos idosos era formada por mulheres (67,13%) e a idade média foi de 71,59±7,77 anos; prevaleceu a faixa etária de 60 a 79 anos. Foram dispensadas 87 especialidades farmacêuticas distintas, totalizando 1.336 medicamentos, sendo em média 4,67±2,52 medicamentos prescritos por idoso, variando de um a 15 medicamentos/idoso. Verificou-se polifarmácia em 135 idosos (47,20%). Os medicamentos mais prescritos atuam no sistema cardiovascular, no aparelho digestivo e metabolismo e no sangue e órgão hematopoiéticos. Do total de especialidades farmacêuticas, 14 (16,09%) foram considerados medicamentos potencialmente inapropriados, de acordo com os critérios de Beers, que foram prescritos a 62 (21,68%) idosos. Estão expostos a interações medicamentosas 40 (56,34%) idosos que receberam medicamentos potencialmente inapropriados, dos quais 27 (67,50%) estão expostos a duas ou mais interações. Verificaram-se polimedicação e uso de medicamentos potencialmente inapropriados entre os idosos em estudo, mas estas podem estar sendo necessárias, pois foram identificados medicamentos indicados para as doenças crônicas prevalentes nessa faixa etária. Diante disso, sugere-se o uso dos critérios de Beers na avaliação da farmacoterapia em idosos, destacando-se ainda a necessidade de incorporar o uso de terapias não farmacológicas, a fim de favorecer a redução no consumo de medicamentos.

Cyclical vomiting syndrome: Recognition, assessment and management.

Cyclical vomiting syndrome (CVS) is a functional, debilitating disorder of childhood frequently leading to hospitalization. Affected children usually experience a stereotypical pattern of vomiting though it may vary between different individuals. The vomiting is intense often bilious, and accompanied by disabling nausea. Identifiable precipitating factors for CVS include psychosocial stressors, infections, lack of sleep and occasionally even food triggers. Often, it may be difficult to distinguish episodes of CVS from other causes of acute abdomen and altered consciousness. Thus, the diagnosis of CVS remains largely one of exclusion. Investigations routinely done during the work-up of a child with suspected CVS include both blood and imaging modalities. Plasma lactate, ammonia, amino acid and acylcarnitine profiles as well as urine organic acid profile are indicated to exclude inborn errors of metabolism. The treatment remains challenging and targeted at prevention or shortening of the attacks and can be considered as abortive, supportive and prophylactic. Use of non-pharmacological therapy is also part of the management of CVS. The prognosis of CVS is variable. More insight into the pathogenesis of this disorder as well as role of non-pharmacological therapy is needed.

The therapeutic use of doll therapy in dementia

Over the next 15 years, the number of people with dementia in the UK will increase significantly. There are clear limitations associated with the sole use of pharmacological interventions to address the cognitive decline and related problems that people with dementia and their carers will experience. As a result, health professionals, including nurses, need to consider the development and use of nonpharmacological therapies to help resolve the distress and decline in social function that people with dementia can experience. The use of doll therapy in dementia care appears to be increasing, even though there is limited empirical evidence to support its use and therapeutic effectiveness. It is suggested by advocates of doll therapy that its use can alleviate distress and promote comfort in some people with dementia. Despite these encouraging claims, the theoretical basis for the use of doll therapy in dementia is poorly understood and morally questionable. The purpose of this article is to provide healthcare professionals with a succinct overview of the theory behind the therapeutic use of dolls for people with dementia, a presentation and appraisal of the available empirical evidence and an appreciation of the potential ethical dilemmas that are involved.

Neuropathic Pain Post Spinal Cord Injury Part 1: Systematic Review of Physical and Behavioral Treatment

Neuropathic pain has various physiologic and psychosocial aspects. Hence, there is a growing use of adjunct nonpharmacological therapy with traditional pharmacotherapy to reduce neuropathic pain post spinal cord injury (SCI). The purpose of this study was to conduct a systematic review of published research on nonpharmacological treatment of neuropathic pain after SCI. MEDLINE, CINAHL, EMBASE, and PsycINFO databases were searched for articles addressing nonpharmacological treatment of pain post SCI. Articles were restricted to the English language. Article selection was conducted by 2 independent reviewers with the following inclusion criteria: the subjects participated in a treatment or intervention for neuropathic pain; at least 50% of the subjects had an SCI; at least 3 subjects had an SCI; and a definable intervention was being studied. Data extracted included study design, study type, subject demographics, inclusion and exclusion criteria, sample size, outcome measures, and study results. Randomized controlled trials (RCTs) were assessed for quality using the Physiotherapy Evidence Database (PEDro) assessment scale. Levels of evidence were assigned to each intervention using a modified Sackett scale. The 16 articles selected for this review fell into 1 of 2 categories of nonpharmacological management of pain after SCI: physical and behavioral treatments. The pooled sample size of all studies included 433 participants. Of the 16 studies included, 7 were level 1, 3 were level 2, and 6 were level 4 studies. Physical interventions demonstrated the strongest evidence based on quality of studies and numbers of RCTs in the nonpharmacological treatment of post-SCI pain. Of these interventions, transcranial electrical stimulation had the strongest evidence of reducing pain. Despite a growing body of literature, there is still a significant lack of research on the use of nonpharmacological therapies for SCI pain.

Latest Osteoarthritis Guidelines Address Benefits of Exercise

Latest Osteoarthritis Guidelines Address Benefits of Exercise

The management of procedural pain at the Italian Centers of Pediatric Hematology–Oncology: state-of-the-art and future directions

The quality of life of children with cancer can be affected by the experience of cancer-related pain, treatment-related pain, procedural pain, generalized pain, and long-term chronic pain, and the consequences may be permanent. Treatment-related pain and procedural pain are often reportedly the most painful experiences relating to their illness. Procedural pain treatment is therefore now considered essential. This multicenter survey investigated how procedural pain is managed at Italian Pediatric Hematology-Oncology Centers. From April to October 2010, questionnaires were collected from the directors and/or referent of the Italian Centers of Pediatric Hematology-Oncology about the management of lumbar punctures, bone marrow aspirates, and biopsies. We received responses from 67% of the centers (which performed a total of 13,271 procedures per year). Fifty percent of the procedures were performed in the operating room. The sedation-analgesia was provided "almost always" for 84% of procedures. Non-pharmacological treatments were used in 55% of the centers. The specialist who practiced analgesia was the anesthetist in 83.3% of the cases. A nationwide multicentre survey has been conducted for the first time to verify the management of procedural pain in Pediatric Hematology-Oncology patients. The results indicate that many aspects in the management of procedural pain appear consistent with the international guidelines. Some problems still remain, including the inability to ensure adequate sedation-analgesia in all the patients--often due to the lack of adequate staff, the frequent use of the operating room, and an underdeveloped use of non-pharmacological therapies.