Visual Numeric Rating Scale Research Articles

Vaginal assessment and expedited amniotomy in oral misoprostol labor induction in nulliparas: a randomized trial

Labor is induced in 20-30% of maternities, with an increasing trend of use. Labor induction with oral misoprostol is associated with reduced risk of cesarean deliveries and has a safety and effectiveness profile comparable to those of mechanical methods such as Foley catheter use. Labor induction in nulliparous women continues to be challenging, with the process often quite protracted. The eventual cesarean delivery rate is high, particularly when the cervix is unfavorable and ripening is required. Vaginal examination can cause discomfort and emotional distress particularly to nulliparous women, and plausibly can affect patient satisfaction with the induction and birth process. The aim of this study was to evaluate regular (4-hourly prior to each oral misoprostol dose with amniotomy when feasible) compared with restricted (only if indicated) vaginal assessments during labor induction with oral misoprostol in term nulliparous women MATERIALS AND METHODS: We performed a randomized trial between November 2016 and September 2017 in a university hospital in Malaysia. Our oral misoprostol labor induction regimen comprised 50 μg of misoprostol administered 4 hourly for up to 3 doses in the first 24 hours. Participants assigned to regular assessment had vaginal examinations before each 4-hourly misoprostol dose with a view to amniotomy as soon as it was feasible. Participants in the restricted arm had vaginal examinations only if indicated. Primary outcomes were patient satisfaction with the birth process (using an 11-point visual numerical rating scale), induction to vaginal delivery interval, and vaginal delivery rate at 24 hours. Data from 204 participants (101 regular, 103 restricted) were analyzed. The patient satisfaction score with the birth process was as follows (median [interquartile range]): 7 [6-9] vs 8 [6-10], P= .15. The interval of induction to vaginal delivery (mean ± standard deviation) was 24.3 ± 12.8 vs 31.1 ± 15.0 hours (P= .013). The vaginal delivery rate at 24 hours was 27.7% vs 20.4%; (relative risk [RR], 1.4; 95% confidence interval [CI], 0.8-2.3; P= .14) for the regular vs restricted arms, respectively. The cesarean delivery rate was 50% vs 43% (RR, 1.1; 95% CI, 0.9-1.5; P= .36). When assessed after delivery, participants' fidelity to their assigned vaginal examination schedule in a future labor induction was 45% vs 88% (RR, 0.5; 95% CI, 0.4-0.7; P < .001), and they would recommend their assigned schedule to a friend (47% vs 87%; RR, 0.6; 95% CI, 0.5-0.7; P< .001) in the regular compared with the restricted arms, respectively. Despite a shorter induction to vaginal delivery interval with regular vaginal examination and a similar vaginal delivery rate at 24hours and birth process satisfaction score, women expressed a higher preference for the restricted examination schedule and were more likely to recommend such a schedule to a friend.

24: Labor outcomes of immediate versus delayed oxytocin administration after amniotomy, a randomized controlled trial

To compare duration of labor, mode of delivery, maternal satisfaction and early neonatal outcomes following immediate (within 15-30 minutes) versus delayed (2 hours) oxytocin administration after amniotomy among low risk women in labour. Pragmatic randomized single blind two armed clinical trial in which women in labour at term who had hypotonic uterine contractions were assigned to immediate (within 15-30 minutes) versus delayed (at 2 hours) oxytocin administration after amniotomy at Kenyatta National Hospital in Nairobi, Kenya. We compared the duration of time from amniotomy to second stage, vaginal delivery and decision to cesarean delivery between the two arms. Secondary outcomes were mode of delivery, early neonatal outcomes, maternal satisfaction and actual need of oxytocin. We used intent-to treat analysis for all outcomes. A total of 209 low risk women at a cervical dilation of 4-5 cm and with hypotonic uterine contractions were enrolled between February and July 2018 and randomized to immediate and delayed oxytocin administration after amniotomy. Labor was monitored using a partograph. The baseline characteristics were similar between the two groups. The average time to delivery was 4.6 (standard deviation [SD] 2.6) hours versus 4.9 hours (SD 2.7) following immediate versus delayed oxytocin administration respectively and was similar between the two groups (relative risk [RR] 1.02, 95% confidence interval [CI] 0.97–1.08, P=0.403). The cesarean section rate was not different following immediate (16%) versus delayed (22%) oxytocin administration RR 1.4 95% CI 0.8-2.5, p=0.263. The maternal satisfaction on a visual numerical rating scale (median [interquartile range]) was 4 [3–5] and was similar between the two arms. Time to second stage, decision to cesarean delivery, fetal hears rate patterns, APGAR score at one minute and birthweights were similar between the two arms. In the delayed arm, oxytocin infusion was not required for 28% of women. Immediate or delayed oxytocin administration for hypotonic uterine contractions after amniotomy does not significantly alter the duration of labor, mode of delivery, early neonatal outcomes or maternal satisfaction.

A preliminary investigation examining patient reported outcome measures for low back pain and utilisation amongst chiropractors in Australia: facilitators and barriers to clinical implementation

BackgroundThe current utilisation of patient reported outcome measures (PROMs) for low back pain (LBP) within the Australian Chiropractic profession is unknown. The aims of this study were to determine the current utilisation of LBP PROMs amongst Chiropractors in Australia and to identify the potential barriers and facilitators of using PROMs for LBP in Chiropractic practice.MethodsA cross sectional online survey was distributed to Chiropractors in Australia who were members of the Chiropractic Association of Australia (CAA) and Chiropractic Australia (CA) between June–August 2016. Three thousand fourteen CAA members and 930 CA members were invited to participate totaling 3944 potential participants.ResultsThe findings from this survey provides baseline data for the prevalence of LBP PROMs within the Australian Chiropractic profession. A total of 558 participants completed the survey reflecting a response rate of 14.1%. 72.5% of respondents used LBP PROMs in clinical practice. PROMs were categorised into pain, function and health. At initial patient consultations the most commonly used pain PROMs were the pain diagram, Visual Analogue Scale and Numeric Rating Scale. Most commonly used functional LBP PROMs were the Oswestry Disability Index, Functional Rating Index and Roland Morris Questionnaire. The Health Status Questionnaire (HSQ) was the most commonly used health LBP PROM followed by RAND Health Questionnaires.ConclusionMost of the survey respondents use PROMs in clinical practice. The most common barrier chiropractors identified that prevent LBP PROM utilisation was the lack of operational definition surrounding PROMs, as well as how to use them and the perception that they are time consuming. Facilitatory factors to implement PROMs included using simple administration systems, utilising electronic forms and consistent implementation. This research indicates that there is a potential need to further educate the Chiropractic profession regarding PROMs.

Characteristics of Glutamate-Evoked Pain in the Masseter Region: Differences Between Targeted Injections in Subcutaneous, Muscle, and Bone Tissues

To investigate whether glutamate-evoked pain in the masseter region differs between three different depths of injection, targeting subcutaneous, muscle, and bone tissues. A total of 16 healthy volunteers participated and, in a randomized order, received injections of glutamate (1.0 M, 0.2 mL) and isotonic saline (0.9%, 0.2 mL) in the masseter region that targeted subcutaneous, intramuscular, and bone surface tissues. Following injection, pain intensity was measured using electronic visual analog scale (eVAS) and numeric rating scale (NRS) scores of unpleasantness, tiredness, tension, soreness, and stiffness. Pressure pain sensitivity (PPS), pain drawing areas, and McGill Pain Questionnaire (MPQ) scores were also assessed. Repeated-measures analysis of variance, McNemar test, and Tukey post hoc tests were used for statistical analyses. P < .05 was considered statistically significant. Overall, subcutaneous injections induced significantly more unpleasantness and pain than intramuscular injections, and PPS scores evoked after glutamate injection at the surface of the bone were significantly higher than after intramuscular glutamate injection. Subcutaneous glutamate injections were more often described as "sharp" and "pinching." The subcutaneous injection was more painful and unpleasant than the intramuscular injection. The glutamate injection at the surface of the bone sensitized the deep pain tissues to pressure stimulation. Clinically, it may be difficult to differentiate between the source or site of pain originating from the masseter region, but the specific quality and word descriptors could assist in differential diagnosis.

Migraine and Non‐Migraine Headaches Following Diagnostic Catheter‐Based Cerebral Angiography

No reliable estimates of headaches following catheter-based cerebral angiography are available. We performed an observational cohort study to ascertain the frequency and type ofheadaches following catheter-based cerebral angiography. Consecutive patients who underwent cerebral angiography through the transfemoral (or infrequently radial) route were included. Each patient underwent a brief neurological assessment after the procedure and more detailed assessment was performed if any patient reported occurrence of a headache. The headaches were classified as migraine if the diagnostic criteria specified by International Headache Society were met. The headache severity was classified using a visual numeric rating scale and time to reach pain free status for 2 consecutive hours was ascertained. Migraine headaches occurred in 5 (3.1%, 95% confidence interval [CI] 1.0-7.2%) of 158 patients who underwent cerebral angiography. The median severity of migraine headaches was 10/10 and time to resolution of headaches was 120 minutes (range 60-360 minutes). Migraine headaches occurred in 4 (18.1%, 95% CI 5.2-40.3%) of 22 patients with a history of migraine and 4 (23.5%, 95% CI 6.8-50%) of 17 patients with regular migraine headaches (≥1 episodes per month). Headaches occurred in 6 (3.8%, 95%CI 1.8-8.0%) patients who did not meet the criteria for migraine headaches. We provide occurrence rates of migraine headaches, an under-recognized adverse event, in patients undergoing catheter-based cerebral angiography.

New Programming Modes of Spinal Cord Stimulation for Chronic Pain: A Systematic Review of Outcomes with Burst and High-Frequency Technology

AbstractSpinal cord stimulation (SCS) is a well-established, evidence-based treatment for chronic pain. For decades, implantation of tonic SCS systems has relied on epidural electric lead placement to overlap regions of pain with paresthesias to achieve maximal postoperative pain relief. During the course of tonic SCS treatment, tolerances to the stimulation frequency may develop, leading to reduced efficacy. Recent developments in novel programming modes, such as high-frequency 10 kHz (HF10) and burst, stray from tonic SCS in their electrical stimulation delivery patterns and unique ability to deliver SCS without engendering paresthesias. To date, no review has analyzed outcomes of both HF10 SCS and burst SCS for chronic back and limb pain. This article aims to review all HF10 and burst SCS prospective observational and randomized controlled trials for chronic back and limb pain. The literature search identified 21 papers—10 HF10 SCS papers, 9 burst SCS papers, and 2 papers assessing both HF10 and burst SCS concurrently. Burst SCS and HF10 SCS have been subjected to randomized controlled studies and have used similar patient pain score reporting on a visual analog scale (VAS) and numeric rating scale (NRS). Results from these studies have reported significant reductions in axial back pain and limb pain in patients sustained for up 20 months with burst SCS treatment and up to 36 months with HF10 SCS. Both novel programming modes show promise as viable treatments for those suffering from chronic pain and/or patients who may no longer be responders to tonic SCS.

A Systematic Review and Meta‐analysis of Ketamine as an Alternative to Opioids for Acute Pain in the Emergency Department

Opioids are commonly prescribed in the emergency department (ED) for the treatment of acute pain. Analgesic alternatives are being explored in response to an epidemic of opioid misuse. Low-dose ketamine (LDK) is one opioid alternative for the treatment of acute pain in the ED. This systematic review and meta-analysis sought to quantify whether LDK is an effective and safe opioid alternative for acute pain reduction in adults in the ED setting. (PROSPERO Registration Number CRD42017065303). This was a systematic review of randomized controlled trials comparing intravenous opioids to LDK for relief of acute pain in the ED. Studies where the control group initially received opioids prior to ketamine were excluded. A research librarian designed the electronic search strategy. Changes in visual analog scale or numeric rating scale pain scales were analyzed to determine the relative effects of LDK and opioids in the treatment of acute pain. Three studies met the criteria for inclusion in this meta-analysis. Compared to pain scale reduction with morphine, ketamine was not inferior (relative reduction = 0.42, 95% confidence interval = -0.70 to 1.54). No severe adverse events were reported in any study, but higher rates of nonsevere adverse events were observed with ketamine. Ketamine is noninferior to morphine for the control of acute pain, indicating that ketamine can be considered as an alternative to opioids for ED short-term pain control.

Could the complex regional pain syndrome (Sudeck atrophy), emerged as a distal radius at the typical site fracture complication, be prevented by physical therapy?

the complex regional pain syndrome (CRPS)-Sudeck disease is a frequent complication of a distal radius at the typical site fracture (DRF). Aim of the study was to evaluate the conventional physical agents application alone and combined with light therapy for treatment of distal radius at the typical site fracture and to follow-up patients for the CRPS occurrence in a six months period. Study comprised 52 female patients with DRF, involved after removing of the plaster and divided into two age-matched groups. Besides identical drug therapy, group 1 was treated with cryotherapy, exercises and group 2 with cryotherapy, exercises and the bioptron (polarized, polychromatic, non-coherent low energy radiation) light on the wrist and dorsal side of the hand. Patients were evaluated at 0, 7 and 15 days for pain [Visual Numerical Rating Scale (VAS)], range of the wrist motion-supination and pronation, and the hand fist forming capacity and followed up for 6 months. Results were analysed by computer statistic programme SPSS 20.0. Pain was significantly decreased in group 2 at 15th day of therapy. Significant improvement in supination was shown for group 2 on 7th ( P = 0.019) and 15th day of treatment ( P = 0.001). Both groups have shown significant improvement in VAS, supination and pronation on 15th day of therapy, as compared to baseline ( P = 0.000). The complete hand fist forming capacity was achieved in 16 (61.5%) patients in group 1 and 19 (73.1%) in group 2. In a 6 months period of follow-up, CRPS was developed in 4 patients (15.4%) from group 1. Bioptron light therapy combined with conventional therapy has shown good pain control, significant degree of pain reduction and improvement of the wrist motion range, with no CRPS development within the 6 months period of follow-up. Further studies would be beneficial.

Efficacy and Safety Outcome Domains and Outcome Measures in Systematic Reviews of Neuropathic Pain Conditions.

Heterogeneity of outcome domains, used in interventional trials and systematic reviews (SRs) for neuropathic pain (NeuP), makes decisions on the comparative effectiveness of available treatments difficult. This study analyzed outcome domains and measures used in SRs of randomized controlled trials on efficacy and safety of interventions for NeuP and compared them with the core outcome set (COS) and core outcome measures (COMs) for chronic pain recommended by the Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (IMMPACT). Five electronic databases were searched to find SRs of interventions for NeuP. Outcome domains and measures were independently extracted by 2 authors, and compared against the IMMPACT-recommended COS and COMs. Outcome domains specified in the methods and reported in the results were also compared. Ninety-seven SRs were analyzed. The 2 core domains most frequently specified in the methods and reported in the results of SRs were pain and symptoms and adverse events. Pain intensity was mostly assessed with Visual Analog Scale (n=59) and Numerical Rating Scale (n=29). The incidence (n=70) and severity (n=60) were most commonly reported for adverse events. There were 240 different outcome measures used for the assessment of treatment efficacy and safety. Authors of SRs in the field of NeuP insufficiently use relevant recommended COS and COMs for chronic pain. More effort should be put into the implementation of COS to ensure that the study results can be compared and combined. There is a need for defining core outcome domains and measures specific for NeuP.

Assessing the severity of atopic dermatitis in clinical trials and practice

There is a tremendous need for accurate and reproducible scoring systems for the grading of skin disease to further the development of research and standards of care. There are presently greater than 60 measures that have been used to assess the severity of atopic dermatitis. These assessments vary considerably with respect to content, scale, instructions, validity, and concordance. This contribution reviews the available scoring systems of atopic dermatitis signs based on their design and merit in specific settings. These scores assess lesional intensity and/or extent, symptoms, disease course, and epidermal function. Scoring atopic dermatitis, Investigator Global Assessment, and Eczema Area and Severity Index are the most commonly used assessments of atopic dermatitis signs. Eczema Area and Severity Index has emerged as the preferred outcome measure of atopic dermatitis signs for use in clinical trials. Unfortunately, Eczema Area and Severity Index can be cumbersome in clinical practice. Itch intensity (visual analog or numeric rating scales) and Patient-Oriented Eczema Measure have emerged as the preferred patient-reported outcome in clinical trials. Clinicians’ gestalt global assessment of severity, Patient-Oriented Eczema Measure, and intensity of itch may be feasible for clinical practice.

Pre-operative use of dexamethasone does not reduce incidence or intensity of bleaching-induced tooth sensitivity. A triple-blind, parallel-design, randomized clinical trial.

This study evaluated the effect of the administration of pre-operative dexamethasone on tooth sensitivity stemming from in-office bleaching. A triple-blind, parallel-design, randomized clinical trial was conducted on 70 volunteers who received dexamethasone or placebo capsules. The drugs were administered in a protocol of three daily 8-mg doses of the drug, starting 48h before the in-office bleaching treatment. Two bleaching sessions with 37.5% hydrogen peroxide gel were performed with a 1-week interval. Tooth sensitivity (TS) was recorded on visual analog scales (VAS) and numeric rating scales (NRS) in different periods up to 48h after bleaching. The color evaluations were also performed. The absolute risk of TS and its intensity were evaluated by using Fisher's exact test. Comparisons of the TS intensity (NRS and VAS data) were performed by using the Mann-Whitney U test and a two-way repeated measures ANOVA and Tukey's test, respectively. In both groups, a high risk of TS (Dexa 80% x Placebo 94%) was detected. No significant difference was observed in terms of TS intensity. A whitening of approximately 3 shade guide units of the VITA Classical was detected in both groups, which were statistically similar. It was concluded that the administration pre-operatively of dexamethasone, in the proposed protocol, does not reduce the incidence or intensity of bleaching-induced tooth sensitivity. The use of dexamethasone drug before in-office bleaching treatment does not reduce incidence or intensity of tooth sensitivity. NCT02956070.

Electroacupuncture for postoperative pain management after total knee arthroplasty: Protocol for a systematic review and meta-analysis.

Total knee arthroplasty (TKA) is one of the most common joint replacement surgeries in the United States. Postoperative pain is still a major complication after TKA. Electroacupuncture (EA) has been commonly used in clinical practice for pain after TKA, but its effects and safety remain uncertain. This protocol is described for a systematic review to investigate the beneficial effects and safety of EA for postoperative pain after TKA. Randomized controlled trials (RCTs) related to EA treatment of pain after TKA will be collected from 3 databases of English literature, namely PubMed, Embase, and Cochrane Library, and 4 databases of Chinese literatures, namely CBM, CNKI, VIP and Wanfang database. The retrieved trials will be those published from the time when the respective databases were built to January 2018. The therapeutic effects according to the change from baseline in the amount of pain measured by the visual analogue scale (VAS) or numerical rating scale, will be accepted as the primary outcomes. We will use RevMan V.5.3 software as well to compute the data synthesis carefully when a meta-analysis is allowed. This systematic review and meta-analysis will provide a high-quality synthesis of current evidence of EA for pain after TKA. The conclusion of our systematic review will provide evidence to judge whether EA is an effective intervention for patient with postoperative pain after TKA. PROSPERO CRD 42018082407.

Good correlation between visual analogue scale and numerical rating scale in the assessment of nasal obstruction.

Results from telephone interviews may be needed to supplement those from mailed questionnaires when response rates are inadequate. This study assessed the correlation between visual analogue scale ratings used in mailed questionnaires and numerical rating scale scores used in telephone interviews. Patients scheduled for nasal septal surgery routinely respond to a visual analogue scale of obstruction during the day and at night. In this study, they were also asked to verbally rate their sense of obstruction using whole numbers. There was no significant difference between visual analogue scale and numerical rating scale obstruction scores. Ratings of nasal obstruction obtained with a numerical rating scale in telephone interviews are comparable to visual analogue scale scores in mailed questionnaires.

Evaluation of several clinical parameters after bleaching with hydrogen peroxide at different concentrations: A randomized clinical trial

ObjectiveThis randomized double-blind clinical trial compared tooth sensitivity (TS), bleaching efficacy, and cytokine levels after applying in-office bleaching treatments containing 15% and 35% hydrogen peroxide (HP15% and HP35%, respectively). MethodsTwenty-five volunteers were randomly assigned to receive HP15% or HP35% treatment. The bleaching agent was applied in three 15-min applications per session. Two bleaching sessions were separated by a 1-week interval. The participants scored TS using a visual analog scale and numerical rating scale. Bleaching efficacy was determined by subjective and objective methods. Gingival crevicular fluid was collected from three jaws sites per patient for the analysis of fluid volume. Flow cytometry was used to analyze gingival crevicular fluid levels of interleukin (IL)-1β, IL-2, IL-4, IL-6, IL-10, tumor necrosis factor, and interferon-gamma. All measurements were obtained before and after bleaching. All data were statistically analyzed (α = 0.05). ResultsThe absolute risk and intensity of TS was higher for HP35% than for HP15% (p > 0.002). One month post-bleaching, HP35% produced more bleaching than HP15% (p = 0.02). However patient perception (p = 0.06) and patient satisfaction (p = 0.53) with regard to bleaching were not significantly different. No significant differences existed in the gingival fluid volume (p > 0.38) or in any cytokine level (p > 0.05) for either HP concentration. ConclusionTreatment: with HP35% is more effective than HP15%, but generates a greater risk and intensity of TS. No inflammatory changes occurred despite the difference in the HP concentrations. Clinical significanceHydrogen peroxide at a lower concentration (e.g., 15%) should be considered a good treatment alternative for in-office bleaching because the higher concentration for in-office bleaching generates a greater risk and intensity of TS for patients.

Treatment of Uremic Pruritus: A Systematic Review

Uremic pruritus is a common and burdensome symptom afflicting patients with advanced chronic kidney disease (CKD) and has been declared a priority for CKD research by patients. The optimal treatments for uremic pruritus are not well defined. Systematic review. Adult patients with advanced CKD (stage≥ 3) or receiving any form of dialysis. PubMed, CINAHL, Embase, International Pharmaceutical Abstracts, Scopus, Cochrane Library, and ClinicalTrials.gov from their inception to March 6, 2017, were systematically searched for randomized controlled trials (RCTs) of uremic pruritus treatments in patients with advanced CKD (stage≥ 3) or receiving any form of dialysis. 2 reviewers extracted data independently. Risk of bias was assessed using the Cochrane Collaboration risk-of-bias tool. Any intervention for the treatment of uremic pruritus was included. A quantitative change in pruritus intensity on a visual analogue, verbal rating, or numerical rating scale. 44 RCTs examining 39 different treatments were included in the review. These treatments included gabapentin, pregabalin, mast cell stabilizers, phototherapy, hemodialysis modifications, and multiple other systemic and topical treatments. The largest body of evidence was found for the effectiveness of gabapentin. Due to the limited number of trials for the other treatments included, we are unable to comment on their efficacy. Risk of bias in most studies was high. Heterogeneity in design, treatments, and outcome measures rendered comparisons difficult and precluded meta-analysis. Despite the acknowledged importance of uremic pruritus to patients, with the exception of gabapentin, the current evidence for treatments is weak. Large, simple, rigorous, multiarm RCTs of promising therapies are urgently needed.

How to obtain the biopsychosocial record in multidisciplinary pain clinic? An action research study

Abstract Background Patients with complicated chronic non-malignant pain (CCNMP) should be referred to the multidisciplinary treatment based on the biopsychosocial pain model. This is not a trivial task to obtain the biopsychosocial record (BPSR) during the first visit in multidisciplinary pain center – some important data can be missing, but it is difficult to choose the right questions. Purpose To find the optimal method for obtaining of BPSR in patients with CCNMP. Methods The action research methodology is used. First, the literature search was done. Second, the meetings between therapists were hold. Third, the patients are asked about their experiences with obtaining of BPSR. Results The following area of interest were identified: (1) patient’s demographic data, (2) lifestyle factors, (3) previous diseases, (4) concurrent diseases, (5) previous pain treatments, (6) pain intensity and effect of the actual pain treatment, (7) general activity, (8) mood, (9) walking activity, (10) work ability, (11) home activities, (12) relations with other people, (13) sleep, (14) enjoyment of life, (15) patients expectations from treatment, and (16) treatment goals. Patients are asked about those variables. Either Visual Analogue Scale or Numeric Rating Scale is used for assessment of pain intensity and pain influence on variables (7) to (14). First, data about variables (1) to (6) are collected by the physician. Next, data about variables (7) to (15) are gathered under interview with the nurse. Last, the physician and the nurse keep the meeting on treatment goals and treatment course. Up to date (February 2017), 8 patients were asked about their experience with obtaining of BPSR. All but one patient were very satisfied. Conclusions The method presented above seems to be promising approach to obtaining of BPSJ in patients with CCNMP. The study is ongoing and updated results will be presented at the conference.

PENGARUH LAMAZE EXERCISE TERHADAP SKALA NYERI MENSTRUASI (DYSMENORRHOEA) PADA REMAJA PUTRI DI SMA BUDI MULIA JAKARTA

Menstrual pain present as cramps (ranging from mild to severe), which may disturb dailyactivities. Lamaze exercise is non pharmacological method which use breathingrelaxation. This research was to analyze Lamaze exercise to reduction of menstrual pain.This study used pra experimental pre post test design. The population was the studentswith menstrual pain at Budi Mulia Senior High School Jakarta. The sampling techniquewas purposive sampling. Thirty one students participated in this study. The independentvariable was Lamaze exercise and the dependent variable was menstrual pain.Instrument which used to measure pain was Visual Analog Numeric Rating Scale. Datawere analyzed with Wilcoxon Signed Rank Test with significance α ≤ 0.005. The resultshowed that Lamaze exercise decreasd menstrual pain. The result of statistical testshowed significance level p = 0.000 and the deviation between pre and post mean is2.32, which means that there was decreasing menstrual pain in student in pre test andpost test. It can be concluded that Lamaze exercise can influence menstrual pain indecrease respondent of the research. Lamaze exercise can provide a relaxing effect.Further experiment with different respondent characteristic to obtain more wide range ofresult.Keywords: menstrual pain, Lamaze, relaxing effect, non pharmacological method

The association between mindfulness and post-operative pain in gynecologic oncology patients undergoing minimally invasive hysterectomy.

10079 Background: Studies demonstrate an inverse relationship between mindfulness and chronic pain. However, the relationship between mindfulness and acute post-operative pain has not yet been thoroughly investigated. The objective of this study is to determine if there is an association between pre-operative level of mindfulness and post-operative pain outcomes in women undergoing minimally invasive hysterectomy. Methods: For this prospective cohort study, women planning to undergo laparoscopic or robotic hysterectomy were prospectively recruited at the gynecologic oncology outpatient clinic at our institution. Baseline mindfulness was assessed at the pre-operative clinic visit using the Five Facet Mindfulness Questionnaire (FFMQ). Post-operative pain, using the Visual Numeric Rating Scale (VNRS-11), and opiate pain medication usage were evaluated via chart review and post-operative surveys completed at 1 to 2 week and 4 to 6 week post-operative clinic visits. Results: One hundred twenty four women completed the 6 week post-operative follow-up period, of which 80% were undergoing surgery for malignancy. Baseline mindfulness was inversely correlated with post-operative pain as measured by both the average and highest reported VNRS-11 values during the inpatient stay (r = -0.21, p = 0.019; r = -0.21, p = 0.016). At the 1 to 2 week post-operative visit, self-reported pain score was also inversely correlated with pre-operative mindfulness score (r = -0.24, p = 0.009). This relationship was not observed at the 4 to 6 week post-operative visit (r = -0.08, p = 0.403). Higher pre-operative mindfulness was also associated with lower opiate usage (r = -0.16, p = 0.077), though this relationship was not statistically significant. Conclusions: Higher pre-operative mindfulness is associated with more favorable post-operative pain outcomes, including lower reported numeric pain scores, in gynecologic oncology patients undergoing minimally invasive hysterectomy. This relationship provides an opportunity to target the modifiable personality characteristic of mindfulness, to improve post-operative pain in women planning gynecologic surgery.

Immediate Compared With On-Demand Maternal Full Feeding After Planned Caesarean Delivery: A Randomised Trial

Objective To evaluate immediate compared with on-demand full maternal oral feeding after caesarean delivery Study design A randomised trial. Setting Obstetric unit of a university hospital in Kuala Lumpur, Malaysia. Population Women admitted for a planned caesarean under spinal anaesthesia. Methods Participants were randomised to a sandwich meal served immediately on return to the ward or on-demand. Main outcome measures Primary outcomes were patient satisfaction VAS (visual analog scale of 100 mm) on the feeding regimen and vomiting at 24 hours. Results 453 women were initially enrolled, 395 were randomised and available for analysis. Median (full range) patient satisfaction VAS scores were 82 (15–100) versus 84 (0–100) mm, P = 0.88 and vomiting rates were 1/197 (0.5%) versus 2/198 (1.0%), P > 0.99 for immediate compared with on-demand feeding, respectively. The immediate versus on-demand arms first ate at a median of 105 (35–210) versus 165 (45–385) minutes, P < 0.001, had second meal at 5.3 (1.2–15.5) versus 5.8 (2.2–29.7), P < 0.001, flatus passage at 9.5 (3.1–29.0) versus 10.3 (2.8–24.6), P = 0.023 hours post-caesarean and opiate analgesia use was 10/197 (5.1%) versus 23/198 (11.6%), P = 0.028, RR 0.4 (95% CI 0.2–0.9), NNTb 16 (95% CI 8–89). The median visual numerical rating scale (0–10 scale) for nausea and bloating at 8, 16 and 24 hours was similarly scored at zero in both arms. Other outcomes were similar. Conclusion Immediate full feeding has some advantage over on-demand feeding. Both regimens are tolerated well. Patients probably should be fed as soon as practicable after a caesarean. Tweetable abstract Full maternal oral feeding should commence as soon as practicable after an uncomplicated caesarean section.

КЛИНИЧЕСКОЕ ИССЛЕДОВАНИЕ ЭФФЕКТИВНОСТИ ПРИМЕНЕНИЯ СПЕЦИАЛИЗИРОВАННОЙ ЗУБНОЙ ПАСТЫ ПРИ ГИПЕРЕСТЕЗИИ ДЕНТИНА

Background Dental hypersensitivity is one of the most commonly experienced dental pathologies. Tooth hypersensitivity is most commonly associated with loss of hard tissue due to caries, increased abrasion, erosion of enamel, wedge-shaped defects and gingival recession. Systemic mechanisms in dentine hypersensitivity (DH) development have a neurological nature and occur against the background of chronic somatic diseases; the treatment and prevention of hypersensitivity generally employs combination therapeutic approaches. With limited forms of DH, local treatment aimed at protecting the tooth pulp nerve endings is usually sufficient. The most widely available carrier of mineral components for remineralisation therapy is toothpaste, the effectiveness of which depends on its composition. The aim of this study is to investigate the clinical effectiveness of «SENSODYNE® Restoration and Protection» toothpaste for reducing dentine hypersensitivity. Methods An evaluation of the stomatological status, prevalence and intensity of dentine sensitivity and effectiveness of treatment when using «SENSODYNE® Restoration and Protection» toothpaste was carried out in 55 patients aged 21 to 34 years who did not have chronic somatic diseases or bad habits. In order to determine the intensity of the pain response, the visual analogue (VAS) and numeric rating (NRS) scales were used; these are equally verbal rating scale (VRS) was also used. Results On the basis of clinical methods – as well as referring to visual, verbal and numerical rating scales – it was established that the effectiveness of one month of treatment was 94.2 % and 100 % respectively. Conclusions The use of «Sensodyne® Restoration and Protection» toothpaste contributed to a significant improvement of the hygienic condition of the oral cavity as well as a reducing or eliminating hypersensitivity of the hard tissues of teeth and bleeding gums, as confirmed by the positive dynamics of the studied parameters.