Abstract Background Extremity fractures are common, and most are managed operatively; however, despite successful reduction, up to half of patients report persistent post-surgical pain. Furthermore, psychological factors such as stress, distress, anxiety, depression, catastrophizing, and fear-avoidance behaviors have been associated with the development of chronic pain. The purpose of this pilot study was to examine the feasibility of a randomized controlled trial to determine the effect of in-person cognitive behavioral therapy (CBT) vs. usual care on persistent post-surgical pain among patients with a surgically managed extremity fracture. Methods Eligible patients were randomized to either in-person CBT or usual care. We used four criteria to judge the composite measure of feasibility: 1) successful implementation of CBT at each clinical site, 2) 40 patients recruited within 6 months, 3) treatment compliance in a minimum 36 of 40 participants (90%), and 4) 32 of 40 participants (80%) achieving follow-up at one year. The primary clinical outcome was persistent post-surgical pain at one year after surgery. Results Only two of the four participating sites were able to implement the CBT regimen due to difficulties with identifying certified therapists who had the capacity to accommodate additional patients into their schedule within the required timeframe (i.e., 8 weeks of their fracture). Given the challenges associated with CBT implementation, only one site was able to actively recruit patients. This site screened 86 patients and enrolled 3 patients (3.5%) over a period of three months. Participants were unable to comply with the in-person CBT, with no participants attending an in-person CBT session. Follow-up at one year could not be assessed as the pilot study was stopped early, three months into the study, due to failure to achieve the other three feasibility criteria. Conclusion Our pilot trial failed to demonstrate the feasibility of a trial of in-person CBT versus usual care to prevent persistent pain after surgical repair of traumatic long-bone fractures and re-enforces the importance of establishing feasibility before embarking on definitive trials. Protocol modifications to address the identified barriers include the delivery of our intervention as a therapist-guided, remote CBT program. Trial registration ClinicalTrials.gov (Identifier NCT03196258); Registered June 22, 2017, https://clinicaltrials.gov/ct2/show/NCT03196258
The aim of this study was to determine what is considered a long oral surgery and conduct a cost-effective analysis of sedative agents used for intravenous sedation (IVS) and sedation protocols for such procedures. Pubmed and Google Scholar databases were used to identify human studies employing IVS for extractions and implant-related surgeries, between 2003 and July/2023. Sedation protocols and procedure lengths were documented. Sedative satisfaction, operator satisfaction, and sedation assessment were also recorded. Cost estimation was based on The British National Formulary (BNF). To assess bias, the Cochrane Risk of Bias tools were employed. This review identified 29 randomised control trials (RCT), six cohorts, 14 case-series, and one case-control study. The study defined long procedures with an average duration of 31.33 minutes for extractions and 79.37 minutes for implant-related surgeries. Sedative agents identified were midazolam, dexmedetomidine, propofol, and remimazolam. Cost analysis revealed midazolam as the most cost-effective option (<10 pence per procedure per patient) and propofol the most expensive option (approximately £46.39). Bias analysis indicated varying degrees of bias in the included studies. Due to diverse outcome reporting, a comparative network approach was employed and revealed benefits of using dexmedetomidine, propofol, and remimazolam over midazolam. Midazolam, dexmedetomidine, propofol, and remimazolam demonstrated safety and efficacy as sedative agents for conscious IVS in extended procedures like extractions or implant-related surgeries. While midazolam is the most cost-effective option, dexmedetomidine, propofol, and remimazolam offer subjective and clinical benefits. The relatively higher cost of propofol may impede its widespread use. Dexmedetomidine and remimazolam stand out as closely priced options, necessitating further clinical investigations for comparative efficacy assessment.
Background:Sleep is a vital physiologic process, serious outcomes results due to lack of sleep. The circadianrhythm plays an important role in our biologic function. Various studies have recorded the function ofcircadian rhythm in our body and the various environmental parameters which affect the sleep of the patients.Along with other factors critical illness also contributes to the vulnerability of the patient.The recovery ofthe patients depends on the quality of the sleep. Hence this study assess the quality of sleep among thepatients in HDU.Objective:To assess the quality of sleep among the patients in HDU.Methodology: A NonExperimental Descriptive Research Approach is used. 30 samples who had three days of HDU stay wereselected by using NonProbability Purposive Sampling Technique. Data was congregated using ModifiedPittsburgh sleep Quality Index.In order to establish the reliability of the tool test-retest method was usedand the pearson’s correlation coefficient was found to be 0.98. Result: Majority of them, 50% had agegroup of 41-50 years. 23% had age group of 51-60 years and 13.33% has 31-40 years and above 60 yearsage group. Majority 66.67% were male and few 33.33% were female. Majority 63.33% had three days ofHDU stay whereas 36.67% had 4 days of HDU stay. 33.33% had diagnosis related to cardiovascular, 30%had respiratory related diagnosis, 20% were related to gastrointestinal, 13.34 % were from endocrine andfew 3.33% were from other systems. The quality of sleep reveals that majority 40% of them had poor sleep(score 30-44), 26.66% had average sleep (score 15-29), 20% had good sleep (score 1-14), 13.33% had verygood sleep (score 0)Conclusion: The findings indicate that the questionnaire was effective in assessing thequality of sleep among the patients in HDU. The study also concluded that majority of the patients in HDUhad poor quality of sleep.
Background: Hemodialysis is the medical procedure to remove extra fluid and harmful waste productsfrom blood and to correct electrolyte imbalance of patient whose kidney can no longer do it. It is done usinga hemodialysis machine and dialyzer also called as “artificial kidney. Haemodialysis is one of three renalreplacement therapies. The important role play by the kidneys in the body are in the regulation of bodyelectrolytes; controlling the acid base balance. The primary function of excretory system is to maintainbody’s state of homeostasis by carefully regulating the fluid and electrolytes, removing wastes. Irregularityin the functioning of kidneys and lower urinary tract is common and may occur at any age with varyingdegrees of severity. Dialysis is needed if kidneys no longer remove enough wastes and fluid from your bloodto keep healthy.Purpose and Objective: The purpose of the study was to evaluate effectiveness of information educationcommunication module on knowledge and practice regarding home care management among patient onhemodialysis. 1. To assesses the level of knowledge and practice of hemodialysis patient regarding homecare management. 2. To evaluate the effectiveness of information education communication (IEC) moduleregarding home care management of hemodialysis patient. 3. To associate the knowledge and practice ofpatient on hemodialysis regarding home care management with the selected demographic variables.Methodology: A quasi-experimental non-randomized pre-post-test control group design was used involving40 patients of haemodialysis with AV fistula. After obtaining informed and written consent from the patient,samples were selected using Non-Probability Purposive sampling technique and allocated into two groups of20 patients each in experimental and control group. Self-Structured questioner was used for data collection.The data was analysed by using descriptive and inferential statistics. The statistics used were frequency,mean, percentage, standard deviation and Fishers exact statistic.Results: The descriptive analysis was done to evaluate effectiveness of information education communicationon knowledge and practice regarding home care management among patient on hemodialysis which showsthat information education communication module is effective for enhancement of knowledge and practiceregarding home care management in experimental group than in control group. In experimental group, themean knowledge score was from 8.35(pre-test) to 13.15(post-test) with SD from 1.42(pre-test) to 0.99(posttest) and The mean practice score was from 12.15(pre-test) to 13.8(post-test) with SD from 1.04(pre-test)to 0.52(post-test).The demographic variable for knowledge and practice regarding home care managementamong patient on hemodialysis are not significantly associated.Conclusion: This concluded from the result of the study that information education communication (IEC)module is having significant effect on knowledge and practice regarding home care management. Thedemographic variable for knowledge and practice regarding home care management among patient onhemodialysis are not significantly associated.
Background: Nursing is a field of clinical expertise, which deals with caring for the patients with illness andproviding them a quality nursing care. To provide a good quality Nursing care, it is very important that theNurses should be properly trained and expert in providing care. A clinical educator plays a very important intraining and updating nurses with the updated and current trends in Healthcare sector. Clinical preceptorshipis one of the best methods used to train the nurses in Clinical setting. Clinical preceptorship is a method ofteaching and guiding students by a knowledgeable nurse in medical area to train them in clinical Skills andtechniques.Clinical preceptorship is a concept which is mostly used in western countries. In India clinical preceptorshipis not practiced.Since it is a new concept in India scenario, this study evaluated the knowledge and attitude of NurseEducators towards clinical preceptorship.Methods: The study was conducted amongst Nursing Educators through online survey method.Results: More than 50 % of the Nursing professors does not have any knowledge about Nursing preceptorship.Out the educators having knowledge about Clinical preceptorship maximum had a positive attitude towardsit.Conclusion: The Nursing Educators in India are very much favourable with the concept of Clinicalpreceptorship, whilst there is knowledge gap present.
Passive smoking has become a serious health issue in the recent times. World is facing serious public healthproblem known as Second Hand Smoke (SHS). Globally, it is estimated that one-third of the populationis frequently exposed to Second Hand Smoke, with 0.6 million individuals dying each year from SHSexposure. This paper was in response to the rising trend of active smoking where the nearby people areaffected more than the actual smokers. This study was conducted with objectives to assess the knowledge,attitude and association between knowledge and attitude. Quantitative research approach with descriptiveresearch design was used on a sample size 50 women with age group of 12 years and above using nonprobability purposive sampling. Analysis of data was done by using descriptive and inferential statistics.
Self reported oral health knowledge and practices of 83 traditional healers in Zonkizizwe (56) and Dube (27) Gauteng Province, South Africa were carried out using a questionnaire and clinical photographs of common oral conditions. The mean age for the total group was 49.5 with 35 males and 48 females. Although only 17 of the healers were members of a professional association, many indicated their willingness to join one. 40 (71%) of healers in Zonkizizwe kept written client records but far fewer 3 (11%) did so in Dube. More than 90% of traditional healers from both areas correctly identified photographs of gingival inflammation, dental caries and oral candidiasis. Over 50% of healers from both areas had patients who presented with mouth problems. Ninety percent of healers in Zonkizizwe referred patients to the formal health care sector but less than 50% in Dube did so. A vast majority of healers gave oral health advice to their patients, many of whom gave specific tooth brush instruction. The study provides an initial understanding of the practices of healers regarding oral health.
Placenta previa affects approximately 0.5% of pregnancies. After four cesarean sections, however, it affects 10% of pregnancies. Rates of disease have increased over the late 20th century and early 21st century. Such a case was witnessed where a 36 year-old female (G4P2L1D1A1) with 25 weeks of gestation came to the OPD with complains of breathlessness. She is known case of RH incompatibility and was administered Anti-D immunoglobulin injection during previous pregnancy, yet was advised to take Anti-D immunoglobulin injection after 28 weeks of gestation.
'%3e%3ccircle r='20' fill='%23008'/%3e%3ccircle r='17.5' fill='%23fff'/%3e%3ccircle r='3.5' fill='%23008'/%3e%3cg id='d'%3e%3cg id='c'%3e%3cg id='b'%3e%3cg id='a' fill='%23008'%3e%3ccircle r='.875' transform='rotate(7.5 -8.75 133.5)'/%3e%3cpath d='M0 17.5.6 7 0 2l-.6 5L0 17.5z'/%3e%3c/g%3e%3cuse xlink:href='%23a' transform='rotate(15)'/%3e%3c/g%3e%3cuse xlink:href='%23b' transform='rotate(30)'/%3e%3c/g%3e%3cuse xlink:href='%23c' transform='rotate(60)'/%3e%3c/g%3e%3cuse xlink:href='%23d' transform='rotate(120)'/%3e%3cuse xlink:href='%23d' transform='rotate(-120)'/%3e%3c/g%3e%3c/svg%3e)