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Wei C, Fu D, Ma T, Chen M, Wang F, Chen G, Wang Z. Sensing patches for biomarker identification in skin-derived biofluids. Biosens Bioelectron 2024; 258:116326. [PMID: 38696965 DOI: 10.1016/j.bios.2024.116326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 04/15/2024] [Accepted: 04/21/2024] [Indexed: 05/04/2024]
Abstract
In conventional clinical disease diagnosis and screening based on biomarker detection, most analysis samples are collected from serum, blood. However, these invasive collection methods require specific instruments, professionals, and may lead to infection risks. Additionally, the diagnosis process suffers from untimely results. The identification of skin-related biomarkers plays an unprecedented role in early disease diagnosis. More importantly, these skin-mediated approaches for collecting biomarker-containing biofluid samples are noninvasive or minimally invasive, which is more preferable for point-of-care testing (POCT). Therefore, skin-based biomarker detection patches have been promoted, owing to their unique advantages, such as simple fabrication, desirable transdermal properties and no requirements for professional medical staff. Currently, the skin biomarkers extracted from sweat, interstitial fluid (ISF) and wound exudate, are achieved with wearable sweat patches, transdermal MN patches, and wound patches, respectively. In this review, we detail these three types of skin patches in biofluids collection and diseases-related biomarkers identification. Patch classification and the corresponding manufacturing as well as detection strategies are also summarized. The remaining challenges in clinical applications and current issues in accurate detection are discussed for further advancement of this technology (Scheme 1).
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Affiliation(s)
- Chen Wei
- Department of Chemistry, College of Sciences, Northeastern University, Shenyang, 110819, China
| | - Danni Fu
- Department of Chemistry, College of Sciences, Northeastern University, Shenyang, 110819, China
| | - Tianyue Ma
- Department of Chemistry, College of Sciences, Northeastern University, Shenyang, 110819, China
| | - Mo Chen
- Department of Biomedical Engineering, McGill University, Montreal, QC, H3G 0B1, Canada; Rosalind & Morris Goodman Cancer Institute, McGill University, Montreal, QC, H3G 0B1, Canada
| | - Fangling Wang
- Department of Chemistry, College of Sciences, Northeastern University, Shenyang, 110819, China
| | - Guojun Chen
- Department of Biomedical Engineering, McGill University, Montreal, QC, H3G 0B1, Canada; Rosalind & Morris Goodman Cancer Institute, McGill University, Montreal, QC, H3G 0B1, Canada.
| | - Zejun Wang
- Department of Chemistry, College of Sciences, Northeastern University, Shenyang, 110819, China.
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2
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Voigt KR, Wullaert L, Gobardhan PD, Doornebosch PG, Verhoef C, Husson O, Ramakers C, Grünhagen DJ. Feasibility, reliability and satisfaction of (automated) capillary carcinoembryonic antigen measurements for future home-based blood sampling: the prospective CASA-I study. Colorectal Dis 2024. [PMID: 38949106 DOI: 10.1111/codi.17085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Revised: 04/12/2024] [Accepted: 06/08/2024] [Indexed: 07/02/2024]
Abstract
AIM Follow-up for colorectal cancer (CRC) necessitates regular monitoring of carcinoembryonic antigen (CEA) at the hospital. Capillary home-based blood collection, including minimally invasive techniques such as lancet sampling or an automated upper arm device (TAP-II), has the potential to replace a significant portion of hospital-based blood sampling, thereby enhancing self-reliance and quality of life. The objectives of this study were to assess the feasibility, reliability and preference for CEA blood collection. METHODS Baseline venous and capillary (by lancet and TAP-II) blood samples were collected from 102 participants, including 20 CRC patients with elevated CEA levels, 60 CRC patients undergoing postoperative outpatient monitoring and 20 healthy volunteers. The second group performed capillary blood collections at home on two consecutive follow-up appointments and subsequently sent them to the hospital. Satisfaction was assessed via patient reported outcome measures on pain, burden, ease of use and preference. RESULTS The Pearson's correlation test of all usable samples resulted in a linear coefficient of 0.998 (95% CI 0.997-0.998) for the TAP-II method and 0.997 (95% CI 0.996-0.998) for the lancet method, both compared to venipuncture. Following the initial blood collection, 86% of the participants (n = 102) favoured the TAP-II, rating it as the least painful and burdensome option. After two home-based blood samples, the preference for the TAP-II method persisted, with 64% of the patients endorsing its use. CONCLUSION This study demonstrated the feasibility of home-based capillary sampling of CEA. The TAP-II blood collection is the most reliable method and is preferred by patients over venipuncture and lancet sampling.
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Affiliation(s)
- Kelly R Voigt
- Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Lissa Wullaert
- Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - P D Gobardhan
- Department of Surgery, Amphia Hospital, Breda, The Netherlands
| | - P G Doornebosch
- Department of Surgery, IJsselland Ziekenhuis, Capelle aan den IJssel, The Netherlands
| | - Cornelis Verhoef
- Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Olga Husson
- Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Christian Ramakers
- Department of Clinical Chemistry, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Dirk J Grünhagen
- Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
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3
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Issin A, Yurten H, Özcan S. No-anesthesia for Colles fracture. Injury 2024; 55:111614. [PMID: 38820668 DOI: 10.1016/j.injury.2024.111614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Revised: 05/13/2024] [Accepted: 05/14/2024] [Indexed: 06/02/2024]
Abstract
BACKGROUND This study aims to measure the perceived pain during the reduction of Colles fracture without anesthesia in both children and adults. It describes the process and reveals duration for reduction, total hospital stays and compares them with the same procedure under hematoma block. METHODS We employed the Wong-Baker FACES pain scale to assess pain reduction in 135 adults and 98 pediatric patients undergoing Colles fracture reduction with or without hematoma block. We also measured the time required for the reduction and the overall process. RESULTS For fracture reduction without anesthesia, Wong-Baker FACES scores were 9.2 for children and 8.7 for adults. With hematoma block, scores dropped to 7.5 for children and 5.2 for adults with only a 10 min addition to the hospital stay. Pain scores among pediatric patients exhibited moderate to strong negative correlations with age. The reduction maneuver itself took an average of 5 s. CONCLUSIONS The reduction of a Colles fracture is nearly instantaneous, making the reduction without anesthesia tolerable. Pediatric patients don't benefit from hematoma block as much as adult counterparts. It significantly reduced pain scores by 1.7 points in children and 3.5 points in adults. LEVEL OF EVIDENCE Level I, Randomized Controlled Trial.
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Affiliation(s)
- Ahmet Issin
- Erzincan Binali Yıldırım University, Mengücek Gazi Education and Research Hospital Orthopedics and Traumatology Department, Erzincan, Turkey
| | - Hakan Yurten
- Elazığ Fethi Sekin City Hospital, Orthopedics and Traumatology Department, Elazığ , Turkey
| | - Seçkin Özcan
- Yalova Education and Research Hospital Orthopedics and Traumatology Department, Yalova, Turkey.
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Phillips K, Callaghan BL, Webb A, Kan J, Ooi CY, Kasparian NA. MEDIC: Development and validation of a new instrument to assess emotional reactivity to medical stimuli in a representative community sample of adults. J Psychiatr Res 2024; 176:265-275. [PMID: 38901391 DOI: 10.1016/j.jpsychires.2024.06.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Revised: 06/05/2024] [Accepted: 06/13/2024] [Indexed: 06/22/2024]
Abstract
To support investigation of the etiology and psychophysiology of medical traumatic stress, we developed a standardized set of emotionally-salient medical images, called the 'MEDical Image Collection' (MEDIC), for use in neuroimaging or psychological research. This study aimed to establish internal consistency, test re-test reliability, and congruent validity of the image set. A representative sample of 300 adults in the United States were recruited via research recruitment platform, Prolific. Participants rated 124 images depicting medical stimuli on one of two dimensions: emotional arousal (i.e., how strongly an evoked emotion is felt) or affective valence (i.e., how positive or negative the evoked emotion is). Sociodemographic and health-related characteristics, including experiences during the COVID-19 pandemic, were also assessed. To assess test re-test reliability, a subset (n = 200) rated the images on the same dimension a second time, 3 months later. The MEDIC image set was found to: (a) elicit a range of emotional arousal and valence ratings, (b) have excellent inter-rater reliability, (c) moderate test-retest reliability, and (d) good face validity. Results indicate the new MEDIC 124-image set is a reliable and valid instrument, enabling researchers to provide context-specific and emotionally-salient stimuli to individuals when studying affective responses in relation to health and medicine.
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Affiliation(s)
- Katelyn Phillips
- School of Clinical Medicine, Discipline of Paediatrics & Child Health, UNSW Medicine and Health, University of New South Wales (UNSW Sydney). UNSW Sydney, High St, Kensington, NSW, 2052, Australia
| | - Bridget L Callaghan
- Department of Psychology, University of California Los Angeles, 1285 Psychology Building Box, Los Angeles, CA, 951563, USA
| | - Annabel Webb
- Cerebral Palsy Alliance Research Institute, Discipline of Child and Adolescent Health, Faculty of Health and Medicine, The University of Sydney, Sydney, 88 Mallett St, Camperdown, NSW, 2050, Australia
| | - Janice Kan
- School of Psychological Sciences, College of Health and Medicine, University of Tasmania, Private Bag 30, Hobart, TAS, 7001, Australia
| | - Chee Y Ooi
- School of Clinical Medicine, Discipline of Paediatrics & Child Health, UNSW Medicine and Health, University of New South Wales (UNSW Sydney). UNSW Sydney, High St, Kensington, NSW, 2052, Australia; Department of Gastroenterology, Sydney Children's Hospital, Randwick, Australia; Sydney Children's Hospital, High St, Randwick, NSW, 2031, Australia
| | - Nadine A Kasparian
- Heart and Mind Wellbeing Center, Heart Institute and the Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center and Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
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5
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Doménech-García V, Pecos-Martín D, Blasco-Abadía J, Bellosta-López P, López-Royo MP. Placebo and nocebo effects of percutaneous needle electrolysis and dry-needling: an intra and inter-treatment sessions analysis of a three-arm randomized double-blinded controlled trial in patients with patellar tendinopathy. Front Med (Lausanne) 2024; 11:1381515. [PMID: 38903823 PMCID: PMC11187289 DOI: 10.3389/fmed.2024.1381515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Accepted: 05/23/2024] [Indexed: 06/22/2024] Open
Abstract
Objective This study aimed to investigate the influence of potential placebo and nocebo effects on pain perception of percutaneous needle electrolysis (PNE) in individuals with patellar tendinopathy. Methods In this secondary analysis of a three-arm randomized double-blinded controlled trial, intra and inter-session pain perception data from 48 sporting participants with patellar tendinopathy between 18 and 45 years were investigated. Participants were divided into 3 parallel groups: "no-sham group" [PNE intervention], "single-sham group" [sham PNE by using dry needling], and "double-sham group" [sham PNE by using sham needles]. Every group received 4 sessions of the needling therapies targeting the patellar tendon over 8 weeks and was instructed to perform a unilateral eccentric exercise program of the quadriceps muscle on the affected side. Clinical and needle-related pain was assessed before, during, and after each treatment session using a visual analog scale. Results No differences were found between groups intra- or inter-session in terms of pain reduction (P = 0.424) despite clinical pain decreased in all groups since the first treatment session (P < 0.001). Furthermore, although the double-sham group showed a lower percentage of participants reporting needle-related pain during needle intervention (P = 0.005), the needle-related pain intensity after needle intervention was similar between groups (P = 0.682). Moreover, there were no group differences for the duration of pain sensation after any needle intervention (P = 0.184), extending in many cases beyond 24 h. Conclusion Needling therapies for individuals with patellar tendinopathy are prone to elicit placebo effects regarding clinical pain and nocebo effects regarding needling-related pain. Clinicians and physical therapists treating musculoskeletal pain conditions should consider the added value and potential mechanisms of action before routinely using needle techniques.
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Affiliation(s)
| | - Daniel Pecos-Martín
- Departamento de Enfermería y Fisioterapia, Universidad de Alcalá, Alcalá de Henares, Spain
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Conway AE, Golden DBK, Brough HA, Santos AF, Shaker MS. Serologic measurements for peanut allergy: Predicting clinical severity is complex. Ann Allergy Asthma Immunol 2024; 132:686-693. [PMID: 38272114 DOI: 10.1016/j.anai.2024.01.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 01/14/2024] [Accepted: 01/15/2024] [Indexed: 01/27/2024]
Abstract
Allergist-immunologists use serologic peanut allergy testing to maximize test sensitivity and specificity while minimizing cost and inconvenience. Recent advances toward this goal include a better understanding of specific IgE (sIgE) and component testing, epitope-sIgE assays, and basophil activation testing. Predicting reaction severity with serologic testing is challenged by a range of co-factors that influence reaction severity, such as the amount and form of any allergen consumed and comorbid disease. In 2020, the Allergy Immunology Joint Task Force on Practice Parameters recommended Ara h 2-sIgE as the most cost-effective diagnostic test for peanut allergy because of its superior performance, when compared with skin prick testing and serum IgE. Basophil activation testing, a functional test of allergic response not evaluated in the Joint Task Force on Practice Parameters guideline, is a promising option for both allergy diagnosis and prognosis. Similarly, epitope-sIgE testing may improve prediction of reaction thresholds, but further validation is needed. Despite advances in food allergy testing, many of these tools remain limited by cost, accessibility, and feasibility. In addition, there is a need for further research on how atopic dermatitis may be modifying serologic food allergy severity assessments. Given these limitations, allergy test selection requires a shared decision-making approach so that a patient's values and preferences regarding financial impact, inconvenience, and psychological effects are considered in the context of clinician expertise on the timing and use of optimized testing.
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Affiliation(s)
| | - David B K Golden
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Helen A Brough
- Department of Women and Children's Health (Pediatric Allergy), School of Life Courses Sciences, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom; Children's Allergy Service and Children's Allergy Service, Evelina Children's Hospital, Guy's and St. Thomas's NHS Foundation Trust, London, United Kingdom
| | - Alexandra F Santos
- Department of Women and Children's Health (Pediatric Allergy), School of Life Courses Sciences, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom; Children's Allergy Service and Children's Allergy Service, Evelina Children's Hospital, Guy's and St. Thomas's NHS Foundation Trust, London, United Kingdom; Peter Gorer Department of Immunobiology, School of Immunology and Microbial Sciences, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
| | - Marcus S Shaker
- Dartmouth Geisel School of Medicine, Hanover, New Hampshire; Section of Allergy and Immunology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.
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Sherwood SJ, Tak C, Bhakta ZN, Packer K, Jacobs H, Liou TG, Young DC. A comparison of aminoglycoside antibiotic serum concentrations collected by peripheral veins and peripherally inserted central catheters in adults with cystic fibrosis. Pediatr Pulmonol 2024; 59:1740-1746. [PMID: 38501330 DOI: 10.1002/ppul.26986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 02/27/2024] [Accepted: 03/13/2024] [Indexed: 03/20/2024]
Abstract
BACKGROUND People with cystic fibrosis (PwCF) are frequently hospitalized for treatment of pulmonary exacerbation. The Cystic Fibrosis Foundation Pulmonary Guidelines support the use of intravenous aminoglycosides with therapeutic drug monitoring for the treatment of pulmonary exacerbation due to Pseudomonas aeruginosa. Serum intravenous tobramycin concentrations are commonly collected by peripheral venipuncture (PV). Discomfort associated with collection of samples by PV prompts collection via PICC, but the accuracy of intravenous tobramycin serum levels collected by PICC has not been documented in adult PwCF. The primary study objective was to evaluate the difference between intravenous tobramycin serum levels collected by PV and PICC in adult PwCF. METHODS The authors conducted a prospective case-control study of adult PwCF admitted to University of Utah Health for a pulmonary exacerbation receiving tobramycin by a single lumen PICC. The authors compared tobramycin peak and random serum levels collected by PV and PICC using a detailed flush and waste protocol. RESULTS The authors analyzed a total of 19 patients with peripheral and PICC samples. The mean tobramycin peak collected by PV (27.2 mcg/mL) was similar to the mean peak collected by PICC (26.9 mcg/mL) (paired samples Wilcoxon signed-rank test, p = .94). The correlation coefficient was 0.88 (95% CI = 0.85-0.91, p < .001). CONCLUSION Tobramycin serum samples collected by PICC appear to be similar in value to PV collections. Collecting aminoglycoside levels by PICC rather than PV may reduce patient discomfort and improve quality of life. Additional multicenter studies are needed to confirm these results.
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Affiliation(s)
- Sabrina J Sherwood
- The Cystic Fibrosis Center of Idaho, St. Luke's Health System, Boise, Idaho, USA
| | - Casey Tak
- Department of Pharmacotherapy, University of Utah College of Pharmacy, Salt Lake City, UT, USA
- Department of Pharmacotherapy, The University of North Carolina at Chapel Hill, Asheville, North Carolina, USA
| | - Zubin N Bhakta
- The Adult Cystic Fibrosis Center, University of Utah, Salt Lake City, Utah, USA
| | - Kristyn Packer
- Department of Pharmacotherapy, University of Utah College of Pharmacy, Salt Lake City, UT, USA
- Division of Respiratory, Critical Care and Occupational Pulmonary Medicine, Department of Internal Medicine, School of Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Hollyann Jacobs
- The Adult Cystic Fibrosis Center, University of Utah, Salt Lake City, Utah, USA
| | - Theodore G Liou
- The Adult Cystic Fibrosis Center, University of Utah, Salt Lake City, Utah, USA
- Division of Respiratory, Critical Care and Occupational Pulmonary Medicine, Department of Internal Medicine, School of Medicine, University of Utah, Salt Lake City, Utah, USA
| | - David C Young
- Department of Pharmacotherapy, University of Utah College of Pharmacy, Salt Lake City, UT, USA
- The Adult Cystic Fibrosis Center, University of Utah, Salt Lake City, Utah, USA
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Hahn M, Frantz AM, Eckert A, Reif A. [Barriers for Implementation of PGx Testing in Psychiatric Hospitals in Germany: Results of the FACT-PGx Study]. FORTSCHRITTE DER NEUROLOGIE-PSYCHIATRIE 2024; 92:221-229. [PMID: 37130546 DOI: 10.1055/a-2060-0694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
OBJECTIVE The FACT-PGx study was conducted to analyze barriers to implementation of pharmacogenetic testing in psychiatric hospitals in Germany and to propose solutions for its faster and easier implementation in all hospitals. METHODS 104 patients (50% female) were genotyped and participated in the study. 67 completed a survey. To analyze the correlation between continuous data (age) of the survey, the wilcoxon rank test and for categorial data (education level, history of treatment and episodes), t-test was used. RESULTS No patient declined to be genotyped. 99% believed that genotyping could help to shorten their hospital stay. Patients >40 years of age and with higher educational levels were willing to pay for the PGx (p=0.009). On average, patients were willing to pay 117.42€ +/-140.49€ and to wait 15.83+/- 8.92 days for the results. Processes differed significantly between routine laboratory screening and PGx testing which could be a barrier for implementation. CONCLUSION Patients are not barriers to but enablers of an implementation of PGx. New process flows can be barriers, but can be overcome by optimization.
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Affiliation(s)
- Martina Hahn
- Klinik für Psychiatrie, Psychosomatik und Psychotherapie, Universitätsklinikum Frankfurt, Frankfurt am Main, Germany
- Klinik für psychische Gesundheit, varisano Klinikum Frankfurt Hoechst, Frankfurt, Germany
| | - Amelie Merle Frantz
- Klinik für Psychiatrie, Psychosomatik und Psychotherapie, Universitätsklinikum Frankfurt, Frankfurt am Main, Germany
| | - Andreas Eckert
- Klinik für Psychiatrie, Psychosomatik und Psychotherapie, Universitätsklinikum Frankfurt, Frankfurt am Main, Germany
| | - Andreas Reif
- Klinik für Psychiatrie, Psychosomatik und Psychotherapie, Universitätsklinikum Frankfurt, Frankfurt am Main, Germany
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Shah S, Patel P, Bagwe P, Kale A, Ferguson A, Adediran E, Arte T, Singh R, Uddin MN, D’Souza MJ. Intranasal Immunization for Zika in a Pre-Clinical Model. Viruses 2024; 16:865. [PMID: 38932158 PMCID: PMC11209107 DOI: 10.3390/v16060865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Revised: 05/27/2024] [Accepted: 05/27/2024] [Indexed: 06/28/2024] Open
Abstract
Humans continue to be at risk from the Zika virus. Although there have been significant research advancements regarding Zika, the absence of a vaccine or approved treatment poses further challenges for healthcare providers. In this study, we developed a microparticulate Zika vaccine using an inactivated whole Zika virus as the antigen that can be administered pain-free via intranasal (IN) immunization. These microparticles (MP) were formulated using a double emulsion method developed by our lab. We explored a prime dose and two-booster-dose vaccination strategy using MPL-A® and Alhydrogel® as adjuvants to further stimulate the immune response. MPL-A® induces a Th1-mediated immune response and Alhydrogel® (alum) induces a Th2-mediated immune response. There was a high recovery yield of MPs, less than 5 µm in size, and particle charge of -19.42 ± 0.66 mV. IN immunization of Zika MP vaccine and the adjuvanted Zika MP vaccine showed a robust humoral response as indicated by several antibodies (IgA, IgM, and IgG) and several IgG subtypes (IgG1, IgG2a, and IgG3). Vaccine MP elicited a balance Th1- and Th2-mediated immune response. Immune organs, such as the spleen and lymph nodes, exhibited a significant increase in CD4+ helper and CD8+ cytotoxic T-cell cellular response in both vaccine groups. Zika MP vaccine and adjuvanted Zika MP vaccine displayed a robust memory response (CD27 and CD45R) in the spleen and lymph nodes. Adjuvanted vaccine-induced higher Zika-specific intracellular cytokines than the unadjuvanted vaccine. Our results suggest that more than one dose or multiple doses may be necessary to achieve necessary immunological responses. Compared to unvaccinated mice, the Zika vaccine MP and adjuvanted MP vaccine when administered via intranasal route demonstrated robust humoral, cellular, and memory responses. In this pre-clinical study, we established a pain-free microparticulate Zika vaccine that produced a significant immune response when administered intranasally.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Martin J. D’Souza
- Vaccine Nanotechnology Laboratory, Center for Drug Delivery Research, College of Pharmacy, Mercer University, Atlanta, GA 30341, USA
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10
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da Cunha Lima EA, Toledo LV, Correia MDL, de Almeida Pereira D, Caetano RO, Faria TB, de Castro Moura C, Krempser P, Braga LM. Effect of a Non-pharmacological Intervention on Vaccine-related Pain: Randomized Clinical Trial. Pain Manag Nurs 2024:S1524-9042(24)00154-1. [PMID: 38772758 DOI: 10.1016/j.pmn.2024.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 04/03/2024] [Accepted: 04/07/2024] [Indexed: 05/23/2024]
Abstract
BACKGROUND Acute pain during vaccine administration is an expected event; however, some strategies, such as the use of high frequency vibration devices associated with cryotherapy, may minimize it. AIM Evaluate the effect of high frequency vibration associated with cryotherapy on the level of pain related to the administration of influenza vaccine by intramuscular route in adults. METHOD A randomized clinical trial was conducted with 350 adults who received the influenza vaccine. Participants allocated to the intervention group used a high-frequency vibration device associated with cryotherapy during vaccination, and those in the control group administered the vaccine according to the service routine. RESULTS Mean self-reported pain after vaccination of participants who used the device was lower (1.5 ±1.7) when compared to those who did not use it (1.9 ±1.9) (p = .041). There was an association of higher levels of pain after vaccination with participants in the control group (p = .011), females (p = .042), with higher level of pain expected with vaccination (p < .001) and higher level of anxiety before (p < .001) and after vaccination (p = .001). CONCLUSIONS The use of high frequency vibration associated with cryotherapy has been shown to be a viable non-pharmacological intervention for the reduction of pain associated with influenza vaccination in adults.
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Affiliation(s)
| | - Luana Vieira Toledo
- Department of Medicine and Nursing. Federal University of Viçosa, Viçosa, Brazil
| | | | | | | | | | | | - Paula Krempser
- Child Department and Public Health, Federal University of Juiz de Fora, Juiz de Fora, Brazil
| | - Luciene Muniz Braga
- Department of Medicine and Nursing. Federal University of Viçosa, Viçosa, Brazil
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Alwafi H, Naser AY, Alsaleh NA, Asiri JK, Almontashri RM, Alqarni LM, Salawati RS, Alsharif A, Aldhahir AM, Alqarni AA, Hafiz W, Alqahtani JS, Salawati E, Almatrafi MA, Bahlol M. Prevalence, factors associated and management of needle phobia among the general population in Saudi Arabia and Egypt. BMC Psychiatry 2024; 24:363. [PMID: 38745314 PMCID: PMC11094992 DOI: 10.1186/s12888-024-05757-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 04/11/2024] [Indexed: 05/16/2024] Open
Abstract
OBJECTIVE This study aims to assess the prevalence of needle phobia among Saudi and Egyptian adult populations. In addition, underlying causes and strategies that can be utilized to address needle fear were investigated. METHODS A cross-sectional online survey study was conducted in Saudi Arabia and Egypt between 1 May and 30 June 2023. Participants aged 18 years and above and living in Saudi Arabia and Egypt were eligible to complete the survey. Participants were invited to participate in this study through social media platforms (Facebook, X, Snapchat, and Instagram). A convenience sampling technique was used to recruit the study participants. A 21-item questionnaire consisting of four sections including a Likert scale score was used to answer the research objectives. Numeric data were presented as mean ± SD. For categorical variables, percentages were used. Comparison between groups were made by Student's t-test or Mann Whitney test according to data distribution. Chi squared tests for categorical values were conducted. A binary logistic regression analysis was conducted to investigate factors associated with needle phobia. RESULTS A total of 4065 participants were involved in this study (Saudi Arabia: 2628 and Egypt: 1437). Around one-third of the study participants (36.5%) confirmed that they have needle phobia. Most of the study participants (81.1%) reported that they have had needle phobia since they were under 18 years of age. Pain, general anxiety, and fear of making a mistake during the procedure were the most commonly reported contributors for fear of needles during or before a medical procedure. Around 15.8% of the study participants reported that they have tried to get rid of phobia from needles. Non-surgical alternatives (such as oral medications and patches) and using smaller/thinner needles were the most commonly reported interventions that reduced fear of needles. Binary logistic regression analysis identified that females, those who are aged (41-50 years), widowed, those with bachelor's degrees and higher education, and those unemployed were more likely to have needle phobia compared to others. CONCLUSION Our study highlighted the high prevalence of needle fear within an adult population in Egypt and Saudi Arabia. Females, those who are aged (41-50 years), those widowed, those with higher education degrees, those unemployed, those working in the health sector and people with low income were more likely to have needle phobia compared to others.
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Affiliation(s)
- Hassan Alwafi
- Department of Pharmacology and Toxicology, Faculty of Medicine, Umm Al-Qura University, 8WMR+23J Mecca, Al Abdeyah, Alawali, Mecca, Saudi Arabia.
| | - Abdallah Y Naser
- Department of Applied Pharmaceutical Sciences and Clinical Pharmacy, Faculty of Pharmacy, Isra University, Amman, Jordan.
| | - Nada A Alsaleh
- Department of Pharmacy Practice, Faculty of Pharmacy, Princess Nourah bint Abdulrahman University, Riyadh, Kingdom of Saudi Arabia
| | | | | | | | | | - Alaa Alsharif
- Department of Pharmacy Practice, Faculty of Pharmacy, Princess Nourah bint Abdulrahman University, Riyadh, Kingdom of Saudi Arabia
| | - Abdulelah M Aldhahir
- Respiratory Therapy Department, Faculty of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia
| | - Abdullah A Alqarni
- Department of Respiratory Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Waleed Hafiz
- Department of Internal Medicine, Faculty of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Jaber S Alqahtani
- Department of Respiratory Care, Prince Sultan Military College of Health Sciences, Dammam, Saudi Arabia
| | - Emad Salawati
- Department of Family Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Mohammed A Almatrafi
- Department of Pediatrics, Faculty of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Mohamed Bahlol
- Speciality of Pharmaceutical Management and Economics, Department of Pharmacy Practice and Clinical Pharmacy, Faculty of Pharmacy, Egyptian Russian University, Cairo, Egypt
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Zavlanou C, Savary V, Mermet S, Sander D, Corradi-Dell’Acqua C, Rudrauf D, Tisserand Y, Sahyoun C. Virtual reality vs. tablet for procedural comfort using an identical game in children undergoing venipuncture: a randomized clinical trial. Front Pediatr 2024; 12:1378459. [PMID: 38803637 PMCID: PMC11128582 DOI: 10.3389/fped.2024.1378459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 04/30/2024] [Indexed: 05/29/2024] Open
Abstract
Introduction Recent research has explored the effectiveness of interactive virtual experiences in managing pain and anxiety in children during routine medical procedures, compared to conventional care methods. However, the influence of the specific technology used as an interface, 3-dimensions (D) immersive virtual reality (VR) vs. 2D touch screens, during pediatric venipuncture, remains unexamined. This study aimed to determine if immersive VR is more effective than a tablet in reducing pain and anxiety during short procedures. Methods An interactive game was designed by clinicians and psychologists, expert in pain theory, hypnosis, and procedural pain and anxiety relief, and was tailored for both VR and tablet use. Fifty patients were randomly assigned to either the Tablet or VR group. The primary outcome measures were pain and anxiety levels during the procedure. Secondary outcome measures included the need for physical restraint, duration of the procedure, enjoyment levels, and satisfaction ratings from both parents and nurses. Results Participants, in both groups, had low levels of pain and anxiety. Physical restraint was infrequently used, procedures were brief, and high satisfaction levels were reported by patients, parents, and nurses. Discussion This study suggests that the type of technology used as a support for the game has a minimal effect on the child's experience, with both groups reporting low pain and anxiety levels, minimal physical restraint, and high enjoyment. Despite immersive VR's technological advancements, this study underscores the value of traditional tablets with well-designed interactive games in enhancing children's wellbeing during medical procedures. Clinical Trial Registration [ClinicalTrials.gov], identifier [NCT05065307].
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Affiliation(s)
- Christina Zavlanou
- Swiss Center for Affective Sciences, University of Geneva, Geneva, Switzerland
| | - Valentine Savary
- Swiss Center for Affective Sciences, University of Geneva, Geneva, Switzerland
| | - Stephanie Mermet
- Division of Pediatric Emergency Medicine, Children’s Hospital of Geneva, Geneva University Hospitals, Geneva, Switzerland
| | - David Sander
- Swiss Center for Affective Sciences, University of Geneva, Geneva, Switzerland
| | | | - David Rudrauf
- Swiss Center for Affective Sciences, University of Geneva, Geneva, Switzerland
| | - Yvain Tisserand
- Swiss Center for Affective Sciences, University of Geneva, Geneva, Switzerland
| | - Cyril Sahyoun
- Division of Pediatric Emergency Medicine, Children’s Hospital of Geneva, Geneva University Hospitals, Geneva, Switzerland
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Hoebeke P, Hittelman A, Jenkins B, Geib T, Titanji W, Bogaert G. Results of a study examining the use of onabotulinumtoxinA in pediatric patients with overactive bladder. J Pediatr Urol 2024:S1477-5131(24)00256-0. [PMID: 38906707 DOI: 10.1016/j.jpurol.2024.04.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 04/05/2024] [Accepted: 04/30/2024] [Indexed: 06/23/2024]
Abstract
BACKGROUND There is a lack of approved treatments for pediatric patients with overactive bladder (OAB) with inadequate response to anticholinergic therapy. OnabotulinumtoxinA 100U is approved to treat OAB in adults based on data from randomized, pivotal trials. OBJECTIVE To investigate the efficacy and safety of onabotulinumtoxinA treatment of OAB in children aged 12-17 years who were not adequately managed with anticholinergics. STUDY DESIGN In this multinational, multicenter, randomized, double-blind, parallel-group, multiple-dose study (NCT02097121), pediatric patients with OAB were randomized 1:1:1 to receive onabotulinumtoxinA 25U, 50U, or 100U (≤6 U/kg). Patients could request retreatment starting at week 12. The primary endpoint was change from baseline to week 12 after treatment 1 in daily frequency of daytime urinary incontinence (UI) episodes. Safety assessments evaluated treatment-emergent adverse events (TEAEs). RESULTS Of 68 screened patients, 55 received ≥1 treatment. Mean age was 14 years; 85.5% of patients were female. At week 12 after treatment 1, least squares mean change from baseline in daily frequency of daytime UI episodes showed a numerically greater reduction in the 100U arm (-2.4) versus the 25U arm (-1.4; P = 0.38), with a significant within-group change from baseline in the 100U arm (P = 0.0027). Achievement of treatment response was significantly greater with onabotulinumtoxinA 100U vs 25U (Figure). Median time to request retreatment was ≥16 weeks in all groups. The most frequently reported TEAEs were nasopharyngitis (10.9%) and urinary tract infection (UTI; 10.9%). Urinary retention was observed in 1 patient during treatment cycle 2; there were no serious TEAEs of UTI or urinary retention. Throughout 2 additional treatment cycles continued efficacy for the 100U dose arm was observed along with a consistent safety profile. DISCUSSION Change in daily frequency of UI episodes at week 12 in treatment cycle 1 was not significantly different between arms. However, ≥50% response rate was significantly higher with onabotulinumtoxinA 100U versus 25U. Enrollment challenges that lowered the sample size could have reduced statistical power. Also, the lack of a placebo arm and the observed benefit with the 25U comparator limited interpretation. CONCLUSIONS OnabotulinumtoxinA injections were well tolerated in children with OAB at all doses studied. Although the primary endpoint was not met, the significantly greater treatment response rate observed with onabotulinumtoxinA 100U versus 25U suggests additional benefit of the higher dose, without additional safety concerns.
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Affiliation(s)
- Piet Hoebeke
- Ghent University Hospital, Corneel Heymanslaan 10, 9000 Gent, Belgium.
| | - Adam Hittelman
- Yale School of Medicine, 330 Cedar Street, #208058, New Haven, CT, USA.
| | - Brenda Jenkins
- Allergan, an AbbVie Company, 2525 Dupont Drive, Irvine, CA, USA.
| | - Till Geib
- Allergan, an AbbVie Company, 2525 Dupont Drive, Irvine, CA, USA.
| | - Wilson Titanji
- Allergan, an AbbVie Company, 2525 Dupont Drive, Irvine, CA, USA.
| | - Guy Bogaert
- Universitair Ziekenhuis Leuven, Herestraat 49, 3000 Leuven, Belgium.
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14
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G Popova P, Chen SP, Liao S, Sadarangani M, Blakney AK. Clinical perspective on topical vaccination strategies. Adv Drug Deliv Rev 2024; 208:115292. [PMID: 38522725 DOI: 10.1016/j.addr.2024.115292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 03/01/2024] [Accepted: 03/19/2024] [Indexed: 03/26/2024]
Abstract
Vaccination is one of the most successful measures in modern medicine to combat diseases, especially infectious diseases, and saves millions of lives every year. Vaccine design and development remains critical and involves many aspects, including the choice of platform, antigen, adjuvant, and route of administration. Topical vaccination, defined herein as the introduction of a vaccine to any of the three layers of the human skin, has attracted interest in recent years as an alternative vaccination approach to the conventional intramuscular administration because of its potential to be needle-free and induce a superior immune response against pathogens. In this review, we describe recent progress in developing topical vaccines, highlight progress in the development of delivery technologies for topical vaccines, discuss potential factors that might impact the topical vaccine efficacy, and provide an overview of the current clinical landscape of topical vaccines.
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Affiliation(s)
- Petya G Popova
- School of Biomedical Engineering, University of British Columbia, 2222 Health Sciences Mall, Vancouver, British Columbia V6T 2B9, Canada; Michael Smith Laboratories, University of British Columbia, 2185 East Mall, Vancouver, British Columbia V6T 1Z4, Canada
| | - Sunny P Chen
- School of Biomedical Engineering, University of British Columbia, 2222 Health Sciences Mall, Vancouver, British Columbia V6T 2B9, Canada; Michael Smith Laboratories, University of British Columbia, 2185 East Mall, Vancouver, British Columbia V6T 1Z4, Canada
| | - Suiyang Liao
- School of Biomedical Engineering, University of British Columbia, 2222 Health Sciences Mall, Vancouver, British Columbia V6T 2B9, Canada; Michael Smith Laboratories, University of British Columbia, 2185 East Mall, Vancouver, British Columbia V6T 1Z4, Canada; Life Science Institute, University of British Columbia, 2350 Health Sciences Mall, Vancouver, British Columbia V6T 1Z3, Canada
| | - Manish Sadarangani
- Vaccine Evaluation Center, BC Children's Hospital Research Institute, 950 West 28th Ave, Vancouver, British Columbia V5Z 4H4, Canada; Department of Pediatrics, University of British Columbia, 4480 Oak St, Vancouver, BC V6H 0B3, Canada
| | - Anna K Blakney
- School of Biomedical Engineering, University of British Columbia, 2222 Health Sciences Mall, Vancouver, British Columbia V6T 2B9, Canada; Michael Smith Laboratories, University of British Columbia, 2185 East Mall, Vancouver, British Columbia V6T 1Z4, Canada.
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15
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Zoratto N, Klein‐Cerrejon D, Gao D, Inchiparambil T, Sachs D, Luo Z, Leroux J. A Bioinspired and Cost-Effective Device for Minimally Invasive Blood Sampling. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2024; 11:e2308809. [PMID: 38450888 PMCID: PMC11095219 DOI: 10.1002/advs.202308809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 02/02/2024] [Indexed: 03/08/2024]
Abstract
Conventional venipuncture is invasive and challenging in low and middle-income countries. Conversely, point-of-care devices paired with fingersticks, although less invasive, suffer from high variability and low blood volume collection. Recently approved microsampling devices address some of these issues but remain cost-prohibitive for resource-limited settings. In this work, a cost-effective microsampling device is described for the collection of liquid blood with minimal invasiveness and sufficient volume retrieval for laboratory analyses or immediate point-of-care testing. Inspired by the anatomy of sanguivorous leeches, the single-use device features a storage compartment for blood collection and a microneedle patch hidden within a suction cup. Finite Element Method simulations, corroborated by mechanical analyses, guide the material selection for device fabrication and design optimization. In piglets, the device successfully collects ≈195 µL of blood with minimal invasiveness. Additionally, a tailor-made lid and adapter enable safe fluid transportation and integration with commercially available point-of-care systems for on-site analyses, respectively. Taken together, the proposed platform holds significant promise for enhancing healthcare in the pediatric population by improving patient compliance and reducing the risk of needlestick injuries through concealed microneedles. Most importantly, given its cost-effective fabrication, the open-source microsampling device may have a meaningful impact in resource-limited healthcare settings.
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Affiliation(s)
- Nicole Zoratto
- Institute of Pharmaceutical SciencesDepartment of Chemistry and Applied BiosciencesETHZurich8093Switzerland
| | - David Klein‐Cerrejon
- Institute of Pharmaceutical SciencesDepartment of Chemistry and Applied BiosciencesETHZurich8093Switzerland
| | - Daniel Gao
- Institute of Pharmaceutical SciencesDepartment of Chemistry and Applied BiosciencesETHZurich8093Switzerland
| | - Tino Inchiparambil
- Institute of Pharmaceutical SciencesDepartment of Chemistry and Applied BiosciencesETHZurich8093Switzerland
| | - David Sachs
- Institute for Mechanical SystemsDepartment of Mechanical and Process EngineeringETHZurich8093Switzerland
| | - Zhi Luo
- Department of Biomedical EngineeringSouthern University of Science and TechnologyShenzhenGuangdong518055P.R. China
| | - Jean‐Christophe Leroux
- Institute of Pharmaceutical SciencesDepartment of Chemistry and Applied BiosciencesETHZurich8093Switzerland
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16
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Chidley E, Burns-Nader S. Exploring young adults' fears related to healthcare and dental procedures. J Family Med Prim Care 2024; 13:1830-1836. [PMID: 38948590 PMCID: PMC11213395 DOI: 10.4103/jfmpc.jfmpc_961_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 12/12/2023] [Accepted: 12/17/2023] [Indexed: 07/02/2024] Open
Abstract
Background and Purpose Fear and anxiety related to dental and healthcare procedures are common among young adults and can negatively impact dental and healthcare consumership, resulting in poor health outcomes. Purpose This cross-sectional study aimed to examine young adults' experiences of fear related to dental and healthcare procedures and the potential relationships between the two forms of fear experiences and demographic factors. Methods Young adults (252) were recruited from a large public university and completed a survey about their dental and healthcare fear/anxiety as well as their confidence in healthcare professionals. Descriptive and correlational analyses were completed to describe the experiences of young adults and the relationships between variables. Results Ten types of fear/anxiety were identified related to healthcare procedures, with the most common being needles and pain. Nine fears/anxieties were identified for dental visits, of which pain and sensory experiences other than pain were most common. Female participants were significantly more likely to report fear/anxiety related to dental procedures, and there was a statistically significant relationship between fear/anxiety related to healthcare procedures and that related to dental procedures. There was also a significant negative relationship found between confidence in healthcare providers and fear/anxiety related to healthcare procedures. Conclusions Young adults experience fear/anxiety related to healthcare and dentist visits, and this fear/anxiety can impact their confidence in healthcare providers, such as primary physicians. The findings of the current study suggest primary care providers should be aware of potential fears/anxieties and offer patients appropriate supports.
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Affiliation(s)
- Ellie Chidley
- Department of Human Development and Family Studies, University of Alabama, Tuscaloosa, AL, United States
| | - Sherwood Burns-Nader
- Department of Human Development and Family Studies, University of Alabama, Tuscaloosa, AL, United States
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17
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Kammerer E, Elliott SA, Hartling L, Basi C, Dennett L, Khangura JK, Scott SD, Candelaria P, Ruzycki S, Ali S. Pain experiences of marginalized children in the emergency department: A scoping review protocol. PLoS One 2024; 19:e0296518. [PMID: 38635744 PMCID: PMC11025926 DOI: 10.1371/journal.pone.0296518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 12/14/2023] [Indexed: 04/20/2024] Open
Abstract
INTRODUCTION Pain affects all children, and in hospitals across North America, this pain is often undertreated. Children who visit the emergency department (ED) experience similar undertreatment, and they will often experience a painful procedure as part of their diagnostic journey. Further, children and their caregivers who experience social injustices through marginalization are more likely to experience healthcare disparities in their pain management. Still, most of our knowledge about children's pain management comes from research focused on well-educated, white children and caregivers from a middle- or upper-class background. The aim of this scoping review is to identify, map, and describe existing research on (a) how aspects of marginalization are documented in randomized controlled trials related to children's pain and (b) to understand the pain treatment and experiences of marginalized children and their caregivers in the ED setting. METHODS AND ANALYSIS The review will follow Joanna Briggs Institute methodology for scoping reviews using the Participant, Concept, Context (PCC) framework and key terms related to children, youth, pain, ED, and aspects of marginalization. We will search Medline, Embase, PsychInfo, CINAHL, Web of Science, Cochrane Library Trials, iPortal, and Native Health Database for articles published in the last 10 years to identify records that meet our inclusion criteria. We will screen articles in a two-step process using two reviewers during the abstract and full-text screening stages. Data will be extracted using Covidence for data management and we will use a narrative approach to synthesize the data. ETHICS AND DISSEMINATION Ethical approval is not required for this review. Findings will be disseminated in academic manuscripts, at academic conferences, and with partners and knowledge users including funders of pain research and healthcare professionals. Results of this scoping review will inform subsequent quantitative and qualitative studies regarding pain experiences and treatment of marginalized children in the ED.
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Affiliation(s)
- Elise Kammerer
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Sarah A. Elliott
- Alberta Research Centre for Health Evidence, Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
- Department of Pediatrics, Cochrane Child Health, University of Alberta, Edmonton, AB, Canada
| | - Lisa Hartling
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
- Alberta Research Centre for Health Evidence, Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
- Department of Pediatrics, Cochrane Child Health, University of Alberta, Edmonton, AB, Canada
- Women and Children’s Health Research Institute, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Calveen Basi
- Departments of Chemistry and Psychology, Faculty of Science, University of Alberta, Edmonton, AB, Canada
| | - Liz Dennett
- Geoffrey and Robyn Sperber Health Sciences Library, University of Alberta, Edmonton, AB, Canada
| | - Jaspreet K. Khangura
- Department of Emergency Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | | | - Patricia Candelaria
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Shannon Ruzycki
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Samina Ali
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
- Women and Children’s Health Research Institute, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
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18
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Lin GC, Friedl HP, Grabner S, Gerhartl A, Neuhaus W. Transport of Non-Steroidal Anti-Inflammatory Drugs across an Oral Mucosa Epithelium In Vitro Model. Pharmaceutics 2024; 16:543. [PMID: 38675204 PMCID: PMC11054638 DOI: 10.3390/pharmaceutics16040543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 04/08/2024] [Accepted: 04/10/2024] [Indexed: 04/28/2024] Open
Abstract
Non-steroidal anti-inflammatory drugs (NSAIDs) are one of the most prescribed drugs to treat pain or fever. However, oral administration of NSAIDs is frequently associated with adverse effects due to their inhibitory effect on the constitutively expressed cyclooxygenase enzyme 1 (COX-1) in, for instance, the gastrointestinal tract. A systemic delivery, such as a buccal delivery, of NSAIDs would be beneficial and additionally has the advantage of a non-invasive administration route, especially favourable for children or the elderly. To investigate the transport of NSAIDs across the buccal mucosa and determine their potential for buccal therapeutic usage, celecoxib, diclofenac, ibuprofen and piroxicam were tested using an established oral mucosa Transwell® model based on human cell line TR146. Carboxyfluorescein and diazepam were applied as internal paracellular and transcellular marker molecule, respectively. Calculated permeability coefficients revealed a transport ranking of ibuprofen > piroxicam > diclofenac > celecoxib. Transporter protein inhibitor verapamil increased the permeability for ibuprofen, piroxicam and celecoxib, whereas probenecid increased the permeability for all tested NSAIDs. Furthermore, influence of local inflammation of the buccal mucosa on the transport of NSAIDs was mimicked by treating cells with a cytokine mixture of TNF-α, IL-1ß and IFN-γ followed by transport studies with ibuprofen (+ probenecid). Cellular response to pro-inflammatory stimuli was confirmed by upregulation of cytokine targets at the mRNA level, increased secreted cytokine levels and a significant decrease in the paracellular barrier. Permeability of ibuprofen was increased across cell layers treated with cytokines, while addition of probenecid increased permeability of ibuprofen in controls, but not across cell layers treated with cytokines. In summary, the suitability of the in vitro oral mucosa model to measure NSAID transport rankings was demonstrated, and the involvement of transporter proteins was confirmed; an inflammation model was established, and increased NSAID transport upon inflammation was measured.
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Affiliation(s)
- Grace C. Lin
- Competence Unit Molecular Diagnostics, AIT Austrian Institute of Technology GmbH, 1210 Vienna, Austria (A.G.)
| | - Heinz-Peter Friedl
- Competence Unit Molecular Diagnostics, AIT Austrian Institute of Technology GmbH, 1210 Vienna, Austria (A.G.)
| | - Sarah Grabner
- Competence Unit Molecular Diagnostics, AIT Austrian Institute of Technology GmbH, 1210 Vienna, Austria (A.G.)
| | - Anna Gerhartl
- Competence Unit Molecular Diagnostics, AIT Austrian Institute of Technology GmbH, 1210 Vienna, Austria (A.G.)
| | - Winfried Neuhaus
- Competence Unit Molecular Diagnostics, AIT Austrian Institute of Technology GmbH, 1210 Vienna, Austria (A.G.)
- Department of Medicine, Faculty of Medicine and Dentistry, Danube Private University, 3500 Krems, Austria
- Division of Pharmaceutical Technology and Biopharmaceutics, University of Vienna, 1090 Vienna, Austria
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Cheng Y, Yang J, Han S, Lu Y. Near-Infrared Triggered Biodegradable Microneedle Patch for Controlled Macromolecule Drug Release. Macromol Biosci 2024:e2400105. [PMID: 38591155 DOI: 10.1002/mabi.202400105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 04/05/2024] [Indexed: 04/10/2024]
Abstract
Transdermal drug delivery of macromolecule drugs attracts significant attention due to the advantage of convenience and biocompatibility. However, the practical usage of it is limited by the low delivery efficiency and poor drug absorption. To develop an efficient, safe, and controllable transdermal delivery method, the near-infrared (NIR) triggered calcium sulfate and gelatin biodegradable composite microneedle (MN) patches are developed. The MN patches are fabricated by polydimethylsiloxane (PDMS) molds, and the structure data can be adjusted by changing the molds. Such an MN patch can release both macro and micro molecule drugs. After loading with photothermal converter IR780, which can transfer energy of light to heat, the release of macromolecule drugs in MNs can be controlled by applying NIR irradiation. The control effect can be enhanced by spraying 1-tetradecanol (TD) coating and optimizing the ratio (weight) of gelatin and calcium sulfate to 2:6. Besides, the MN patch can deliver drugs through the skin barrier, and the process can be controlled by NIR. Moreover, the insulin-loaded MN patch exhibits some therapeutic effects on healthy mice. This work suggests that biodegradable MNs can achieve controllable drug delivery and potentially be applied in individual treatment via transdermal ingestion.
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Affiliation(s)
- Yifan Cheng
- Department of Chemical Engineering, Tsinghua University, Beijing, 100084, China
- Key Laboratory of Industrial Biocatalysis, Ministry of Education, Tsinghua University, Beijing, 100084, China
| | - Junzhu Yang
- Department of Chemical Engineering, Tsinghua University, Beijing, 100084, China
- Key Laboratory of Industrial Biocatalysis, Ministry of Education, Tsinghua University, Beijing, 100084, China
| | - Sanyang Han
- Institute of Biopharmaceutical and Health Engineering, Shenzhen International Graduate School, Tsinghua University, Shenzhen, 518055, China
| | - Yuan Lu
- Department of Chemical Engineering, Tsinghua University, Beijing, 100084, China
- Key Laboratory of Industrial Biocatalysis, Ministry of Education, Tsinghua University, Beijing, 100084, China
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20
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Dörfer C, Chmiela K, Arweiler NB, Petersilka GJ, Dommisch H, Heckel R, Kahl M, Kuzmanova D, Purucker P, Springer C. Evaluation of acceptance and preference of topical lidocaine application versus articaine injection anesthesia after nonsurgical periodontal treatment: A randomized clinical trial. J Periodontol 2024. [PMID: 38563593 DOI: 10.1002/jper.23-0466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 11/14/2023] [Accepted: 12/01/2023] [Indexed: 04/04/2024]
Abstract
BACKGROUND To compare acceptance and preference of topical lidocaine gel anesthesia with articaine injection anesthesia in patients with moderate periodontitis undergoing scaling and root debridement. METHODS Ninety-one patients completed this randomized multicenter split-mouth controlled study and underwent two separate periodontal treatment sessions on different days, one with a topical intrapocket lidocaine gel application and the other with an articaine injection anesthesia in a different order depending on randomization. Parameters measured were the patients' preference for topical lidocaine gel anesthesia or injection anesthesia with articaine (primary efficacy criterion), their maximum and average pain, and their intensity of numbness as well as experience of side effects; the probing depth; and the dentists' preference and their evaluations of handling/application, onset and duration of anesthetic effect, and patient compliance. RESULTS After having experienced both alternatives, 58.3% of the patients preferred the topical lidocaine gel instillation into the periodontal pockets. The safety profile of the lidocaine gel differed positively from the safety profile of articaine injection in type and frequency of adverse drug reactions. The dentists' acceptance and preference regarding either anesthetic method studied were balanced. CONCLUSIONS Instillation of lidocaine gel into the periodontal pocket is a preferred alternative to injection anesthesia for most of the patients and an equivalent alternative for dentists in nonsurgical periodontal therapy.
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Affiliation(s)
- Christof Dörfer
- Clinic for Conservative Dentistry and Periodontology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Kathrin Chmiela
- Clinic for Periodontology and Peri-Implant Diseases, Philipps University Marburg, UKGM, Marburg, Germany
| | - Nicole B Arweiler
- Clinic for Periodontology and Peri-Implant Diseases, Philipps University Marburg, UKGM, Marburg, Germany
| | | | - Henrik Dommisch
- Department of Periodontology, Oral Medicine and Surgery, Charité--Universitäty Medicine Berlin, Centrum Zahn-, Mund- und Kieferheilkunde, Berlin, Germany
| | | | - Maren Kahl
- Clinic for Conservative Dentistry and Periodontology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Denica Kuzmanova
- Department of Periodontology, Oral Medicine and Surgery, Charité--Universitäty Medicine Berlin, Centrum Zahn-, Mund- und Kieferheilkunde, Berlin, Germany
| | - Peter Purucker
- Department of Periodontology, Oral Medicine and Surgery, Charité--Universitäty Medicine Berlin, Centrum Zahn-, Mund- und Kieferheilkunde, Berlin, Germany
| | - Claudia Springer
- Clinic for Conservative Dentistry and Periodontology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
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21
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Truong TM, Pathak GN, Singal A, Taranto V, Rao BK. Deucravacitinib: The First FDA-Approved Oral TYK2 Inhibitor for Moderate to Severe Plaque Psoriasis. Ann Pharmacother 2024; 58:416-427. [PMID: 37341177 DOI: 10.1177/10600280231153863] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/22/2023] Open
Abstract
OBJECTIVE The objective of this study was to review the safety and efficacy of deucravacitinib, a tyrosine kinase 2 (TYK2) inhibitor for moderate to severe plaque psoriasis. DATA SOURCES Literature was reviewed from MEDLINE and Clinicaltrials.gov up to December 2022 using the terms "deucravacitinib" and "BMS-986165." STUDY SELECTION Relevant articles in English relating to the pharmacodynamics, pharmacokinetics, efficacy, and safety of deucravacitinib were included. A total of 6 trial results were included. STUDY SELECTION AND DATA EXTRACTION Deucravacitinib showed clinical efficacy across all the phase II and III clinical trials. Excluding the long-term extension study, there were 2248 subjects across all studies, with 63.2% of patients receiving deucravacitinib 6 mg daily. Of these subjects, the average proportion achieving a PASI 75 (a reduction of greater than 75% in the Psoriasis Area and Severity Index) at week 16 was 65.1%. Patients receiving deucravacitinib 6 mg once daily had a higher rate of achieving both PASI 75 response and a Static Physician's Global Assessment (sPGA) score of 0 or 1, compared with oral apremilast 30 mg twice daily. The safety profile of deucravacitinib includes mild adverse events (AEs), most commonly nasopharyngitis, with serious AEs reported ranging from 1.35% to 9.5%. RELEVANCE TO PATIENT CARE AND CLINICAL PRACTICE IN COMPARISON WITH EXISTING MEDICATIONS While many available therapies for moderate to severe plaque psoriasis rely on an injectable dosage form or extensive monitoring, deucravacitinib can potentially reduce patient medication-related burden. This review summarizes the efficacy and safety of oral deucravacitinib for the treatment of severe plaque psoriasis. CONCLUSION Deucravacitinib shows a consistent efficacy and safety profile as the first oral TYK2 inhibitor approved for adult patients with moderate to severe plaque psoriasis who are eligible for systemic therapy or phototherapy treatment.
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Affiliation(s)
- Thu Minh Truong
- Department of Dermatology, Rutgers Robert Wood Johnson Medical School, Somerset, NJ, USA
- School of Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Gaurav N Pathak
- School of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Amit Singal
- School of Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA
| | | | - Babar K Rao
- Department of Dermatology, Rutgers Robert Wood Johnson Medical School, Somerset, NJ, USA
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22
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Grant D, Smith J, Bottoms L. Assessing the role of biomarker feedback in a 12-week community weight management programme among overweight men: A pilot study. PLoS One 2024; 19:e0299636. [PMID: 38547224 PMCID: PMC10977703 DOI: 10.1371/journal.pone.0299636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 02/10/2024] [Indexed: 04/02/2024] Open
Abstract
BACKGROUND The primary objective of this study was to examine the feasibility of recruitment, retention, and delivery of biomarker feedback among men partaking in Shape Up, a physical activity for health programme. Secondarily, it explored the potential effects of biomarker feedback on participants' adherence and motivation levels. METHODS In this two-arm non-randomised pilot study, 46 men (mean±SD age 46.0±8.6 years) participating in the 12-week Shape Up programme were assigned to a control group or biomarker feedback group. Biomarker feedback consisted of 3 blood test panels: at baseline, 12 weeks, and 24 weeks (follow-up), each with a doctor's report. Both groups completed questionnaires (Short Active Lives Survey [SALS], Treatment Self-Regulation Questionnaire [TSRQ], and EQ-5D-5L) to gauge levels of motivation and engagement. The mean difference was calculated between baseline and programme end. Recruitment, retention, and attendance rates were determined. RESULTS Mean recruitment (approach-to-consent), retention, and attendance rates were 96.3%, 92.3%, and 83.7% in the control group, and 85.2%, 86.2%, and 81.5% in the biomarker feedback group, respectively. Of biomarker feedback group participants, 86.4% attended their 12-week blood test and 45.5% attended their follow-up blood test. The mean 12-week differences (95% CI) for the control group and biomarker feedback group were 138.1 (2.7, 273.5) and 467.3 (249.4, 685.2) for active minutes per week, 0.2 (-0.8, 1.2) and 0.4 (0.0, 0.8) for autonomous TSRQ domains, 0.2 (-0.3, 0.8) and 0.8 (0.1, 1.4) for controlled TSRQ domains, and 19 (12.7, 26.5) and 27.2 (19.8, 34.6) for EQ-5D-5L scores, respectively. CONCLUSION Biomarker feedback was well-received by participants and deemed feasible, with high recruitment and retention rates for the duration of the 12-week programme. Biomarker feedback may affect aspects of motivation but did not appear to influence adherence to the programme. Biomarker data may provide additional evidence of programme efficacy. Important design considerations are provided for definitive larger-scale trials.
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Affiliation(s)
- Daniel Grant
- Medichecks, Ranch House, Chapel Lane, Bingham, Nottingham, United Kingdom
| | - Joshua Smith
- Medichecks, Ranch House, Chapel Lane, Bingham, Nottingham, United Kingdom
| | - Lindsay Bottoms
- Centre for Research in Psychology and Sport Sciences, University of Hertfordshire, Hatfield, United Kingdom
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Tsurayya G, Nazhifah CA, Pirwanja MR, Zulfa PO, Tatroman MRR, Fakri F, Iqhrammullah M. Once-Weekly Somapacitan as an Alternative Management of Growth Hormone Deficiency in Prepubertal Children: A Systematic Review and Meta-Analysis of Randomized Controlled Trial. CHILDREN (BASEL, SWITZERLAND) 2024; 11:227. [PMID: 38397339 PMCID: PMC10887308 DOI: 10.3390/children11020227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 01/27/2024] [Accepted: 02/06/2024] [Indexed: 02/25/2024]
Abstract
Growth hormone treatment has effectively restored normal growth in children with growth hormone deficiency (GHD); however, it poses challenges in compliance with a daily growth hormone injection regimen, leading to low adherence and persistence rates. Once-weekly Somapacitan is a potential alternative for treating children with GHD. This study aimed to evaluate the efficacy, safety, and adherence of once-weekly subcutaneous Somapacitan compared to daily growth hormone injection in prepubertal children with GHD. A search for the published records was carried out on 17 October 2023 utilizing the searching feature available on PubMed, Embase, and Scopus. Primary study outcomes included (1) efficacy, measured by height velocity (HV), standard deviation score (SDs), height SDs, insulin-like growth factor-SDs (IGF-I SDs), and bone age vs. chronological age ratio (BA vs. CA); (2) safety, assessed through adverse events and injection site reactions; and (3) adherence, determined by the percentage of the sample completing treatments. Secondary outcomes evaluated disease burden scores, divided into three subgroup domains: emotional well-being, physical functional, and social well-being scores. We retrieved 6 studies that were eligible for the systematic review (417 versus 186 for intervention and control, respectively). Only 2 of the total included studies were eligible for pooled analysis (175 versus 82 for intervention and control, respectively). The efficacy profile of Somapacitan was similar to daily growth hormones, indicated by HV (mean difference (MD = 0.04; p = 0.96), HV SDs (MD = -0.71; p = 0.09), height SDs (MD = 0.11; p = 0.69), IGF-I SDs (MD = 0.06; p = 0.70), and CA vs. BA (MD = 0.67; p = 0.70)), demonstrated similar and non-inferior outcomes. Treatment adherence is 3 times higher in the Somapacitan group as compared to control (OR = 3.02; p = 0.03) with adherence rates reaching 95% and 88% for Somapacitan and Norditropin®, respectively. The disease burden measurement is similar in Somapacitan and daily growth hormones (MD = -0.62; p = 0.83), as indicated by the Growth Hormone Deficiency-Child Impact Measure. In almost all outcomes, the level of confidence is strong. The confidence level in the data is generally strong, but for CA vs. BA and the subgroup of severe adverse events with heterogeneity >50%, the confidence level is moderate. Although the efficacy and safety profiles of Somapacitan were found to be similar to those of daily growth hormones, a reduced frequency of once-weekly Somapacitan injections led to increased adherence. PROSPERO registration: CRD42023473209.
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Affiliation(s)
- Ghina Tsurayya
- Medical Research Unit, School of Medicine, Universitas Syiah Kuala, Banda Aceh 23111, Indonesia; (G.T.); (C.A.N.); (M.R.P.); (P.O.Z.); (M.R.R.T.)
| | - Cut Alifiya Nazhifah
- Medical Research Unit, School of Medicine, Universitas Syiah Kuala, Banda Aceh 23111, Indonesia; (G.T.); (C.A.N.); (M.R.P.); (P.O.Z.); (M.R.R.T.)
| | - Muhammad Rahmat Pirwanja
- Medical Research Unit, School of Medicine, Universitas Syiah Kuala, Banda Aceh 23111, Indonesia; (G.T.); (C.A.N.); (M.R.P.); (P.O.Z.); (M.R.R.T.)
| | - Putri Oktaviani Zulfa
- Medical Research Unit, School of Medicine, Universitas Syiah Kuala, Banda Aceh 23111, Indonesia; (G.T.); (C.A.N.); (M.R.P.); (P.O.Z.); (M.R.R.T.)
| | - Muhammad Raihan Ramadhan Tatroman
- Medical Research Unit, School of Medicine, Universitas Syiah Kuala, Banda Aceh 23111, Indonesia; (G.T.); (C.A.N.); (M.R.P.); (P.O.Z.); (M.R.R.T.)
| | - Fajar Fakri
- Department of Pharmacy, Faculty of Mathematics and Natural Sciences, Universitas Syiah Kuala, Banda Aceh 23111, Indonesia
| | - Muhammad Iqhrammullah
- Postgraduate Program of Public Health, Universitas Muhammadiyah Aceh, Banda Aceh 23123, Indonesia;
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Li W, Wu N, Zhou S, Du W, Xu Z, Liu Z. Factors influencing the use of epidural labor analgesia: a cross-sectional survey analysis. Front Med (Lausanne) 2024; 10:1280342. [PMID: 38384316 PMCID: PMC10880097 DOI: 10.3389/fmed.2023.1280342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 12/14/2023] [Indexed: 02/23/2024] Open
Abstract
Introduction This study aimed to explore the personal and organizational factors influencing the lack of implementation of epidural labor analgesia (ELA). Methods This study was conducted at the Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China. A total of 451 women who underwent vaginal delivery without ELA between 8 October 2021 and 30 March 2022, were included. A questionnaire was used to collect the relevant data. We derived and validated the variable, without ELA, by using binary logistic regression analysis. Results Of the total 451 included, 355 (78.7%) initially preferred ELA, whereas 96 (21.3%) rejected it directly. Five variables were validated (p < 0.05): multiparas, ELA would lead to back pain, experienced ELA in previous delivery, the inner attitude toward labor pain, and blood routine and coagulation function not being tested within 14 days. The sensitivity and specificity of this model were 96.3 and 69.8%, respectively. Conclusion The corresponding training should be provided to the medical staff to identify women at high risk of rejecting ELA during the prenatal examination process using a questionnaire, then provide them with knowledge regarding ELA, so that ELA can benefit more mothers. Additionally, the existing organizational factor should be addressed in order to efficiently provide ELA services to mothers. Clinical trial registration This study was registered at the Chinese Clinical Trial Registry (Chi CTR 2000034625) on July 12, 2020.
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Affiliation(s)
- Wei Li
- Department of Anesthesiology, Shanghai Key Laboratory of Maternal-Fetal Medicine, Shanghai Institute of Maternal-Fetal Medicine and Gynecologic Oncology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Na Wu
- Nursing Department of Shanghai Key Laboratory of Maternal-Fetal Medicine, Shanghai Institute of Maternal-Fetal Medicine, and Gynecologic Oncology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Shuangqiong Zhou
- Department of Anesthesiology, Shanghai Key Laboratory of Maternal-Fetal Medicine, Shanghai Institute of Maternal-Fetal Medicine and Gynecologic Oncology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Weijia Du
- Department of Anesthesiology, Shanghai Key Laboratory of Maternal-Fetal Medicine, Shanghai Institute of Maternal-Fetal Medicine and Gynecologic Oncology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Zhendong Xu
- Department of Anesthesiology, Shanghai Key Laboratory of Maternal-Fetal Medicine, Shanghai Institute of Maternal-Fetal Medicine and Gynecologic Oncology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Zhiqiang Liu
- Department of Anesthesiology, Shanghai Key Laboratory of Maternal-Fetal Medicine, Shanghai Institute of Maternal-Fetal Medicine and Gynecologic Oncology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China
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Jaju KK, Nasim I, Choudhari S, Sandeep A H. Comparative Evaluation of the Anesthetic Efficacy of Needle-Free Anesthesia and Conventional Anesthesia in Patients With Symptomatic Irreversible Pulpitis: A Randomized Clinical Trial. Cureus 2024; 16:e54661. [PMID: 38524054 PMCID: PMC10960589 DOI: 10.7759/cureus.54661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Accepted: 02/21/2024] [Indexed: 03/26/2024] Open
Abstract
Introduction Pain is the primary reason for which most of the patients seek endodontic treatment. Local anesthesia is considered to be the most important step in the procedure to reduce the pain. However, the majority of the patients do not cooperate due to the fear of syringe anesthesia. The aim of this clinical trial was to compare the anesthetic efficacy of needle-free anesthesia and conventional anesthesia in patients with symptomatic irreversible pulpitis undergoing root canal therapy. Materials and methods A total of 54 patients were enrolled in the study, and the treatment was administered by a single operator. The initial assessment of vitality included cold testing, heat testing, and electric pulp testing. Preoperative pain was assessed using the Visual Analog Scale (VAS) before the administration of anesthesia. Local anesthesia was administered according to the group assigned: Group 1 (conventional anesthesia) and Group 2 (needle-free anesthesia). The pain was assessed during the administration of anesthesia. Following the administration of anesthesia, the vitality of the tooth was evaluated using cold testing, heat testing, and electric pulp testing. Subsequently, the tooth was isolated with a rubber dam, and the access cavity was prepared. The pain was assessed during access cavity preparation and during the first file insertion. Working length was determined using an apex locator (Root ZX Mini, J Morita, Saitama, Japan) and was confirmed using intraoral periapical radiographs. Later on, further treatment was carried out. Results A total of 54 participants were included in this clinical trial. There was no significant difference in mean age distribution between the two groups (p=0.852). Considering the frequency distribution of gender, there was no significant difference; however, Group 1 had more female participants (59.3%) compared to Group 2 (33.3%). There was a significant reduction in the mean pain score in Group 2 compared to Group 1 during the delivery of anesthetic agents (p=0.000). Conclusion Needle-free anesthesia proves to be equally effective as the conventional syringe system in patients experiencing symptomatic irreversible pulpitis undergoing root canal treatment. However, it is noteworthy that patients exhibited greater comfort levels with needle-free anesthesia systems specifically during the administration of the anesthetic solution.
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Affiliation(s)
- Krishna Kanth Jaju
- Conservative Dentistry and Endodontics, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences (SIMATS) Saveetha University, Chennai, IND
| | - Iffat Nasim
- Conservative Dentistry and Endodontics, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences (SIMATS) Saveetha University, Chennai, IND
| | - Sahil Choudhari
- Conservative Dentistry and Endodontics, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences (SIMATS) Saveetha University, Chennai, IND
| | - Hima Sandeep A
- Conservative Dentistry and Endodontics, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences (SIMATS) Saveetha University, Chennai, IND
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Consolascio D, Bronz G, Lardelli PF, Milani GP, Lava SAG, Terziroli Beretta Piccoli B, Bianchetti MG, Bergmann MM, Rizzi M. Hoigné's syndrome, an uncommon mimicker of anaphylaxis: Systematic literature review. J Autoimmun 2024; 143:103164. [PMID: 38194789 DOI: 10.1016/j.jaut.2023.103164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 12/17/2023] [Accepted: 12/20/2023] [Indexed: 01/11/2024]
Abstract
The term Hoigné's syndrome denotes a mimicker of anaphylaxis, which occurs immediately after the parenteral administration of a drug and is likely caused by non-thrombotic pulmonary and systemic drug micro-embolization. It has so far been documented uniquely in case reports and small case series. Because this condition has never been systematically evaluated, we performed a structured literature review (pre-registered as CRD42023392962). The search was carried out in Excerpta Medica, National Library of Medicine, and Google Scholar. Cases with features consistent with anaphylaxis, urticaria, angioedema, asthma, syncope, anxiety, or panic attack triggered by needle phobia, and local anesthetic systemic toxicity were excluded. For the final analysis, we retained reports published between 1951 and 2021, which presented 247 patients with Hoigné's syndrome: 37 children and 211 adults with a male: female ratio of 2.1 : 1.0. The patients presented within 1 min after parenteral administration of a drug (intramuscular penicillin in 90 % of the cases) with chest discomfort, shortness of breath, fear of death, psychomotor agitation, and auditory or visual hallucinations and impairment. Recovery occurred within 30 min. The diagnosis of Hoigné's syndrome was also established in five patients 66-91 years of age with pre-existing cardiovascular or pulmonary diseases, who suddenly died after the administration of penicillin despite not exhibiting the aforementioned symptoms. It was therefore speculated that pulmonary drug micro-embolization induced a lethal cardiovascular compromise in these individuals. Histologic investigations supporting this hypothesis were performed in only one case. The diagnosis of Hoigné's pulmonary drug micro-embolization was established also in five patients with pre-existing cardiovascular or pulmonary diseases, who suddenly died after the administration of penicillin despite not exhibiting the afore mentioned symptoms. Histologic investigations supporting this hypothesis were performed in only one case. In conclusion, Hoigné's syndrome is an uncommon non-immune-mediated reaction. This report seeks to promote broader awareness and knowledge regarding this alarming mimicker of anaphylaxis. Diagnosis relies solely on clinical evaluation.
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Affiliation(s)
- Danilo Consolascio
- Family medicine, Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Gabriel Bronz
- Pediatric Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | - Pietro F Lardelli
- Family medicine, Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Gregorio P Milani
- Pediatric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Sebastiano A G Lava
- Pediatric Cardiology Unit, Department of Pediatrics, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland; Clinical Pharmacology and Therapeutics Group, University College London, London, United Kingdom
| | - Benedetta Terziroli Beretta Piccoli
- Epatocentro Ticino, Lugano, Switzerland; Faculty of Life Sciences & Medicine, King's College London, King's College Hospital, London, United Kingdom; Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland.
| | - Mario G Bianchetti
- Family medicine, Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Marcel M Bergmann
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland; Pediatric Allergy Unit, Department of Pediatrics, Gynecology and Obstetrics, University Hospitals of Geneva, Geneva, Switzerland
| | - Mattia Rizzi
- Pediatric Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland; Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland; Pediatric Oncology/Hematology Unit, Department of Women-Mother-Child, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
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McNally K, Roess A, Weinstein A, Lindley L, Wallin R. School Nurses' Experiences and Roles in Promoting and Administering the HPV Vaccine: A Systematic Review Using the Socioecological Framework. J Sch Nurs 2024; 40:43-57. [PMID: 37828750 DOI: 10.1177/10598405231206109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2023] Open
Abstract
Understanding the school nurse's experience in human papillomavirus (HPV) vaccine promotion can reduce vaccine disparities. HPV vaccination is critical to cancer prevention. Despite the importance of the school nurse in vaccine promotion, there is a lack of understanding. This article aims to examine the knowledge, attitude, experience, and role of school nurses related to HPV vaccination and promotion in school settings. A systematic search for school nurses and their experiences related to HPV vaccination was conducted. A thematic synthesis was undertaken using the socioecological model. This review highlights the complexity of HPV vaccine promotion in schools over time. Multilevel factors impact nursing practice. Nurses have good vaccine knowledge and positive attitudes. Poor workflow processes, competing demands, and vaccine communication challenge school nurses. The themes that were synthesized informed the LEADS model. With the support of school nurses, reaching the goal of eliminating cervical cancer as a public health problem is possible.
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Affiliation(s)
- Kimberly McNally
- George Mason University College of Health and Human Services, Fairfax, VA, USA
| | | | | | - Lisa Lindley
- Alexandria City Public Schools, Alexandria, VA, USA
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McKeage JW, Tan AZH, Taberner AJ. Large volume subcutaneous delivery using multi-orifice jet injection. Int J Pharm 2024; 649:123605. [PMID: 37981248 DOI: 10.1016/j.ijpharm.2023.123605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 11/08/2023] [Accepted: 11/11/2023] [Indexed: 11/21/2023]
Abstract
Needle-free jet injection is an alternative drug delivery technique that uses the liquid drug itself to penetrate through the skin. This technology is not only a promising alternative to hypodermic needles but also has the potential to replace intravenous delivery with rapid, needle-free subcutaneous delivery for large-volume treatments. In this work we propose a parallelised, 'multi-orifice' approach to overcome the volume constraints of subcutaneous tissue. We present a prototype multi-orifice nozzle with up to seven orifices and use this nozzle to perform injections into samples of ex vivo porcine tissue. These injections demonstrated the rapid (<0.15 s) delivery of up to 2 mL into the tissue using both three and seven orifices. Delivery success (measured as the percentage of fluid deposited in the tissue relative to the total volume that left the device) was very similar when using three versus seven injection orifices. A computational fluid dynamic model of multi-orifice jet injection is also presented. This model predicts that jet production is largely unaffected as the spacing between orifices is changed from 3 mm to 48 mm. This finding is supported by measurements of the speed, volume, and shape of the jets produced by the prototype nozzle that showed very similar jets were produced through all seven orifices. These findings demonstrate the feasibility of multi-orifice jet injection for needle-free delivery of large volumes. This promising technique has the potential to improve patient experience and reduce healthcare costs in large volume parenteral delivery applications.
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Affiliation(s)
- James W McKeage
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand.
| | - Andrew Z H Tan
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Andrew J Taberner
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand; Department of Engineering Science, Faculty of Engineering, University of Auckland, Auckland, New Zealand
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Anggraini YE, Trisnowati N, Martien R, Danarti R. A randomised clinical trial study assessing the efficacy of 5% losartan potassium loaded in ethosomal gel to treat human keloids: a trial protocol. Trials 2024; 25:12. [PMID: 38167064 PMCID: PMC10759551 DOI: 10.1186/s13063-023-07880-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 12/15/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Keloid is a skin disorder that results from excessive fibrous tissue growth in the area of the initial trauma. Treating keloids can be challenging since the success of various treatments varies from one study to another. Triamcinolone acetonide injection, a standard treatment, can cause undesirable side effects. Meanwhile, the effectiveness of existing topical therapies for keloids is not always reliable. The pro-inflammatory, pro-proliferative, and pro-fibrotic effects of angiotensin II in human skin contribute to keloid formation. Losartan potassium, an angiotensin II blocker, has the potential to act as an anti-keloid agent. Due to the thicker skin structure of a keloid and ease of application, ethosome gel is chosen as a safe and comfortable carrier for losartan potassium, making it a good choice for treating keloids. METHODS In this randomised clinical trial, 46 adults with keloids were divided into two treatment groups. One group of 23 participants received 5% losartan potassium loaded in ethosomal gel, while the other group of 23 participants received intralesional injections of 10% triamcinolone acetonide. Over 12 weeks, changes in POSAS 3.0 scores, degree of erythema and pigmentation, surface area, thickness, and pliability of the keloids will be measured at four different times: baseline, 4 weeks, 8 weeks, and 12 weeks. Statistical analysis will be conducted using SPSS software version 24, with a significance level of p < 0.05. DISCUSSION Losartan potassium is believed to be beneficial for keloid management because it inhibits the angiotensin II receptor, which plays a role in inflammation, proliferation, and fibrosis. This study examines the efficacy of 5% losartan potassium loaded in ethosomal gel for human keloids. TRIAL REGISTRATION Clinicaltrial.gov identifier NCT05893108 . Registered on 7 June 2023.
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Affiliation(s)
- Yuni Eka Anggraini
- Faculty of Medicine, Universitas Riau, Kota Pekanbaru, Indonesia
- Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Niken Trisnowati
- Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Ronny Martien
- Faculty of Pharmacy, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Retno Danarti
- Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia.
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Stone TC, Ward V, Hogan A, Alexander Ho KM, Wilson A, McBain H, Duku M, Wolfson P, Cheung S, Rosenfeld A, Lovat LB. Using saliva epigenetic data to develop and validate a multivariable predictor of esophageal cancer status. Epigenomics 2024; 16:109-125. [PMID: 38226541 PMCID: PMC10825730 DOI: 10.2217/epi-2023-0248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 01/04/2024] [Indexed: 01/17/2024] Open
Abstract
Background: Salivary epigenetic biomarkers may detect esophageal cancer. Methods: A total of 256 saliva samples from esophageal adenocarcinoma patients and matched volunteers were analyzed with Illumina EPIC methylation arrays. Three datasets were created, using 64% for discovery, 16% for testing and 20% for validation. Modules of gene-based methylation probes were created using weighted gene coexpression network analysis. Module significance to disease and gene importance to module were determined and a random forest classifier generated using best-scoring gene-related epigenetic probes. A cost-sensitive wrapper algorithm maximized cancer diagnosis. Results: Using age, sex and seven probes, esophageal adenocarcinoma was detected with area under the curve of 0.72 in discovery, 0.73 in testing and 0.75 in validation datasets. Cancer sensitivity was 88% with specificity of 31%. Conclusion: We have demonstrated a potentially clinically viable classifier of esophageal cancer based on saliva methylation.
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Affiliation(s)
- Timothy C Stone
- Division of Surgery & Interventional Science, University College London, Charles Bell House, 43-45 Foley Street, London, W1W 7TY, UK
| | - Vanessa Ward
- Division of Surgery & Interventional Science, University College London, Charles Bell House, 43-45 Foley Street, London, W1W 7TY, UK
| | - Aine Hogan
- Division of Surgery & Interventional Science, University College London, Charles Bell House, 43-45 Foley Street, London, W1W 7TY, UK
| | - Kai Man Alexander Ho
- Division of Surgery & Interventional Science, University College London, Charles Bell House, 43-45 Foley Street, London, W1W 7TY, UK
- Wellcome/EPSRC Centre for Interventional & Surgical Sciences (WEISS), University College London, Charles Bell House, 43-45 Foley Street, London, W1W 7TY, UK
| | - Ash Wilson
- Division of Surgery & Interventional Science, University College London, Charles Bell House, 43-45 Foley Street, London, W1W 7TY, UK
| | - Hazel McBain
- Wellcome/EPSRC Centre for Interventional & Surgical Sciences (WEISS), University College London, Charles Bell House, 43-45 Foley Street, London, W1W 7TY, UK
| | - Margaret Duku
- Wellcome/EPSRC Centre for Interventional & Surgical Sciences (WEISS), University College London, Charles Bell House, 43-45 Foley Street, London, W1W 7TY, UK
| | - Paul Wolfson
- Division of Surgery & Interventional Science, University College London, Charles Bell House, 43-45 Foley Street, London, W1W 7TY, UK
| | - Sharon Cheung
- Division of Surgery & Interventional Science, University College London, Charles Bell House, 43-45 Foley Street, London, W1W 7TY, UK
| | - Avi Rosenfeld
- Department of Computer Science, Jerusalem College of Technology, Havaad Haleumi 21, Givat Mordechai, 91160, Jerusalem, Israel
| | - Laurence B Lovat
- Division of Surgery & Interventional Science, University College London, Charles Bell House, 43-45 Foley Street, London, W1W 7TY, UK
- Wellcome/EPSRC Centre for Interventional & Surgical Sciences (WEISS), University College London, Charles Bell House, 43-45 Foley Street, London, W1W 7TY, UK
- Department of Gastrointestinal Services, University College London Hospital, 235 Euston Road, London, NW1 2BU, UK
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Suleman SK, Yahya NB, Nilsson S, Enskär K. Comparison of trace image colors for kids-book with two active distractions in reducing pain and fear of children during the venipuncture procedure. Eur J Pediatr 2024; 183:113-122. [PMID: 37837462 PMCID: PMC10857977 DOI: 10.1007/s00431-023-05271-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 09/25/2023] [Accepted: 10/07/2023] [Indexed: 10/16/2023]
Abstract
This study investigated the effectiveness of trace image and coloring for kids-book (TICK-B), cough trick, and balloon inflation techniques in reducing pain and fear in children during venipuncture. The current study is a prospective, controlled, and randomized trial (RCT). School-aged children who required venipuncture were involved in the study. Pediatric patients were randomly assigned to four groups: the TICK-B group, the cough trick group, the inflation of balloons, and the control groups. Before and after the procedure, the children and their parents were interviewed. Wong-Baker (FACES) Pain Rating Scale was applied to measure the severity of pain. Children's Fear Scale was applied to measure children's fear. This study involved the 160 children (mean age, 8.39-2.18 years). The severity of pain and fear levels among the children during and after the procedure were significantly different (p = 0.001). Pain and fear were significantly decreased in children in the intervention groups compared with those in the control group (p < 0.05). In the TICK-B group, participants reported significantly less pain and fear during the venipuncture procedure than in the cough trick, balloon inflation, and control groups (P = 0.001, p = 0.001, p = 0.001) and after the procedure (p = 0.001, p = 0.002, p = 0.002). There was a similar significance found in the level of fear during the procedure (p = 0.001, p = 0.002, p = 0.006), and after the procedure (p = 0.001, p = 0.008, p = 0.015). Conclusion: TICK-B was the most effective method for decreasing the pain and fear of children associated with venipuncture procedures. Furthermore, the distraction technique of coughing and inflating balloons also proved efficacious in decreasing the pain and fear of children during venipuncture. Trial registration: The study has been registered with ClinicalTrials.org under the number NCT04983303. It was retrospectively registered on July 26, 2021. What is Known: • Venipuncture, one of the most painful and uncomfortable procedures for children, caused great fear and discomfort during the procedure. What is New: • The TICK-B technique, music listening, and cartoon watching techniques are effective, simple, and safe ways to reduce children's fear and pain. These interventions provide a good way for children and their parents to collaborate during painful medical procedures. • No studies have compared the impact of TICK-B during venipuncture.
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Affiliation(s)
- Sherzad Khudeida Suleman
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
- Psychiatric and Pediatric Nursing Unit, College of Nursing, University of Duhok, Duhok, Kurdistan Region, Iraq.
| | - Nizer Bakir Yahya
- Pediatric Medicine Unit, College of Medicine, Duhok University, Duhok, Kurdistan Region, Iraq
| | - Stefan Nilsson
- Institute of Health and Caring Sciences, University of Gothenburg, Gothenburg, Sweden
| | - Karin Enskär
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
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Bjoraker KJ, Eggerding C, Ellenberg E, Hollander S, Holmes BM, Lindstrom K, McNutt M, Miller S, Northrup H, Rogers M, Rose S, Scott M, Shim S, Wardley B, Wessenberg L, Bilder DA. Best practice recommendations for the management of anxiety during the pegvaliase journey. Mol Genet Metab 2024; 141:107737. [PMID: 38043481 DOI: 10.1016/j.ymgme.2023.107737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 11/16/2023] [Accepted: 11/16/2023] [Indexed: 12/05/2023]
Abstract
BACKGROUND Pegvaliase, an enzyme substitution therapy, is a treatment option for phenylketonuria (PKU). Due to the neuropathophysiology and disease burden of PKU, individuals can experience baseline anxiety unrelated to pegvaliase therapy. In addition, there are aspects of pegvaliase therapy that may be anxiety-inducing for those considering or receiving treatment. The aim of this manuscript is to present best practice recommendations for the identification and management of anxiety symptoms that can occur along the pegvaliase journey. METHODS A modified Delphi approach was used to seek consensus among a multidisciplinary panel of experts. To this end, an in-person meeting was held that was preceded by a medical specialist- and patient-specific survey to develop preliminary recommendations on ways to address anxiety along the pegvaliase journey. After the meeting, an additional survey was conducted to rank the proposed solutions and mitigation strategies from which a set of recommendations was developed. All recommendations were voted on with the aim of consensus generation, defined as achieving ≥75% agreement among experts. RESULTS The panel reached consensus on a total of 28 best practice recommendations for the management of anxiety during the pre-treatment, induction and titration, early maintenance (pre-efficacy), and late maintenance (post-efficacy) stages. The recommendations offer strategies to identify and address the most common causes of pegvaliase-related anxiety, including self-injection, side effects, the titration schedule, prescribed dietary changes, and variable time to efficacy. Overall, managing anxiety in those considering or receiving pegvaliase involves patient-centered communication, shared decision-making, and personalized treatment plans. CONCLUSIONS The best practice recommendations described herein can guide healthcare providers in proactively addressing anxiety during the different stages of pegvaliase treatment, and support providers with initiating and managing pegvaliase in individuals who may experience baseline and treatment-related anxiety.
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Affiliation(s)
| | | | | | - Suzanne Hollander
- Department of Clinical Nutrition, Boston Children's Hospital, Boston, MA, USA; Division of Genetics and Genomics, Boston Children's Hospital, Boston, MA, USA
| | - Brittany M Holmes
- Division of Genetics and Genomics, Boston Children's Hospital, Boston, MA, USA
| | | | - Markey McNutt
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Suzanne Miller
- Program for Inherited Metabolic Diseases, Mount Sinai Health System, New York, NY, USA
| | - Hope Northrup
- Department of Pediatrics, McGovern Medical School at the University of Texas Health Science Center at Houston (UTHealth) and Children's Memorial Hermann Hospital, Houston, TX, USA
| | | | - Sarah Rose
- BioMarin Pharmaceutical Inc., Novato, CA, USA.
| | - Mia Scott
- Individual with PKU, Tucson, AZ, USA
| | - Soo Shim
- Ann and Robert H. Lurie Children's Hospital, Chicago, IL, USA
| | | | | | - Deborah A Bilder
- Department of Psychiatry, University of Utah Huntsman Mental Health Institute, Salt Lake City, UT, USA
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Andrade G, Abdelmonem KYA, Alqaderi N, Teir HJ, Elamin ABA, Bedewy D. Fear of Needles and Seasonal Influenza Vaccine Acceptance Amongst Adults in the United Arab Emirates: A Cross-Sectional Study and Implications for Nursing. SAGE Open Nurs 2024; 10:23779608241261622. [PMID: 38881678 PMCID: PMC11177738 DOI: 10.1177/23779608241261622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 05/13/2024] [Accepted: 05/27/2024] [Indexed: 06/18/2024] Open
Abstract
Introduction Seasonal influenza remains a challenge in the United Arab Emirates, and vaccination is an important preventive measure. However, fear of needles may be an obstacle in vaccination efforts. Objective The purpose of this study was to determine, in a non-clinical sample obtained from the UAE, how much of an impact fear of needles has on the decision to receive the seasonal influenza vaccine. Methods In the period September-December 2022, 372 participants were surveyed on their willingness to be vaccinated, their level of vaccine knowledge, and their level of fear of needles. Logistic regression models were used to assess the impact of fear of needles and vaccine knowledge on the decision to accept the seasonal influenza vaccine. Results Fear of needles and vaccine knowledge are significant predictors in the decision to receive the vaccine. There were no gender or ethnic differences in fear of needles, but there were differences in the decision to receive the vaccines, with women and non-Arabs being more hesitant. Conclusion Fear of needles may be an important variable to account for in public policies designed to improve vaccination rates in the UAE. For public health policy in the UAE, this implies that authorities must dedicate efforts to manage fear of needles in the general population. Efforts to address fear of vaccines in the general population must be made with proper training of nurses. Alternatively, authorities may need to seek oral alternatives for the administration of the seasonal influenza vaccine.
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Affiliation(s)
| | | | | | | | | | - Dalia Bedewy
- Ajman University, Ajman, UAE
- Tanta University, Tanta, Egypt
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Berg Johnsen I, Wichstrøm L, Dahllöf G. Prevalence and stability of blood-injection-injury phobia in childhood-A prospective community study in Norway. Acta Paediatr 2024; 113:105-112. [PMID: 37850719 DOI: 10.1111/apa.17003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 08/15/2023] [Accepted: 10/06/2023] [Indexed: 10/19/2023]
Abstract
AIM An individual with a blood-injection-injury (BII) phobia often avoids exposure to triggers, such as blood tests and clinic appointments, leading to potentially serious health complications. This population-based study examined the prevalence, stability and course of BII phobia in children and adolescents. METHODS The data came from the Trondheim Early Secure Study, conducted from 2007 to 2018. All children born in Trondheim, Norway, in 2003 and 2004 were invited to attend. Clinical interviews were conducted by trained personnel to assess BII phobia in 1042 children (51% female) every 2 years from 4 to 14 years of age. Latent growth curves and logistic regression analyses were used in the data analysis. RESULTS Just under 20% of the cohort experienced a BII phobia at least once, with no significant sex differences. The prevalence of BII phobias increased from 3% at 4 years of age and peaked at about 8% at 10 years of age, before levelling off. The two-year stability increased as 12-14 years of age approached. CONCLUSION The prevalence of BII was affected by age, but not sex. Early BII phobias often recede with time, but children may need treatment if they persist from 8 years of age.
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Affiliation(s)
- Ingrid Berg Johnsen
- Division of Orthodontics and Pediatric Dentistry, Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden
- Center for Oral Health Services and Research, Mid-Norway (TkMidt), Trondheim, Norway
| | - Lars Wichstrøm
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Child and Adolescent Psychiatry, St Olavs Hospital, Trondheim, Norway
| | - Göran Dahllöf
- Division of Orthodontics and Pediatric Dentistry, Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden
- Center for Oral Health Services and Research, Mid-Norway (TkMidt), Trondheim, Norway
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Komiya S, Watanabe J, Terayama T, Kamijo K, Okada H. Efficacy and safety of follitropin delta versus follitropin alpha/beta in infertility treatment: A systematic review and meta-analysis. Reprod Med Biol 2024; 23:e12573. [PMID: 38528991 PMCID: PMC10961712 DOI: 10.1002/rmb2.12573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 02/22/2024] [Accepted: 03/10/2024] [Indexed: 03/27/2024] Open
Abstract
Background Follitropin δ may be an alternative to conventional follitropin α/β for controlled ovarian stimulation (COS) within assisted reproductive treatment (ART), but its efficacy and safety remain unknown. We performed a random-effects meta-analysis to compare the efficacy and safety of follitropin δ and follitropin α/β. Methods We searched randomized controlled trials comparing follitropin δ and follitropin α/β using MEDLINE, Embase, CENTRAL, ClinicalTrials.gov, and WHO-ITCRP on December 14, 2022. The primary outcomes were the live birth rate and the incidence of moderate or severe ovarian hyperstimulation syndrome (OHSS). The certainty of the evidence was assessed using the grading of recommendations assessment, development, and evaluation approach. The protocol was registered on the Open Science Framework. Results Three studies involving 2682 participants were included in our meta-analysis. The results indicated that follitropin δ may result in little to no difference in live birth rates (risk ratio [RR], 1.12; 95% confidence interval [CI], 0.91-1.38; low certainty) and the incidence of moderate or severe OHSS (RR, 0.78; 95% CI, 0.48-1.26; low certainty) compared with follitropin α/β. Conclusion Follitropin δ may result in little to no difference in COS compared with follitropin α/β, especially in terms of live births and safety.
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Affiliation(s)
- Shinnosuke Komiya
- HORAC Grand Front Osaka ClinicOsakaJapan
- Department of Obstetrics and GynecologyKansai Medical University Graduate School of MedicineHirakata, OsakaJapan
| | - Jun Watanabe
- Systematic Review Workshop Peer Support Group (SRWS‐PSG)OsakaJapan
- Division of Gastroenterological, General and Transplant Surgery, Department of SurgeryJichi Medical UniversityShimotsukeJapan
- Division of Community and Family MedicineJichi Medical UniversityShimotsukeJapan
| | - Takero Terayama
- Systematic Review Workshop Peer Support Group (SRWS‐PSG)OsakaJapan
- Division of Traumatology and Critical Care MedicineNational Defense Medical CollegeSaitamaJapan
| | - Kyosuke Kamijo
- Systematic Review Workshop Peer Support Group (SRWS‐PSG)OsakaJapan
- Division of GynecologyNagano Municipal HospitalNaganoJapan
| | - Hidetaka Okada
- Department of Obstetrics and GynecologyKansai Medical University Graduate School of MedicineHirakata, OsakaJapan
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Erdal S, Harman Özdoğan M, Yildirim D, Kuni A, Selçuk S, Güneri A, Arslan EN. Effects of Orange Oil Aromatherapy on Pain and Anxiety During Invasive Interventions in Patients With Hematopoietic Stem Cell Transplants. JOURNAL OF INFUSION NURSING 2024; 47:54-60. [PMID: 38211616 DOI: 10.1097/nan.0000000000000529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2024]
Abstract
Invasive interventions, such as peripheral intravenous cannula, port needle placement, and blood collection, are often required for both inpatient and outpatient follow-up patients with hematological malignancies and hematopoietic stem cell transplants. This prospective, randomized controlled experimental study assessed the effect of orange oil inhalation used in aromatherapy on pain and anxiety levels in invasive interventions with hematological malignancies and hematopoietic stem cell transplants. It was conducted prospectively with 80 patients with hematological malignancies who were treated in the adult bone marrow transplant unit and adult hematology service of a private hospital between May 2021 and April 2022. The orange oil inhalation used in aromatherapy was applied to patients in the intervention group. The Visual Analog Scale (VAS) and State-Trait Anxiety Inventory (STAI) were used for data collection. Regarding the personal characteristics of the patients, 42.5% were ≥61 years old, 60% were men, and 85% were married. VAS pain scores of the intervention group were statistically lower than those of the control group (P < .001). However, there was no statistically significant difference in the STAI scores of groups (P >.05). The study results show that orange oil inhalation has been determined to reduce pain during invasive interventions.
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Affiliation(s)
- Seckin Erdal
- Acibadem Altunizade Hospital, Adult Bone Marrow Transplantation Unit, İstanbul, Turkey (Erdal, Kuni, Selçuk, Güneri, and Arslan); Department of Medical Services and Techniques, Vocational School of Health Services, Sinop University, Sinop, Turkey (Harman Özdoğan); and Department of Nursing, Faculty of Health Sciences, Istanbul Aydin University, İstanbul, Turkey (Yildirim)
- Seckin Erdal, RN, is currently working as a nurse in charge in the adult bone marrow transplant unit at Acibadem Altunizade Hospital. She started her professional career as an emergency, internal medicine, and oncology nurse and has been a nurse in charge of bone marrow transplantation since 1989. In 2015, she founded and chaired the European Blood and Bone Marrow Transplantation Turkey Nurse Group
- Merve Harman Özdoğan, MSN, RN, completed her undergraduate education in 2011 and her graduate education in 2016. She worked as a nurse in the stem cell transplant service for 8 years. She has been working as a lecturer at Sinop University since 2019. Her areas of interest are internal medicine, oncology, hematology, and dialysis
- Dilek Yıldırım, PhD, RN, graduated from Istanbul University Florence Nightingale School of Nursing in 2009. She completed her master's degree at Istanbul University Institute of Health Sciences, Internal Medicine Nursing Master Program, in 2013. She completed a doctorate program at the same university in 2018. Her research areas of interest concern nursing education, palliative care, cancer, pain, cancer symptoms, intensive care nursing research, and internal medicine nursing. Dr. Yildirim is working as an assistant professor at the nursing department in Istanbul Aydin University, Faculty of Health Sciences
- Ayşem Kuni, RN, graduated from Sakarya University, Department of Nursing, in 2014. She has been working as a case manager nurse in the adult bone marrow transplant unit of Acıbadem Altunizade Hospital since 2014
- Sevinc Selçuk, RN, has been working as a training nurse in the adult hematology service of Acıbadem Altunizade Hospital since 2014. She graduated from Ege University, Department of Nursing, in 2014
- Azize Güner, RN, graduated from Konya Health Vocational High School Nursing Department in 2011. She is currently working as a nurse team leader in the adult bone marrow transplant unit of Acıbadem Altunizade Hospital. She began her professional career as a surgery, internal medicine nurse. She has been working as an adult bone marrow transplant nurse since 2014
- Elif Naz Arslan, MPsych, is a clinical psychologist and has a master of science degree in the clinical and community psychology field in University of East London (UEL). She has worked with adults in private clinics since 2017 and is currently working as a clinical psychologist in the adult bone marrow transplantation unit, hematolytic service, and her private clinic
| | - Merve Harman Özdoğan
- Acibadem Altunizade Hospital, Adult Bone Marrow Transplantation Unit, İstanbul, Turkey (Erdal, Kuni, Selçuk, Güneri, and Arslan); Department of Medical Services and Techniques, Vocational School of Health Services, Sinop University, Sinop, Turkey (Harman Özdoğan); and Department of Nursing, Faculty of Health Sciences, Istanbul Aydin University, İstanbul, Turkey (Yildirim)
- Seckin Erdal, RN, is currently working as a nurse in charge in the adult bone marrow transplant unit at Acibadem Altunizade Hospital. She started her professional career as an emergency, internal medicine, and oncology nurse and has been a nurse in charge of bone marrow transplantation since 1989. In 2015, she founded and chaired the European Blood and Bone Marrow Transplantation Turkey Nurse Group
- Merve Harman Özdoğan, MSN, RN, completed her undergraduate education in 2011 and her graduate education in 2016. She worked as a nurse in the stem cell transplant service for 8 years. She has been working as a lecturer at Sinop University since 2019. Her areas of interest are internal medicine, oncology, hematology, and dialysis
- Dilek Yıldırım, PhD, RN, graduated from Istanbul University Florence Nightingale School of Nursing in 2009. She completed her master's degree at Istanbul University Institute of Health Sciences, Internal Medicine Nursing Master Program, in 2013. She completed a doctorate program at the same university in 2018. Her research areas of interest concern nursing education, palliative care, cancer, pain, cancer symptoms, intensive care nursing research, and internal medicine nursing. Dr. Yildirim is working as an assistant professor at the nursing department in Istanbul Aydin University, Faculty of Health Sciences
- Ayşem Kuni, RN, graduated from Sakarya University, Department of Nursing, in 2014. She has been working as a case manager nurse in the adult bone marrow transplant unit of Acıbadem Altunizade Hospital since 2014
- Sevinc Selçuk, RN, has been working as a training nurse in the adult hematology service of Acıbadem Altunizade Hospital since 2014. She graduated from Ege University, Department of Nursing, in 2014
- Azize Güner, RN, graduated from Konya Health Vocational High School Nursing Department in 2011. She is currently working as a nurse team leader in the adult bone marrow transplant unit of Acıbadem Altunizade Hospital. She began her professional career as a surgery, internal medicine nurse. She has been working as an adult bone marrow transplant nurse since 2014
- Elif Naz Arslan, MPsych, is a clinical psychologist and has a master of science degree in the clinical and community psychology field in University of East London (UEL). She has worked with adults in private clinics since 2017 and is currently working as a clinical psychologist in the adult bone marrow transplantation unit, hematolytic service, and her private clinic
| | - Dilek Yildirim
- Acibadem Altunizade Hospital, Adult Bone Marrow Transplantation Unit, İstanbul, Turkey (Erdal, Kuni, Selçuk, Güneri, and Arslan); Department of Medical Services and Techniques, Vocational School of Health Services, Sinop University, Sinop, Turkey (Harman Özdoğan); and Department of Nursing, Faculty of Health Sciences, Istanbul Aydin University, İstanbul, Turkey (Yildirim)
- Seckin Erdal, RN, is currently working as a nurse in charge in the adult bone marrow transplant unit at Acibadem Altunizade Hospital. She started her professional career as an emergency, internal medicine, and oncology nurse and has been a nurse in charge of bone marrow transplantation since 1989. In 2015, she founded and chaired the European Blood and Bone Marrow Transplantation Turkey Nurse Group
- Merve Harman Özdoğan, MSN, RN, completed her undergraduate education in 2011 and her graduate education in 2016. She worked as a nurse in the stem cell transplant service for 8 years. She has been working as a lecturer at Sinop University since 2019. Her areas of interest are internal medicine, oncology, hematology, and dialysis
- Dilek Yıldırım, PhD, RN, graduated from Istanbul University Florence Nightingale School of Nursing in 2009. She completed her master's degree at Istanbul University Institute of Health Sciences, Internal Medicine Nursing Master Program, in 2013. She completed a doctorate program at the same university in 2018. Her research areas of interest concern nursing education, palliative care, cancer, pain, cancer symptoms, intensive care nursing research, and internal medicine nursing. Dr. Yildirim is working as an assistant professor at the nursing department in Istanbul Aydin University, Faculty of Health Sciences
- Ayşem Kuni, RN, graduated from Sakarya University, Department of Nursing, in 2014. She has been working as a case manager nurse in the adult bone marrow transplant unit of Acıbadem Altunizade Hospital since 2014
- Sevinc Selçuk, RN, has been working as a training nurse in the adult hematology service of Acıbadem Altunizade Hospital since 2014. She graduated from Ege University, Department of Nursing, in 2014
- Azize Güner, RN, graduated from Konya Health Vocational High School Nursing Department in 2011. She is currently working as a nurse team leader in the adult bone marrow transplant unit of Acıbadem Altunizade Hospital. She began her professional career as a surgery, internal medicine nurse. She has been working as an adult bone marrow transplant nurse since 2014
- Elif Naz Arslan, MPsych, is a clinical psychologist and has a master of science degree in the clinical and community psychology field in University of East London (UEL). She has worked with adults in private clinics since 2017 and is currently working as a clinical psychologist in the adult bone marrow transplantation unit, hematolytic service, and her private clinic
| | - Ayşem Kuni
- Acibadem Altunizade Hospital, Adult Bone Marrow Transplantation Unit, İstanbul, Turkey (Erdal, Kuni, Selçuk, Güneri, and Arslan); Department of Medical Services and Techniques, Vocational School of Health Services, Sinop University, Sinop, Turkey (Harman Özdoğan); and Department of Nursing, Faculty of Health Sciences, Istanbul Aydin University, İstanbul, Turkey (Yildirim)
- Seckin Erdal, RN, is currently working as a nurse in charge in the adult bone marrow transplant unit at Acibadem Altunizade Hospital. She started her professional career as an emergency, internal medicine, and oncology nurse and has been a nurse in charge of bone marrow transplantation since 1989. In 2015, she founded and chaired the European Blood and Bone Marrow Transplantation Turkey Nurse Group
- Merve Harman Özdoğan, MSN, RN, completed her undergraduate education in 2011 and her graduate education in 2016. She worked as a nurse in the stem cell transplant service for 8 years. She has been working as a lecturer at Sinop University since 2019. Her areas of interest are internal medicine, oncology, hematology, and dialysis
- Dilek Yıldırım, PhD, RN, graduated from Istanbul University Florence Nightingale School of Nursing in 2009. She completed her master's degree at Istanbul University Institute of Health Sciences, Internal Medicine Nursing Master Program, in 2013. She completed a doctorate program at the same university in 2018. Her research areas of interest concern nursing education, palliative care, cancer, pain, cancer symptoms, intensive care nursing research, and internal medicine nursing. Dr. Yildirim is working as an assistant professor at the nursing department in Istanbul Aydin University, Faculty of Health Sciences
- Ayşem Kuni, RN, graduated from Sakarya University, Department of Nursing, in 2014. She has been working as a case manager nurse in the adult bone marrow transplant unit of Acıbadem Altunizade Hospital since 2014
- Sevinc Selçuk, RN, has been working as a training nurse in the adult hematology service of Acıbadem Altunizade Hospital since 2014. She graduated from Ege University, Department of Nursing, in 2014
- Azize Güner, RN, graduated from Konya Health Vocational High School Nursing Department in 2011. She is currently working as a nurse team leader in the adult bone marrow transplant unit of Acıbadem Altunizade Hospital. She began her professional career as a surgery, internal medicine nurse. She has been working as an adult bone marrow transplant nurse since 2014
- Elif Naz Arslan, MPsych, is a clinical psychologist and has a master of science degree in the clinical and community psychology field in University of East London (UEL). She has worked with adults in private clinics since 2017 and is currently working as a clinical psychologist in the adult bone marrow transplantation unit, hematolytic service, and her private clinic
| | - Sevinc Selçuk
- Acibadem Altunizade Hospital, Adult Bone Marrow Transplantation Unit, İstanbul, Turkey (Erdal, Kuni, Selçuk, Güneri, and Arslan); Department of Medical Services and Techniques, Vocational School of Health Services, Sinop University, Sinop, Turkey (Harman Özdoğan); and Department of Nursing, Faculty of Health Sciences, Istanbul Aydin University, İstanbul, Turkey (Yildirim)
- Seckin Erdal, RN, is currently working as a nurse in charge in the adult bone marrow transplant unit at Acibadem Altunizade Hospital. She started her professional career as an emergency, internal medicine, and oncology nurse and has been a nurse in charge of bone marrow transplantation since 1989. In 2015, she founded and chaired the European Blood and Bone Marrow Transplantation Turkey Nurse Group
- Merve Harman Özdoğan, MSN, RN, completed her undergraduate education in 2011 and her graduate education in 2016. She worked as a nurse in the stem cell transplant service for 8 years. She has been working as a lecturer at Sinop University since 2019. Her areas of interest are internal medicine, oncology, hematology, and dialysis
- Dilek Yıldırım, PhD, RN, graduated from Istanbul University Florence Nightingale School of Nursing in 2009. She completed her master's degree at Istanbul University Institute of Health Sciences, Internal Medicine Nursing Master Program, in 2013. She completed a doctorate program at the same university in 2018. Her research areas of interest concern nursing education, palliative care, cancer, pain, cancer symptoms, intensive care nursing research, and internal medicine nursing. Dr. Yildirim is working as an assistant professor at the nursing department in Istanbul Aydin University, Faculty of Health Sciences
- Ayşem Kuni, RN, graduated from Sakarya University, Department of Nursing, in 2014. She has been working as a case manager nurse in the adult bone marrow transplant unit of Acıbadem Altunizade Hospital since 2014
- Sevinc Selçuk, RN, has been working as a training nurse in the adult hematology service of Acıbadem Altunizade Hospital since 2014. She graduated from Ege University, Department of Nursing, in 2014
- Azize Güner, RN, graduated from Konya Health Vocational High School Nursing Department in 2011. She is currently working as a nurse team leader in the adult bone marrow transplant unit of Acıbadem Altunizade Hospital. She began her professional career as a surgery, internal medicine nurse. She has been working as an adult bone marrow transplant nurse since 2014
- Elif Naz Arslan, MPsych, is a clinical psychologist and has a master of science degree in the clinical and community psychology field in University of East London (UEL). She has worked with adults in private clinics since 2017 and is currently working as a clinical psychologist in the adult bone marrow transplantation unit, hematolytic service, and her private clinic
| | - Azize Güneri
- Acibadem Altunizade Hospital, Adult Bone Marrow Transplantation Unit, İstanbul, Turkey (Erdal, Kuni, Selçuk, Güneri, and Arslan); Department of Medical Services and Techniques, Vocational School of Health Services, Sinop University, Sinop, Turkey (Harman Özdoğan); and Department of Nursing, Faculty of Health Sciences, Istanbul Aydin University, İstanbul, Turkey (Yildirim)
- Seckin Erdal, RN, is currently working as a nurse in charge in the adult bone marrow transplant unit at Acibadem Altunizade Hospital. She started her professional career as an emergency, internal medicine, and oncology nurse and has been a nurse in charge of bone marrow transplantation since 1989. In 2015, she founded and chaired the European Blood and Bone Marrow Transplantation Turkey Nurse Group
- Merve Harman Özdoğan, MSN, RN, completed her undergraduate education in 2011 and her graduate education in 2016. She worked as a nurse in the stem cell transplant service for 8 years. She has been working as a lecturer at Sinop University since 2019. Her areas of interest are internal medicine, oncology, hematology, and dialysis
- Dilek Yıldırım, PhD, RN, graduated from Istanbul University Florence Nightingale School of Nursing in 2009. She completed her master's degree at Istanbul University Institute of Health Sciences, Internal Medicine Nursing Master Program, in 2013. She completed a doctorate program at the same university in 2018. Her research areas of interest concern nursing education, palliative care, cancer, pain, cancer symptoms, intensive care nursing research, and internal medicine nursing. Dr. Yildirim is working as an assistant professor at the nursing department in Istanbul Aydin University, Faculty of Health Sciences
- Ayşem Kuni, RN, graduated from Sakarya University, Department of Nursing, in 2014. She has been working as a case manager nurse in the adult bone marrow transplant unit of Acıbadem Altunizade Hospital since 2014
- Sevinc Selçuk, RN, has been working as a training nurse in the adult hematology service of Acıbadem Altunizade Hospital since 2014. She graduated from Ege University, Department of Nursing, in 2014
- Azize Güner, RN, graduated from Konya Health Vocational High School Nursing Department in 2011. She is currently working as a nurse team leader in the adult bone marrow transplant unit of Acıbadem Altunizade Hospital. She began her professional career as a surgery, internal medicine nurse. She has been working as an adult bone marrow transplant nurse since 2014
- Elif Naz Arslan, MPsych, is a clinical psychologist and has a master of science degree in the clinical and community psychology field in University of East London (UEL). She has worked with adults in private clinics since 2017 and is currently working as a clinical psychologist in the adult bone marrow transplantation unit, hematolytic service, and her private clinic
| | - Elif Naz Arslan
- Acibadem Altunizade Hospital, Adult Bone Marrow Transplantation Unit, İstanbul, Turkey (Erdal, Kuni, Selçuk, Güneri, and Arslan); Department of Medical Services and Techniques, Vocational School of Health Services, Sinop University, Sinop, Turkey (Harman Özdoğan); and Department of Nursing, Faculty of Health Sciences, Istanbul Aydin University, İstanbul, Turkey (Yildirim)
- Seckin Erdal, RN, is currently working as a nurse in charge in the adult bone marrow transplant unit at Acibadem Altunizade Hospital. She started her professional career as an emergency, internal medicine, and oncology nurse and has been a nurse in charge of bone marrow transplantation since 1989. In 2015, she founded and chaired the European Blood and Bone Marrow Transplantation Turkey Nurse Group
- Merve Harman Özdoğan, MSN, RN, completed her undergraduate education in 2011 and her graduate education in 2016. She worked as a nurse in the stem cell transplant service for 8 years. She has been working as a lecturer at Sinop University since 2019. Her areas of interest are internal medicine, oncology, hematology, and dialysis
- Dilek Yıldırım, PhD, RN, graduated from Istanbul University Florence Nightingale School of Nursing in 2009. She completed her master's degree at Istanbul University Institute of Health Sciences, Internal Medicine Nursing Master Program, in 2013. She completed a doctorate program at the same university in 2018. Her research areas of interest concern nursing education, palliative care, cancer, pain, cancer symptoms, intensive care nursing research, and internal medicine nursing. Dr. Yildirim is working as an assistant professor at the nursing department in Istanbul Aydin University, Faculty of Health Sciences
- Ayşem Kuni, RN, graduated from Sakarya University, Department of Nursing, in 2014. She has been working as a case manager nurse in the adult bone marrow transplant unit of Acıbadem Altunizade Hospital since 2014
- Sevinc Selçuk, RN, has been working as a training nurse in the adult hematology service of Acıbadem Altunizade Hospital since 2014. She graduated from Ege University, Department of Nursing, in 2014
- Azize Güner, RN, graduated from Konya Health Vocational High School Nursing Department in 2011. She is currently working as a nurse team leader in the adult bone marrow transplant unit of Acıbadem Altunizade Hospital. She began her professional career as a surgery, internal medicine nurse. She has been working as an adult bone marrow transplant nurse since 2014
- Elif Naz Arslan, MPsych, is a clinical psychologist and has a master of science degree in the clinical and community psychology field in University of East London (UEL). She has worked with adults in private clinics since 2017 and is currently working as a clinical psychologist in the adult bone marrow transplantation unit, hematolytic service, and her private clinic
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Mabbott AP, Bedford H. Pain management in infant immunisation: A cross-sectional survey of UK primary care nurses. Prim Health Care Res Dev 2023; 24:e71. [PMID: 38126393 PMCID: PMC10790675 DOI: 10.1017/s146342362300066x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 09/26/2023] [Accepted: 11/13/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Childhood immunisation is a critically important public health initiative. However, since most vaccines are administered by injection, it is associated with considerable pain and distress. Despite evidence demonstrating the efficacy of various pain management strategies, the frequency with which these are used during routine infant vaccinations in UK practice is unknown. AIM This study aimed to explore primary care practice nurses' (PNs) use of evidence-based pain management strategies during infant immunisation, as well as barriers to evidence-based practice. METHODS A questionnaire was developed and distributed to nurses throughout the UK via convenience sampling in paper and online formats. Questions assessed the frequency of pain management intervention use during infant immunisation and barriers to their use. FINDINGS A total of 255 questionnaire responses were received. Over 90% (n = 226) of respondents never used topical anaesthetics or sweet solutions during immunisations, while 41.9% advised breastfeeding occasionally (n = 103). Parent-/caregiver-led distraction was the most frequently used intervention, with most nurses using it occasionally (47.9%, n = 116) or often (30.6%, n = 74). Most practices had no immunisation pain management policy (81.1%, n = 184), and most PNs' previous training had not included pain management (86.9%, n = 186). Barriers to intervention use included lack of time, knowledge and resources. Excluding distraction, pain management strategies were infrequently or never used during infant immunisation. Key barriers to using evidence-based strategies were lack of time, knowledge and resources.
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Affiliation(s)
- Annie P. Mabbott
- University College London Great Ormond Street Institute of Child Health, London, UK
| | - Helen Bedford
- University College London Great Ormond Street Institute of Child Health, London, UK
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Collier AF, Schaefer KR, Uddin A, Noonan C, Dillard DA, Son-Stone L, Manson SM, Buchwald D, MacLehose R. COVID-19 vaccination in urban American Indian and Alaska Native children: Parental characteristics, beliefs and attitudes associated with vaccine acceptance. Vaccine X 2023; 15:100406. [PMID: 38058791 PMCID: PMC10696120 DOI: 10.1016/j.jvacx.2023.100406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 11/07/2023] [Accepted: 11/12/2023] [Indexed: 12/08/2023] Open
Abstract
Background Little is known about vaccination rates for American Indian and Alaska Native (AI/AN) parents and their children, or parental decisions in this regard. Improving vaccination rates is a serious concern due to the disproportionate incidence and morbidity of COVID-19 in AI/AN people. Purpose Our goal was to describe urban AI/AN parental attributes associated with COVID-19 vaccination of their children. Methods Survey participants (n = 572) were ≥18 years of age, had children ≥5 years of age, AI/AN, and seen at one of six urban health organizations serving primarily AI/AN people within the prior year. They were asked about gender, age, education, marital status, perceived stress, trauma history, whether they had received the COVID-19 vaccine, tested positive for COVID-19 in the past, and if their child was vaccinated. They were also asked about 16 vaccine hesitancy reasons. Results Parental vaccination rate was 82%, with 59% of their children vaccinated. Parents who vaccinated their children were older, had higher education, lower stress and trauma, and were more likely to be vaccinated compared to parents who did not vaccinate their children. Forty-two percent of parents indicated they would likely vaccinate their unvaccinated child in the future. Sixteen vaccine hesitancy reasons revealed four factors: distrust, inconvenience, lack of concern about the pandemic, and AI/AN concerns. Parents who had no plans to vaccinate their children had the highest vaccine distrust and lack of concern about the pandemic. Parents with greater vaccine distrust and AI/AN specific concern reported significantly greater trauma history and higher levels of education. Conclusion Even though vaccination rates for AI/AN parents and children are high, the consequences of COVID-19 for AI/AN people are more severe than for other US populations. Providers should use trauma-informed, trust-building and culturally competent communication when discussing choices about vaccination with AI/AN parents.
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Affiliation(s)
| | | | - Azhar Uddin
- Institute for Research and Education to Advance Community Health, Elson S Floyd College of Medicine, Washington State University, United States
| | - Carolyn Noonan
- Institute for Research and Education to Advance Community Health, Elson S Floyd College of Medicine, Washington State University, United States
| | | | - Linda Son-Stone
- First Nations Community Healthsource, Albuquerque, NM, United States
| | - Spero M. Manson
- Centers for American Indian and Alaska Native Health, University of Colorado Anschutz Medical Campus, United States
| | - Dedra Buchwald
- Institute for Research and Education to Advance Community Health, Elson S Floyd College of Medicine, Washington State University, United States
| | - Richard MacLehose
- Department of Epidemiology and Community Health, University of Minnesota, School of Public Health, United States
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Jenabi E, Bashirian S, Salehi AM, Rafiee M, Bashirian M. Virtual reality for pain reduction during intravenous injection in pediatrics: a systematic review and meta-analysis of controlled clinical trials. Clin Exp Pediatr 2023; 66:533-537. [PMID: 37321586 PMCID: PMC10694551 DOI: 10.3345/cep.2022.01193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 03/07/2023] [Accepted: 04/17/2023] [Indexed: 06/17/2023] Open
Abstract
BACKGROUND Intravenous (IV) injections often cause pain, fear, and anxiety in pediatric patients. Virtual reality (VR) is a relatively new intervention that can be used to provide a distraction during or prepare patients for IV injections. PURPOSE To date, no meta-analysis has examined the evidence regarding the effectiveness of VR at reducing pain in pediatric IV injections. METHODS The PubMed, Web of Science, Scopus, and Cochrane Central Register of Controlled Trials databases were searched for articles published through August 7, 2022. The methodological quality of the studies was measured using the Delphi checklist. The chi-square test and the I2 statistic were used to assess heterogeneity across studies. A summary measure of the mean difference in pain scores between the VR and control groups was obtained using a random effects model. All statistical analyses were set at a significance level of 0.05 using Stata 14. RESULTS Nine studies were included in this meta-analysis of VR interventions used during IV injections in pediatric patients. The difference in mean pain score between the intervention and control groups showed significant reductions in the VR group (mean difference, 0.47; 95% confidence interval, 0.3-0.65; I2=9.1%). No interstudy heterogeneity was observed. CONCLUSION Our results suggest that VR effectively reduces pain associated with IV injections in pediatric patients. No interstudy heterogeneity was noted among the analyzed studies. The Delphi checklist was used to assess methodological quality.
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Affiliation(s)
- Ensiyeh Jenabi
- Autism Spectrum Disorders Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Saeid Bashirian
- Autism Spectrum Disorders Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Amir Mohammad Salehi
- Student Research Committee, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Masoud Rafiee
- Behavioral Disorders and Substance Abuse Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Mozhdeh Bashirian
- School for the Contemporary Arts, Simon Fraser University, Vancouver, Canada
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Murdan S, Wei L, van Riet-Nales DA, Gurmu AE, Usifoh SF, Tăerel AE, Yıldız-Peköz A, Krajnović D, Azzopardi LM, Brock T, Fernandes AI, dos Santos ALS, Anto BP, Vallet T, Lee EE, Jeong KH, Akel M, Tam E, Volmer D, Douss T, Shukla S, Yamamura S, Lou X, van Riet BH, Usifoh CO, Duwiejua M, Ruiz F, Furnham A. Association between culture and the preference for, and perceptions of, 11 routes of medicine administration: A survey in 21 countries and regions. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2023; 12:100378. [PMID: 38094713 PMCID: PMC10716026 DOI: 10.1016/j.rcsop.2023.100378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 11/04/2023] [Accepted: 11/22/2023] [Indexed: 03/07/2024] Open
Abstract
Medicines can be taken by various routes of administration. These can impact the effects and perceptions of medicines. The literature about individuals' preferences for and perceptions of the different routes of administration is sparse, but indicates a potential influence of culture. Our aim was to determine: (i) any association between one's culture and one's preferred route of medicine administration and (ii) individual perceptions of pain, efficacy, speed of action and acceptability when medicines are swallowed or placed in the mouth, under the tongue, in the nose, eye, ear, lungs, rectum, vagina, on the skin, or areinjected. A cross-sectional, questionnaire-based survey of adults was conducted in 21 countries and regions of the world, namely, Tunisia, Ghana, Nigeria, Turkey, Ethiopia, Lebanon, Malta, Brazil, Great Britain, United States, India, Serbia, Romania, Portugal, France, Netherlands, Japan, South Korea, Hong Kong, mainland China and Estonia, using the Inglehart-Welzel cultural map to ensure coverage across all cultures. Participants scored the pain/discomfort, efficacy, speed of onset and acceptability of the different routes of medicine administration and stated their preferred route. Demographic information was collected. A total of 4435 participants took part in the survey. Overall, the oral route was the most preferred route, followed by injection, while the rectal route was the least preferred. While the oral route was the most preferred in all cultures, the percentage of participants selecting this route varied, from 98% in Protestant Europe to 50% in the African-Islamic culture. A multinomial logistic regression model revealed a number of predictors for the preferred route. Injections were favoured in the Baltic, South Asia, Latin America and African-Islamic cultures while dermal administration was favoured in Catholic Europe, Baltic and Latin America cultures. A marked association was found between culture and the preference for, and perceptions of the different routes by which medicines are taken. This applied to even the least favoured routes (vaginal and rectal). Only women were asked about the vaginal route, and our data shows that the vaginal route was slightly more popular than the rectal one.
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Affiliation(s)
| | - Li Wei
- UCL School of Pharmacy, 29-39 Brunswick Square, London WC1N 1AX, UK
| | | | - Abyot Endale Gurmu
- Department of Pharmacognosy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Stella Folajole Usifoh
- Department of Clinical Pharmacy & Pharmacy Practice, Faculty of Pharmacy, University of Benin, Benin City, Nigeria
| | - Adriana-Elena Tăerel
- Faculty of Pharmacy, University of Medicine and Pharmacy “Carol Davila”, Bucharest, Romania
| | - Ayca Yıldız-Peköz
- Dept. of Pharmaceutical Technology, Faculty of Pharmacy, Istanbul University, Turkey
| | - Dušanka Krajnović
- Department of Social Pharmacy and Pharmaceutical Legislation, Faculty of Pharmacy, University of Belgrade, Belgrade, Serbia
| | - Lilian M. Azzopardi
- Department of Pharmacy, Faculty of Medicine and Surgery University of Malta, Msida, Malta
| | - Tina Brock
- Department of Clinical Pharmacy, UCSF School of Pharmacy, UCSF Box 0622, 521 Parnassus Ave, San Francisco 94143, USA
| | - Ana I. Fernandes
- Egas Moniz Center for Interdisciplinary Research (CiiEM), Egas Moniz School of Health & Science, 2829-511 Caparica, Almada, Portugal
| | | | - Berko Panyin Anto
- Dept of Clinical & Social Pharmacy, Faculty of Pharmacy & Pharmaceutical sciences, KNUST, Kumasi, Ghana
| | - Thibault Vallet
- ClinSearch, 110 Avenue Pierre Brossolette, 92240 Malakoff, France
| | | | | | - Marwan Akel
- School of Pharmacy, Lebanese International University, Lebanon
- Inspect-Lb (Institut National De Santé Publique, D'épidémiologie Clinique Et De Toxicologie-Liban), Beirut, Lebanon
| | - Eliza Tam
- Department of Pharmacology and Pharmacy, The University of Hong Kong, Hong Kong
| | - Daisy Volmer
- Institute of Pharmacy, Faculty of Medicine, University of Tartu, 50411 Tartu, Estonia
| | | | - Sharvari Shukla
- Symbiosis Statistical Institute, Symbiosis International (Deemed University), Pune, India
| | - Shigeo Yamamura
- Department of Biostatistics, Faculty of Pharmaceutical Sciences, Josai International University, Togane, Chiba, Japan
| | | | - Bauke H.G. van Riet
- Department of Radiotherapy, Netherlands Cancer Institute (at the time of participant recruitment in the Netherlands: MEB and VU University Medical Center), Amsterdam, the Netherlands
| | - Cyril O. Usifoh
- Department of Clinical Pharmacy & Pharmacy Practice, Faculty of Pharmacy, University of Benin, Benin City, Nigeria
| | - Mahama Duwiejua
- Dept of Clinical & Social Pharmacy, Faculty of Pharmacy & Pharmaceutical sciences, KNUST, Kumasi, Ghana
| | - Fabrice Ruiz
- ClinSearch, 110 Avenue Pierre Brossolette, 92240 Malakoff, France
| | - Adrian Furnham
- Dept Leadership and Orgnaisational Behaviour, Norwegian Business School, Norway
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Hockin BCD, Lucci VEM, Wu REY, Nicholas M, Parsons IT, Claydon VE. Pain associated with intravascular instrumentation reduces orthostatic tolerance and predisposes to vasovagal reactions in healthy young adults without needle phobia: a randomised controlled study. Clin Auton Res 2023; 33:673-689. [PMID: 37589875 DOI: 10.1007/s10286-023-00972-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 07/31/2023] [Indexed: 08/18/2023]
Abstract
PURPOSE Vasovagal syncope (VVS), or fainting, is frequently triggered by pain, fear, or emotional distress, especially with blood-injection-injury stimuli. We aimed to examine the impact of intravenous (IV) instrumentation on orthostatic tolerance (OT; fainting susceptibility) in healthy young adults. We hypothesized that pain associated with IV procedures would reduce OT. METHODS In this randomised, double-blind, placebo-controlled, cross-over study, participants (N = 23; 14 women; age 24.2 ± 4.4 years) underwent head-up tilt with combined lower body negative pressure to presyncope on three separate days: (1) IV cannulation with local anaesthetic cream (EMLA) (IV + EMLA); (2) IV cannulation with placebo cream (IV + Placebo); (3) sham IV cannulation with local anaesthetic cream (Sham + EMLA). Participants rated pain associated with IV procedures on a 1-5 scale. Cardiovascular (finger plethysmography and electrocardiogram; Finometer Pro), and forearm vascular resistance (FVR; brachial Doppler) responses were recorded continuously and non-invasively. RESULTS Compared to Sham + EMLA (27.8 ± 2.4 min), OT was reduced in IV + Placebo (23.0 ± 2.8 min; p = 0.026), but not in IV + EMLA (26.2 ± 2.2 min; p = 0.185). Pain was increased in IV + Placebo (2.8 ± 0.2) compared to IV + EMLA (2.0 ± 2.2; p = 0.002) and Sham + EMLA (1.1 ± 0.1; p < 0.001). Orthostatic heart rate responses were lower in IV + Placebo (84.4 ± 3.1 bpm) than IV + EMLA (87.3 ± 3.1 bpm; p = 0.007) and Sham + EMLA (87.7 ± 3.1 bpm; p = 0.001). Maximal FVR responses were reduced in IV + Placebo (+ 140.7 ± 19.0%) compared to IV + EMLA (+ 221.2 ± 25.9%; p < 0.001) and Sham + EMLA (+ 190.6 ± 17.0%; p = 0.017). CONCLUSIONS Pain plays a key role in predisposing to VVS following venipuncture, and our data suggest this effect is mediated through reduced capacity to achieve maximal sympathetic activation during orthostatic stress. Topical anaesthetics, such as EMLA, may reduce the frequency and severity of VVS during procedures requiring needles and intravascular instrumentation.
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Affiliation(s)
- Brooke C D Hockin
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, V5A 1S6, Canada
| | - Vera-Ellen M Lucci
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, V5A 1S6, Canada
| | - Ryan E Y Wu
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, V5A 1S6, Canada
| | - Michelle Nicholas
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, V5A 1S6, Canada
| | - Iain T Parsons
- Research and Clinical Innovation, Royal Centre for Defence Medicine, Birmingham, UK
- School of Cardiovascular Medicine and Sciences, King's College London, London, UK
| | - Victoria E Claydon
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, V5A 1S6, Canada.
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Einarsdóttir Egeland S, Lie HC, Woldseth EM, Korsvold L, Ruud E, Larsen MH, Viktoria Mellblom A. Exploring reported distress before and pain during needle insertion into a venous access port in children with cancer. Scand J Caring Sci 2023; 37:927-937. [PMID: 35076943 DOI: 10.1111/scs.13067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 01/05/2022] [Accepted: 01/08/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Venous access port is commonly used during cancer treatment in children, yet little is known about how children experience such needle insertion procedures. AIM To study distress before and pain after venous access port needle insertion among children and adolescents with cancer. A second aim was to explore associations between their self-report of procedure-related distress and pain with proxy reports by parents and nurses. METHOD The sample included 43 children/adolescents, aged 1-16 years with cancer, treated at two Norwegian university hospitals. The patient, parent(s), and the nurse performing the procedure completed developmentally appropriate 11-point distress and pain scales before and immediately after the venous access port procedure. Data were analysed using descriptive statistics and non-parametric correlations. ETHICAL ISSUES The ethical code of conduct was followed and conformed to the ethical guidelines adopted by the Regional Committee for Medicine and Health Research and the data protector officer at the hospitals. RESULTS For the youngest children (1-5 years), the median distress proxy score was 8 (range 0-9) and pain proxy score 4 (range 0-10). Median distress and pain scores for children aged 6-12 years were 3 (range 0-9) and 1 (range 0-10), respectively, and for the adolescents (age 13-16) 0 (range 0-6) and 1 (range 0-5), respectively. Patients' self-reported distress and pain correlated highly with parents' (distress: rho = 0.83, p < 0.001, pain: rho = 0.92, p < 0.001) and with nurses' proxy ratings (distress: rho = 0.89, p < 0.001, pain: rho = 0.88, p < 0.001). CONCLUSION There were individual age differences in experienced distress/pain associated with venous access port needle insertion, with a trend for younger children to experience higher levels of distress/ pain than the older children. Children's self-report of distress/ pain concurred with both parental and nurse proxy reports.
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Affiliation(s)
- Steinunn Einarsdóttir Egeland
- Department of Paediatric Oncology and Haematology, Division for Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
| | - Hanne Cathrine Lie
- Department of Behavioural Medicine, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Ellen Martha Woldseth
- Department of Pediatric Oncology Medicine and Haematology, Division for Pediatric and Adolescent Medicine, St.Olav's Hospital, University Hospital of Trondheim, Norway
| | | | - Ellen Ruud
- Department of Paediatric Oncology and Haematology, Division for Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway
| | - Marie Hamilton Larsen
- Department of Behavioural Medicine, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Oslo, Norway
- Lovisenberg Diaconal University College, Oslo, Norway
| | - Anneli Viktoria Mellblom
- Regional Centre for Child and Adolescent Mental Health Eastern and Southern Norway (RBUP), Oslo, Norway
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Marks KR, Oyler DR, Strickland JC, Jaggers J, Roberts MF, Miracle DK, Barnes C, Lei F, Smith A, Mackin E, Martin MC, Freeman PR. Bystander preference for naloxone products: a field experiment. Harm Reduct J 2023; 20:171. [PMID: 38017424 PMCID: PMC10685501 DOI: 10.1186/s12954-023-00904-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Accepted: 11/17/2023] [Indexed: 11/30/2023] Open
Abstract
BACKGROUND Bystander administration of naloxone is a critical strategy to mitigate opioid overdose mortality. To ensure bystanders' willingness to carry and administer naloxone in response to a suspected overdose, it is critical to select products for community distribution with the highest likelihood of being utilized. This study examines bystanders' preference for and willingness to administer three naloxone products approved by the FDA for bystander use and identify product features driving preference. METHODS The population was a convenience sample of individuals who attended the Kentucky State Fair, August 18-28, 2022, in Louisville, Kentucky. Participants (n = 503) watched a standardized overdose education and naloxone training video, rated their willingness to administer each of three products (i.e., higher-dose nasal spray, lower-dose nasal spray, intramuscular injection), selected a product to take home, and rated factors affecting choice. RESULTS After training, 44.4% chose the higher-dose nasal spray, 30.1% chose the intramuscular injection, and 25.5% chose the lower-dose nasal spray. Factors most influencing choice on a 10-point Likert scale were ease of use (9 [7-10]), naloxone dose (8 [5-10]), and product familiarity (5 [5-9]). CONCLUSIONS Bystanders expressed high willingness to administer all studied formulations of naloxone products. Product choice preference varied as a function of product features. As the number and variety of available products continue to increase, continuous evaluation of formulation acceptability, in addition to including individuals with lived experience who are receiving and administering overdose reversal agents, is critical to support adoption and save lives.
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Affiliation(s)
- Katherine R Marks
- Department of Behavioral Science, College of Medicine, University of Kentucky, Lexington, KY, USA.
- Department for Behavioral Health, Developmental and Intellectual Disabilities, Cabinet for Health and Family Services, 275 E. Main Street, Frankfort, KY, 40621, USA.
| | - Douglas R Oyler
- Department of Pharmacy Practice and Science, College of Pharmacy, University of Kentucky, Lexington, KY, USA
| | - Justin C Strickland
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jody Jaggers
- Kentucky Pharmacy Education and Research Foundation, Frankfort, KY, USA
| | - Monica F Roberts
- Substance Use Priority Research Area, University of Kentucky, Lexington, KY, USA
| | - Dustin K Miracle
- Department of Pharmacy Practice and Science, College of Pharmacy, University of Kentucky, Lexington, KY, USA
| | - Chase Barnes
- Kentucky Department for Public, Health Division of Public Health Protection & Safety, Frankfort, KY, USA
| | - Feitong Lei
- Department of Biostatistics, College of Public Health, University of Kentucky, Lexington, KY, USA
| | - Amanda Smith
- Department of Pharmacy Practice and Science, College of Pharmacy, University of Kentucky, Lexington, KY, USA
| | - Eric Mackin
- Department of Pharmacy Practice and Science, College of Pharmacy, University of Kentucky, Lexington, KY, USA
| | - Martika C Martin
- Kentucky Pharmacy Education and Research Foundation, Frankfort, KY, USA
| | - Patricia R Freeman
- Department of Pharmacy Practice and Science, College of Pharmacy, University of Kentucky, Lexington, KY, USA
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Nimbalkar SM, Thakkar FA, Thacker JP, Phatak AG, Shinde MK. Comparison of Sucrose vs. Swaddling in Pain Management during Birth Dose of Hepatitis B Vaccine: A Randomized Control Trial. Indian J Pediatr 2023:10.1007/s12098-023-04900-6. [PMID: 37991714 DOI: 10.1007/s12098-023-04900-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 10/05/2023] [Indexed: 11/23/2023]
Abstract
OBJECTIVES To evaluate the efficacy of pain management of 1 ml of 24% sucrose given orally compared to routine care given one minute before vaccination for reduction of pain. METHODS This double-blind randomized controlled trial included term neonates visiting Pediatric OPD for immunization. Neonates were randomly assigned into two groups (Group A- Sucrose, Group B- Swaddling). Commercially available sucrose solution (StayHappi solution 24%) was given in a dose of 1 ml to the neonates. Video recording of the neonate's facial expression was done during the procedure. Duration of cry, latency of onset of cry as well Modified Neonatal Facial Coding Score (MFCS) were the outcome variables. RESULTS The mean (SD) of birth weight and gestational age was 2729 (321.6) g and 38.24 (0.84) d, respectively. Analysis showed significant difference in total MFCS across the groups (P <0.001). Total MFCS was significantly lower in sucrose group [4.88 (1.07) vs. 7.17 (0.95)]. The duration of cry (in seconds) was also found to be significantly lower in sucrose group. CONCLUSIONS Administration of 1 ml 24% sucrose one minute prior to immunization is efficacious in pain management during injectable immunization.
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Affiliation(s)
- Somashekhar M Nimbalkar
- Department of Neonatology, Pramukhswami Medical College, Bhaikaka University, Charutar Arogya Mandal, Karamsad, India.
| | - Fenil A Thakkar
- Department of Pediatrics, Pramukhswami Medical College, Bhaikaka University, Charutar Arogya Mandal, Karamsad, India
| | - Jigar P Thacker
- Department of Pediatrics, Pramukhswami Medical College, Bhaikaka University, Charutar Arogya Mandal, Karamsad, India
| | - Ajay G Phatak
- Central Research Services, Pramukhswami Medical College, Bhaikaka University, Charutar Arogya Mandal, Karamsad, India
| | - Mayur K Shinde
- Central Research Services, Pramukhswami Medical College, Bhaikaka University, Charutar Arogya Mandal, Karamsad, India
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Duncanson E, Le Leu RK, Chur-Hansen A, Masotti T, Collins KL, Burke ALJ, Macauley LP, McDonald S, Jesudason S. Nephrology nurses' perspectives working with patients experiencing needle-related distress. J Ren Care 2023. [PMID: 37975628 DOI: 10.1111/jorc.12483] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 10/25/2023] [Accepted: 10/27/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND A key skill of nephrology nursing is cannulation of patients receiving haemodialysis. Traumatic and unsuccessful cannulation experiences, particularly in the initial weeks of haemodialysis, may contribute to the onset of needle distress for patients. OBJECTIVES To identify the key knowledge, skills and attitudes of nephrology nurses working with haemodialysis patients and the competencies relevant to nephrology nursing working with patients with needle-related distress. DESIGN A qualitative study involving semistructured interviews. Interviews were audio-recorded, transcribed and deductive, and inductive thematic analysis applied. PARTICIPANTS Nephrology nurses (n = 17) were interviewed from a tertiary kidney service in South Australia. Nurses had varying roles and years of experience (range 1-30 years) working with dialysis patients within the service. RESULTS Two overarching themes, (1) Flexibility in Practice and Care and (2) Responsibility of Nephrology Nursing, were identified as relevant across all knowledge, skills and attitudes of nephrology nurses working with patients with needle-related distress. Thirty-six knowledge, skills and attitudes were identified; 12 related to knowledge, 14 related to skills and 10 were identified as attitudes and were summarised under seven broad competencies. CONCLUSION This study identifies potential knowledge, skills and attitudes and competencies required for nephrology nurses working with patients with needle-related distress. It highlights strategies that may prevent the onset and worsening of needle-related distress, as well as reduce it. It also brings to light that nurses desire additional education regarding strategies to improve the patient experience of cannulation and nurse confidence and skill in this area.
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Affiliation(s)
- Emily Duncanson
- Central and Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide, South Australia, Australia
- Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
- Australia and New Zealand Dialysis and Transplant Registry, Adelaide, South Australia, Australia
| | - Richard K Le Leu
- Central and Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide, South Australia, Australia
- Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - Anna Chur-Hansen
- School of Psychology, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - Tahlia Masotti
- School of Psychology, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - Kathryn L Collins
- School of Psychology, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
- Psychology Department, Central Adelaide Local Health Network, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Anne L J Burke
- School of Psychology, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
- Psychology Department, Central Adelaide Local Health Network, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Luke P Macauley
- School of Psychology, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - Stephen McDonald
- Central and Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide, South Australia, Australia
- Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
- Australia and New Zealand Dialysis and Transplant Registry, Adelaide, South Australia, Australia
| | - Shilpanjali Jesudason
- Central and Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide, South Australia, Australia
- Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
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Girgin BA, Göl İ, Gözen D, Çarikçi F, Kirmizibekmez H. Effects of applications manual pressure and shotblocker to reduce needle-related pain and fear in children with type 1 diabetes mellitus. J Pediatr Nurs 2023; 73:84-90. [PMID: 37651942 DOI: 10.1016/j.pedn.2023.08.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 08/05/2023] [Accepted: 08/24/2023] [Indexed: 09/02/2023]
Abstract
BACKGROUND Pain and fear associated with insulin injections can cause children with type 1 diabetes mellitus to avoid insulin injections and skip doses. OBJECTIVE To evaluate and compare pain and fear levels in children aged 6-12 years receiving subcutaneous insulin injection using the manual pressure and ShotBlocker methods. METHODS A randomized controlled study was conducted with 90 children with type 1 diabetes who were allocated using block randomization to the manual pressure, ShotBlocker, and control groups (n = 30 in each group). Fear and pain levels were rated by the children, their parents, and a member of the study team immediately before and after insulin injection using the Children's Fear Scale and Wong-Baker Faces Pain Rating Scale, respectively. RESULTS All groups had similar self-, parent-, and researcher-reported levels of preprocedural pain and fear (p > 0.05). However, pain and fear scores were lower in the manual pressure and ShotBlocker groups than in the control group after injection (p = 0.0001). There was no significant difference in pain and fear scores between the two intervention groups (p > 0.05). CONCLUSION Manual pressure and the ShotBlocker both reduced fear and pain associated with insulin injection in 6- to 12-year-old children with type 1 diabetes. IMPLICATIONS FOR PRACTICE Both the manual pressure and ShotBlocker methods can easily be applied in children receiving insulin injections. As manual pressure is completely cost- and equipment-free, it is a useful option to reduce pain and fear related to insulin injection. CLINICAL TRIAL REGISTRATION NUMBER National Institutes of Health (NIH), ClinicalTrials.gov, NCT05789810.
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Affiliation(s)
- Burcu Aykanat Girgin
- University of Health Sciences, Hamidiye Faculty of Nursing, Department of Pediatric Nursing, Tıbbiye Cad. No:38 Haydarpaşa, Üsküdar, Istanbul, Turkey.
| | - İlknur Göl
- Çankırı Karatekin University, Faculty of Health Sciences, Nursing Department of Public Health Nursing, Uluyazı, Çankırı, Turkey
| | - Duygu Gözen
- İstanbul University-Cerrahpaşa, Florence Nightingale Faculty of Nursing, Pediatric Nursing Department, Turkey
| | - Fatma Çarikçi
- İstanbul Yeni Yüzyıl University, Vocational School of Health Sciences, İstanbul, Turkey
| | - Heves Kirmizibekmez
- İstanbul Ümraniye Research and Training Hospital, Pediatric Endocrinology Service, Ümraniye, Turkey
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Azfr Ali R, Jalal Z, Chandan JS, Subramanian A, Adderley NJ, Nirantharakumar K, Gokhale KM, Paudyal V. Cardiometabolic screening and monitoring in patients prescribed antipsychotic drugs in primary care: A population-based cohort study. Compr Psychiatry 2023; 127:152419. [PMID: 37717342 DOI: 10.1016/j.comppsych.2023.152419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 09/01/2023] [Accepted: 09/04/2023] [Indexed: 09/19/2023] Open
Abstract
BACKGROUND This study aimed to investigate the level of guideline adherence for cardiometabolic health monitoring for patients prescribed antipsychotic medicines in UK primary care. METHODS In this population-based retrospective open cohort study, we used dataset of patients from the IQVIA Medical Research Data (IMRD) database between 1st January 2003 to 31st December 2018. Clinical Read codes were used to identify a cohort of adult patients with a diagnosis of Schizophrenia and at least four prescriptions of an anti-psychotic medication within 12 months of diagnosis. We then extracted data in relation to monitoring of cardiometabolic parameters (body compositions, lipids, and glucose outcomes) at baseline, then at six weeks, 12 weeks, and then 12 months. The frequency of outcome monitoring was described using descriptive statistics. FINDINGS A total of 11,435 patients were eligible and of them (n = 9707; 84·8%) were prescribed second-generation antipsychotics (SGAs). Only a small portion of the cohort (≈2·0%) received complete monitoring (at time points) for certain outcomes. Just over half the patients (n = 6599, 52%) had evidence of any cardiometabolic baseline testing for any of the study outcomes and the high majority had at least one abnormal lab value at baseline (n = 4627, 96·7%). INTERPRETATION In UK primary care, cardiometabolic monitoring practices among patients prescribed antipsychotics remain suboptimal. There is a need to promote guideline adherence to prevent adverse outcomes in antipsychotic users.
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Affiliation(s)
- Ruba Azfr Ali
- School of Pharmacy, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK; Clnical Pharmacy Department, Schoolof Pharmacy, Umm Al Qura University, Makkah, KSA
| | - Zahraa Jalal
- School of Pharmacy, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
| | - Joht Singh Chandan
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | | | - Nicola J Adderley
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | | | - Krishna M Gokhale
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Vibhu Paudyal
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK.
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Chiang N, Sibbald C, Levy R, Lara-Corrales I. Hidradenitis Suppurativa in Children and Adolescents: An Update on Pharmacologic Treatment Options. Paediatr Drugs 2023; 25:659-676. [PMID: 37782437 DOI: 10.1007/s40272-023-00595-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/11/2023] [Indexed: 10/03/2023]
Abstract
Hidradenitis suppurativa (HS) is a chronic, recurrent, inflammatory skin condition that manifests as painful, deep-seated, inflamed nodules and abscesses in the axillary, groin, perianal, perineal, and inframammary regions. The associated pain, malodour, and disfigurement contribute to its profound negative impact on psychosocial spheres and overall quality of life in affected individuals. Although the symptoms of HS classically begin in the second or third decade of life, HS affects children and adolescents as well. Despite this, there are limited pediatric data on treatment, which are largely based on expert opinion, extrapolation of efficacy data in adults with HS, and safety information from medication use in other pediatric diseases. On this basis, there exist several pharmacological modalities in the treatment of children and adolescents with HS including topical therapies, systemic therapies, and biologics. The goals of this review article are to: (1) review the efficacy of different pharmacological treatment modalities in children and adolescents with HS, and (2) review the safety and monitoring considerations of the different treatment options in children and adolescents with HS.
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Affiliation(s)
- Nicholas Chiang
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Cathryn Sibbald
- Division of Dermatology, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
| | - Rebecca Levy
- Division of Dermatology, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
| | - Irene Lara-Corrales
- Division of Dermatology, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, ON, M5G 1X8, Canada.
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Sugai K, Shikuma J, Hiroike S, Abe H, Suzuki R. Successful introduction of sensor-augmented pump therapy in a patient with diabetes and needle phobia: A case report. J Diabetes Investig 2023; 14:1318-1320. [PMID: 37494142 PMCID: PMC10583640 DOI: 10.1111/jdi.14061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 07/11/2023] [Accepted: 07/13/2023] [Indexed: 07/28/2023] Open
Abstract
Needle phobia is a specific phobia classified as an anxiety disorder in the Diagnostic and Statistical Manual of Mental Disorders-5, and can be a serious problem for patients requiring insulin injections. However, there have been few reports to date on the management of adults with diabetes and needle phobia. We here report a case of a woman with pancreatic diabetes who developed needle phobia and could no longer perform self-injections. She started to use a sensor-augmented pump (SAP), and was able to perform a puncture for the insulin pump and the continuous glucose monitoring sensor by herself. The SAP treatment achieved self-management, better glycemic control, and high treatment satisfaction quantified using the Diabetes Treatment Satisfaction Questionnaire in this patient. Our case suggests the therapeutic potential of SAP in adults with needle phobia and diabetes requiring insulin therapy.
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Affiliation(s)
- Keiji Sugai
- Department of Diabetes, Metabolism and EndocrinologyTokyo Medical University HospitalTokyoJapan
| | - Junpei Shikuma
- Department of Diabetes, Metabolism and EndocrinologyTokyo Medical University HospitalTokyoJapan
| | - Satoshi Hiroike
- Department of Diabetes, Metabolism and EndocrinologyTokyo Medical University HospitalTokyoJapan
| | - Hironori Abe
- Department of Diabetes, Metabolism and EndocrinologyTokyo Medical University HospitalTokyoJapan
| | - Ryo Suzuki
- Department of Diabetes, Metabolism and EndocrinologyTokyo Medical University HospitalTokyoJapan
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Perry C, Alsbrooks K, Mares A, Hoerauf K. Comparison of Clinical, Economic, and Humanistic Outcomes Between Blood Collection Approaches: A Systematic Literature Review. J Healthc Qual 2023; 45:359-370. [PMID: 37788441 PMCID: PMC10624413 DOI: 10.1097/jhq.0000000000000399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
BACKGROUND A systematic literature review was performed to understand the prevalence, advantages, and disadvantages of blood collection using different approaches (direct venipuncture or vascular access devices), and interventions used to mitigate the disadvantages. METHODS The review included a broad range of study designs and outcomes. Database searches (Embase, MEDLINE, Cochrane library, and Centre for Reviews and Dissemination) were conducted in March 2021 and supplemented by hand searching. RESULTS One hundred forty-one publications were included. The data indicate that blood sampling from vascular access devices is common in emergency departments, trauma centers, and intensive care units. Studies showed that hemolysis and sample contamination place a considerable economic burden on hospitals. Significant cost savings could be made through enforcing strict aseptic technique, or using the initial specimen diversion technique. CONCLUSIONS Hemolysis and sample contamination are far from inevitable in vascular access device-collected or venipuncture samples; both can be reduced through adherence to strict blood sampling protocols and utilization of the initial specimen diversion technique. Needle-free blood collection devices offer further hope for reducing hemolysis. No publication focused on the difficult venous access population; insertion success rates are likely to be lower (and the benefits of vascular access devices higher) in these patients.
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