Premedication With Single Dose of Acetazolamide for the Control of Referral Shoulder Pain After Laparoscopic Cholecystectomy

The impact of magnesium on shivering incidence in cardiac surgery patients: A systematic review

Background and objective

This scientific review involves a sequential analysis of randomized trial research focused on the incidence of shivering in patients undergoing cardiac surgery. The study conducted a comprehensive search of different databases, up to the end of 2020. Only randomized trials comparing magnesium administration with either placebo or no treatment in patients expected to experience shivering were included. The primary objective was to evaluate shivering occurrence, distinguishing between patients receiving general anesthesia and those not. Secondary outcomes included serum magnesium concentrations, intubation time, post-anesthesia care unit stay, hospitalization duration, and side effects. Data collection included patient demographics and various factors related to magnesium administration.

Material and methods

This scientific review analyzed 64 clinical trials meeting inclusion criteria, encompassing a total of 4303 patients. Magnesium was administered via different routes, primarily intravenous, epidural, and intraperitoneal, and compared against placebo or control. Data included demographics, magnesium dosage, administration method, and outcomes. Heterogeneity was assessed using the I2 statistic. Some studies were excluded due to unavailability of data or non-responsiveness from authors.

Result

and discussion: Out of 2546 initially identified articles, 64 trials were selected for analysis. IV magnesium effectively reduced shivering, with epidural and intraperitoneal routes showing even greater efficacy. IV magnesium demonstrated cost-effectiveness and a favorable safety profile, not increasing adverse effects. The exact dose-response relationship of magnesium remains unclear. The results also indicated no significant impact on sedation, extubation time, or gastrointestinal distress. However, further research is needed to determine the optimal magnesium dose and to explore its potential effects on blood pressure and heart rate, particularly regarding pruritus prevention.

Conclusion

This study highlights the efficacy of intravenous (IV) magnesium in preventing shivering after cardiac surgery. Both epidural and intraperitoneal routes have shown promising results. The safety profile of magnesium administration appears favorable, as it reduces the incidence of shivering without significantly increasing costs. However, further investigation is required to establish the ideal magnesium dosage and explore its potential effects on blood pressure, heart rate, and pruritus prevention, especially in various patient groups.

Systematic Review and Meta-Analysis of Perioperative Administration of Acetazolamide for Management of Postoperative Pain after Laparoscopy

Background and Objective

To perform a systematic review and meta-analysis to evaluate the efficacy of perioperative acetazolamide (ACTZ) administration with laparoscopy for reducing postoperative referred pain.

Methods

The following databases were searched from inception to March 1, 2020: Cochrane, PubMed, PubMed Central, Ovid, and Embase. Electronic search used: Acetazolamide AND (laparoscopy OR laparoscopic OR Celioscopy OR Celioscopies OR Peritoneoscopy OR Peritoneoscopies). No limits or filters were used. We included only studies of patients who underwent abdominal laparoscopy (LSC), had a pain assessment at approximately 24 hours postoperatively, and included a treatment with ACTZ group and a no-treatment or minimal-treatment comparison group.

Results

Five studies met inclusion criteria, with a combined total of 253 participants, 116 in the ACTZ group and 137 in the control group. A Bayesian hierarchical model was assumed for the study specific treatment effects. Posterior sampling was conducted via Markov Chain Monte Carlo methods, and posterior inference carried out on the hierarchical treatment effect. ACTZ significantly decreased average pain scores compared to control group by -0.726 points (95% confidence interval -1.175-0.264). The posterior probability that ACTZ decreases mean pain scores by ≥ 0.5 was 0.846.

Conclusion

Current available evidence demonstrates that perioperative ACTZ may provide a modest improvement in postoperative referred pain following LSC.

Drug Repurposing to Target Neuroinflammation and Sensory Neuron-Dependent Pain

Around 20% of the American population have chronic pain and estimates in other Western countries report similar numbers. This represents a major challenge for global health care systems. Additional problems for the treatment of chronic and persistent pain are the comparably low efficacy of existing therapies, the failure to translate effects observed in preclinical pain models to human patients and related setbacks in clinical trials from previous attempts to develop novel analgesics. Drug repurposing offers an alternative approach to identify novel analgesics as it can bypass various steps of classical drug development. In recent years, several approved drugs were attributed analgesic properties. Here, we review available data and discuss recent findings suggesting that the approved drugs minocycline, fingolimod, pioglitazone, nilotinib, telmisartan, and others, which were originally developed for the treatment of different pathologies, can have analgesic, antihyperalgesic, or neuroprotective effects in preclinical and clinical models of inflammatory or neuropathic pain. For our analysis, we subdivide the drugs into substances that can target neuroinflammation or substances that can act on peripheral sensory neurons, and highlight the proposed mechanisms. Finally, we discuss the merits and challenges of drug repurposing for the development of novel analgesics.

Development and validation of a cultural competence questionnaire for health promotion of Iranian midwives

INTRODUCTION

Cultural competence is the main component of cultural care; therefore, it is necessary to be aware of its levels. The lack of a suitable tool that can measure cultural competence levels among midwives led us to carry out the present study aiming to develop and validate a cultural competence questionnaire for health promotion of Iranian midwives.

METHODOLOGY

This methodological study was performed on 302 midwives selected through three-stage cluster sampling method in 2018 in East Azarbaijan Province. The initial tool was designed after qualitative study and searching similar studies. Then, the tool validity was assessed through evaluating the face and content validity in midwives and performing survey and psychometrics. Finally, the data were statistically analyzed by SPSS version 19 through exploratory factor analysis, item analysis, Cronbach's alpha coefficient, and Pearson correlation, at the significant level of <0.05.

RESULTS

The initial tool was constructed with 42 items in the five-point Likert scale. By eliminating 9 items during face and content validation and 6 items during factor analysis, the final 25-item questionnaire was developed in five areas of theoretical and practical learning, clinical application, cultural skill, cultural excellence, and cultural competence. According to Cronbach's alpha, reliability of the tool was at a good level (0.889) with a confidence interval of 0.95 (P < 0.001).

CONCLUSION

The cultural competence questionnaire for Iranian midwives, with five-factor verification and acceptable validity and reliability can be used in studies considering the components of Iranian culture.

Design and psychometrics cultural competence questionnaire for health promotion of Iranian nurses

INTRODUCTION

As an important factor in the quality of nursing care, cultural competence of nurses should be assessed to improve the quality of care provided. Nursing care is sensitive to culture; therefore, it is necessary to design a tool for evaluation of cultural competence. In this regard, the present study intended to develop a cultural competence questionnaire for Iranian nurses.

MATERIALS AND METHODS

In this methodological study, 350 nurses working in all educational hospitals affiliated to Tabriz University of Medical Sciences were selected through convenience sampling. Questions related to cultural care were selected by experts of this field, and a questionnaire was designed and its validity and reliability were examined.

RESULTS

A 20-item questionnaire was developed which assessed the three areas of learning and education, awareness and knowledge, and skills. Cronbach's alpha of the whole questionnaire was 0.912, and its validity based on the Kaiser-Mayer-Olkin Index was 0.891.

CONCLUSION

This study provides proper evidence regarding the strength of factor structure and the reliability of the developed questionnaire; therefore, it can be considered as a scientific tool for research, educational, and practical purposes in Iranian nurses.