Healthcare providers perspective of chronic pain management in persons with traumatic spinal cord injury accessing the public system in a region of South Africa

PURPOSE

Persons with traumatic spinal cord injury (PWTSCI) have expressed a lack of education from healthcare providers and poor shared-decision making between providers and clients. The aim was to explore the healthcare providers' perspective on factors influencing the optimal management of chronic pain.

METHODS

Healthcare providers were recruited from two institutions at tertiary healthcare level. Interviews explored current chronic pain management practices, influencing factors and recommendations for improvement. Data saturation occurred after interviewing 11 participants. Thematic analysis was used through a socio-ecological model.

RESULTS

The challenges to optimal pain management include appropriate assessment and management of psychological health (intrapersonal level), substance abuse amongst patients (intrapersonal level), access to medication for providers and lack of knowledge by providers (interpersonal and organizational level). To improve chronic pain management, an interdisciplinary team approach should be operationalized at policy and organizational level, monitoring and adjustment of interventions should take place (interpersonal), and family members/caregivers should be involved in the planning and monitoring (interpersonal).

CONCLUSION

Factors, at the interpersonal, intrapersonal, organizational and policy levels, influence optimal chronic pain management in the traumatic spinal cord injury (TSCI) population. To mitigate challenges, guidelines for chronic pain management should be developed, particularly for low-resourced developing countries.

Prevalence of Orthopedic Pains in Children and Adolescents: A Systematic Review and Meta-analysis

Context

Musculoskeletal disorders are among the main causes of death and disability and can impose high costs on individuals and countries. Considering the importance of pain, the present meta-analysis study aimed to investigate the prevalence of orthopedic pains in Iranian children and adolescents.

Methods

The present study was reported in line with PRISMA. The searching process was carried out using keywords, including adolescents, pain, youth, school-age children, shoulder pain, neck pain, shoulder, and neck, AND/OR operators for the articles published during 2000 and 2022 in Scopus, Embase, PubMed, Scientific Information Database, Magiran, International Statistical Institute, and Islamic World Science Citation Center databases. This study reviewed the articles that reported the prevalence of orthopedic pains (i.e., wrists/hands, shoulders, elbows, and knees) among the 5-18-year age group in Iran and extracted their results. Two researchers conducted the search quite independently and extracted the necessary data using a researcher-made checklist. The collected data were analyzed using Comprehensive Meta-Analysis software (CMA3).

Results

Initially, 418 articles were identified, and 14 articles were entered into the systematic review stage. The prevalence rates of pains related to wrists/hands, shoulders, elbows, and knees were 6.6 (95% confidence interval [CI]: 3.2 - 13.0), 26.9 (95% CI: 17.0 - 39.7), 2.9 (95% CI: 1.3 - 6.3), and 6.6 (95% CI: 3.0 - 14.2), respectively.

Conclusions

The prevalence of shoulder and knee pains in individuals under 18 years in Iran was high. Therefore, it is necessary to make necessary interventions and take preventive measures.

Clinical and demographic predictors of symptoms of depression and anxiety in patients with spinal cord injury

Spinal Cord Injury (SCI) is a condition whose consequences can impact the physical, emotional, and social aspects of patient's life, including Depression and Anxiety disorders.

STUDY DESIGN

Using a cross-sectional design, sociodemographic and clinical data were extracted from 556 SCI patients at the time of initial assessment, prior to intensive rehabilitation treatment at the local rehabilitation institute.

OBJECTIVES

Identify the predictive and multivariate relationship between different sociodemographic and clinical variables of Depression and Anxiety symptoms in SCI patients.

SETTING

Lucy Montoro Rehabilitation Institute (LMRI), University of Sao Paulo, Sao Paulo, Brazil.

METHODS

We performed independent univariate and multivariate regression models using the Hospital Anxiety and Depression Scale (HADS) as dependent variable.

RESULTS

Symptoms of depression and anxiety present in SCI patients negatively correlate with the level of independence for locomotion, personal hygiene, bowel control, social interaction measured by the Functional Independence Scale (FIM), type of medication in use and the Language subtest of the MoCA Scale. Unlike previous studies, we did not find a relationship with the use of alcohol and illicit drugs, injury levels, etiological diagnosis or duration of injury. For the anxiety models, the main predictor was Depression symptoms, with SCI-related aspects not being significant. It was found that characteristics of the FIM Scale and cognitive aspects of the MoCA Scale were the main predictors of symptoms of Depression. Characteristics of the injury and motor deficit were not statistically significant.

CONCLUSIONS

These findings can potentially be used to guide clinical practices to identify patients at higher risk of experiencing symptoms of Depression and Anxiety.

The Relationship Between Observing Religious Beliefs and Suffering in Hemodialysis Patients

Chronic renal failure is an advanced and irreversible renal dysfunction. It is also one of the common health problems in the world. Therefore, the aim of this study was to investigate the relationship between observing religious beliefs and suffering in hemodialysis patients. This descriptive-correlational study was performed on 130 hemodialysis patients attending the hospitals of Gonbad Kavous city, Iran. Data collection tools included the temple observing religious beliefs questionnaire and Scholz's experience and perception of suffering questionnaire. The data after collected were entered into SPSS software version 16 to be analyzed using descriptive statistics. This study showed high level of belief in religious practices with the mean and standard deviation of 72.16 ± 11.36 and the level of suffering with 37.28 ± 6.94. Spearman's correlation coefficient showed a significant difference between observing religious beliefs and suffering (r = - 0.18, P = 0.03), so that with the increase in belief in religious practice, the level of patients' suffering decreased. Nurses are required to take the necessary interventions to improve the spiritual and religious dimension of patients.

EMDR as Treatment Option for Conditions Other Than PTSD: A Systematic Review

Eye Movement Desensitisation and Reprocessing (EMDR) is a treatment for post-traumatic stress disorder (PTSD). The technique is known to facilitate reprocessing of maladaptive memories that are thought to be central to this pathology. Here we investigate if EMDR therapy can be used in other conditions. We conducted a systematic literature search on PubMed, ScienceDirect, Scopus, and Web of Science. We searched for published empirical findings on EMDR, excluding those centred on trauma and PTSD, published up to 2020. The results were classified by psychiatric categories. Ninety articles met our research criteria. A positive effect was reported in numerous pathological situations, namely in addictions, somatoform disorders, sexual dysfunction, eating disorders, disorders of adult personality, mood disorders, reaction to severe stress, anxiety disorders, performance anxiety, Obsessive-Compulsive Disorder (OCD), pain, neurodegenerative disorders, mental disorders of childhood and adolescence, and sleep. Some studies reported that EMDR was successful in usually uncooperative (e.g., Dementia) or unproductive cases (e.g., aphasia). Moreover, in some severe medical conditions, when psychological distress was an obstacle, EMDR allowed the continuation of treatment-as-usual. Furthermore, the effects observed in non-pathological situations invite for translational research. Despite a generally positive outlook of EMDR as an alternative treatment option, more methodologically rigorous studies are needed. We discuss the advantages and limitations and possible implications for the hypothesised mechanisms of action.

The Effect of Religion Therapy on the Elderly Cognitive Status

The elderly is passing from a stage to another new stage of life, with cognitive changes and a reduction in the physiological functions of this age. With increasing age, spiritual needs and attitudes increase. So, this study was conducted aimed to investigate the effect of group spiritual therapy on the cognitive state of the elderly. This experimental study was conducted in two experimental and control groups on 50 elderly people in Golestan Province in 2012, by simple random sampling. Data collection tool was Mini-Mental State Examination. In the experimental group, eight group therapy sessions were performed for 45-60 min a week twice. The data were analyzed by software SPSS-16 using descriptive statistics (mean score and SD) and inferential statistics (paired t test, independent t test and covariance test). Independent t test before the intervention in both groups showed no significant difference (P = 0.52). But this test showed a significant difference after the intervention (P < 0.01). Also, ANCOVA test showed a significant difference in both groups (η = 0.26) (P < 0/01) . Regarding the effect of group spiritual therapy on the cognitive state of the elderly, it can be used as a complementary, low cost and effective method for improving the cognitive state of the elderly. For this reason, it is recommended because spiritual therapy creates the concept and meaning of life and increases the life expectancy and quality of life in the elderly.

Investigating the Relationship between Religious Beliefs with Care Burden, Stress, Anxiety, and Depression in Caregivers of Patients with Spinal Cord Injuries

Spinal cord injury (SCI) is one of the most severe diseases associated with the central nervous system of the individuals, which can lead to disability in the patient. The aim of the present study was to determine the relationship between religious beliefs with CG, depression, anxiety and stress (DAS) in caregivers of patients with SCI in the city of Ilam, Iran. This is a descriptive-analytic article, and the study population were caregivers of patients with SCI. A sample size of 150 patients was selected according to previous studies. The questionnaires used for data collection included Religious Coping Questionnaire (RC), Caregiver Questionnaire (CG), and Depression, Anxiety and Stress Scale-21 (DASS-21) Items. In this study, caregivers of patients with SCI were included in the study using convenience sampling method in Ilam city. The researchers identified patient caregivers who met the inclusion criteria. The research objectives were described for caregivers, and the questioners were initiated if caregivers were willing to participate in the study. Literate caregivers completed questionnaires through interviews, and trained questioners completed for illiterate caregivers in the same way (interviewing). Data were analyzed using spss 16 statistical software, and descriptive and analytical methods were used for statistical analysis. According to the findings, the mean (SD) of RC is 18.41 (2.73), negative RC is 7.05 (2.06), positive RC is 11.36 (1.89), stress is 10.78 (6.27), anxiety is 10.12 (5.58), depression is 10.50 (3.08), and CG is 78.16 (27.09). There is a significant relationship between RC levels with stress (P = 0.000, F = 40.565), anxiety (P = 0.000, F = 45.300), and CG (P = 0.000, F = 37.332), but there was no relationship between the RC level with depression status (P = 0.42, F = 0.634). Considering that religion can affect the level of CG, stress, and anxiety of the caregivers of the patients, it is suggested to provide necessary conditions to improve the health status of caregivers of patients with SCI by improving the religion status in patients and performing appropriate interventions in this regard.

The Relationship Between Spiritual Health and Religious Coping with Death Anxiety in the Elderly

The elderly is a period of life when a person reaches the age of 65 years. This study aimed to determine the relationship between spiritual health and religious coping with the death anxiety in the elderly people. The study is a descriptive cross-sectional study: 180 Elderly according to similar studies. Data gathering tools are Paloutzain and Ellison SH questionnaire, religious coping questionnaire and death anxiety questionnaire. SPSS16 and descriptive and analytical tests were used; there was a relationship between religious health and religious coping with the anxiety (p < 0.05).The M(SD) religious health is 39.25 (11.67), existential health is 40.50 (11.29), total spiritual health is 79.75 (22.03), and also the M(SD) religious coping is 23.84 (5.02). Considering the relationship between RC and SH with DA in the elderly, it is necessary to make the necessary spiritual-religious arrangements to reduce DA.

Comparison of the effect of self-care education in a disaster with two student-centered and family-centered approaches to self-care in students

Objectives The purpose of this research was to compare the effect of self-care education in disasters with two student-centered and family-centered approaches to self-care in students of the Red Crescent Societies in the city of Lenjan in 2017. Methods One hundred and fifty individuals were selected by random sampling from 270 people. The research instrument was a questionnaire. The questionnaire was approved by the opinion of supervisors and other experts. The present research is a quasi-experimental study. The covariance analysis was used to determine the difference between the two groups in the experimental and control groups and the effect of educational intervention. All of the above steps were performed using the SPSS 23 statistical program. Results The results indicate that there is a significant difference between the two groups in self-care through the student-centered approach. The mean of the self-care group with a family-centered approach (21.72) was more than the mean of the control group in this variable (16.61). Moreover, the mean of the self-care group's education with family-centered approaches (42.61) was more than the mean of self-care education h in a disaster with a student-centered approach (31.23). Conclusion According to the results of this study, it can be concluded that there is a significant difference between self-care education with two student-centered and family-based approaches to self-care in students, and a family-centered approach has better outcomes.

Effect of acupressure on post tonsillectomy pain in adolescents: a randomized, single-blind, placebo-controlled trial study

Introduction Tonsillectomy is one of the most common pediatric surgeries in the world and pain control following tonsillectomy is very important. Objective The aim of this study is to investigate the effect of acupressure on the amount of pain following tonsillectomy in children. Method One hundred and forty-four children aged 5-12 years old were assigned into one of three groups: interventions, control and placebo. In the intervention group, acupressure was applied at three acupoints and in the placebo group, sham acupressure was applied. In the control group routine care only was applied. Results There was a significant difference between an average of changes in pain score before and after the intervention during the 3 time periods after the tonsillectomy operation in the acupressure group (p = 0.002). Conclusion The results showed that acupressure had a positive effect on pain reduction after tonsillectomy in children in the intervention group.

The effect of rational-emotive behavior therapy on anxiety and resilience in students

BACKGROUND

Adolescence and youth are important periods in the growth and excellence of an individual.

OBJECTIVES

Given the importance of the study, its purpose was to determine the effect of rational-emotive behavior therapy (REBT) on anxiety and resilience in students.

METHODS

Students admitted to the counseling centers of Ilam University were randomly assigned to experimental and control groups. Using convenient sampling method, 30 subjects were selected and randomly assigned to either REBT tests or a control group (10 subjects in each). The 26 codes of ethics were observed in the study and the data were analyzed using SPSS17.

RESULTS

Before the intervention, the anxiety score was 26.75 (4.43) and after the intervention it was 18 (4.403) (p < 0.05), but in the control group it was 31.34 (6.04) before the intervention and after the intervention it was 32.35 (5.17) (p > 0.05). Before the intervention, the anxiety score was 52.77 (13.37) and after the intervention it was 60.00 (14.31) (p < 0.05), but in the control group it was 47.00 (8.73) before the intervention and after the intervention it was 49.76 (9.10) (p > 0.05).

CONCLUSIONS

REBT was effective in students as it reduced anxiety and increased resilience. Thus, it is suggested for use in students' care.

The effect of acceptance and commitment therapy on the mental health of students with an emotional breakdown

Background Mental health is a significant part of one's health and it is very important to pay attention to mental health. Objectives The aim of the study was to examine the effect of acceptance and commitment therapy (ACT) on the mental health of adolescents with an emotional breakdown (EB). Methods This was a semi-experimental study, in which the students with an EB were divided into two groups: the experimental and control groups. Twenty people were selected using the convenience sampling method and randomly assigned to the ACT and control groups (each with 10 people). After obtaining consent to participate in the study, they were asked to fill the questionnaires as a pre-test. Then, the experimental group was treated for nine individual sessions (weekly one session). As this was a repeated measurement method, in sessions 3, 6 and 9, the questionnaires were completed again and the follow-up period was 1 month after the end of the interventions. Results Before the intervention, there was no difference between the score of the impact of love and rumination among the students in the experimental and control groups (p > 0.05); but after the intervention, the score of the impact of love and rumination in the experimental group decreased (p < 0.05). Conclusions It is suggested that ACT should be used at counseling centers of universities and educational institutions.

The effect of acupuncture on postoperative pain, nausea and vomiting after pediatric tonsillectomy: a systematic review

INTRODUCTION

Tonsillectomy is one of the most commonly performed surgical procedures among children around the world and management of post tonsillectomy complications are very important.

OBJECTIVES

The aim of this study was to evaluate the effects of acupuncture on the amount of pain, nausea and vomiting after tonsillectomy in children.

METHODS

In this study, two researchers searched individually for qualified articles on the effects of acupuncture on post-tonsillectomy pain, nausea and vomiting using PubMed, Cochrane Library, Embase, Google scholar and Ovid databases by September 2018.

RESULTS

After critically appraising the searched studies, 12 studies were selected and entered into a systematic review. Among the studies, various acupuncture methods were used.

CONCLUSION

This systematic review shows that acupuncture as a complementary method can prevent and reduce the severity of complications surrounding tonsillectomy.

Examining the effect of implementation of the nursing process on students' health behaviors

Introduction The nursing process is a method for solving the problems used to meet the health and care needs of individuals. Using the nursing process enables nurses to use critical thinking for clinical judgment and their care activities. Thus, the present study was conducted to specify the effect of the implementation of the nursing process on students' health behaviors. Materials and methods The population was first-year high school girl students in Kurdistan in 2016-2017 that comprised 90 students. The questionnaire used was one for the health needs of adolescent girls and was a standard questionnaire with 65 questions. The purpose was to evaluate the health needs of girls from different aspects (mental health, emotional needs, social health needs, educational needs, physical health needs, belief needs). Students were randomly assigned into experimental and control groups and nursing-based interventions were done for the experimental group. Data were analyzed in SPSS. Results The results showed no significant differences between students' health behaviors before the implementation of the nursing process, but after performing the intervention according to the implementation of the nursing process, the status of observing the students' health behaviors significantly improved. Conclusion Given the positive effect of the nursing process on enhancing students' health behaviors, this type of nursing intervention should be done in other studies and in clinics to enhance the health of the students.