Educational intervention on perceived stress among adults with type 2 diabetes and metabolic syndrome: a non-randomized clinical trial.

Objective: To evaluate the effectiveness of Virtual Teaching (VT) Programme regarding palliative care on knowledge, self-efficacy and attitude among Nursing Personnel working in selected hospitals of North India. Methods: A quasi-experimental study with non-equivalent control group pre-test-post-test design was conducted on 121 Nursing Personnel, selected by convenient sampling technique. Knowledge, self-efficacy and attitude were assessed using structured knowledge questionnaire, Palliative Care Self-efficacy Scale, and Frommelt Attitudes toward care of dying scale respectively. Nursing personnel in experimental group received Virtual Teaching Programme regarding palliative care whereas those in comparison group received conventional teaching (CT). The study included a pre-test followed by the teaching (virtual/ conventional) on day one. The post-test was conducted on 15th day after the intervention. Results: The results showed that there was a significant difference in mean post-test knowledge (VT group: 17.11 to CT group: 25.05; t=9.25, p<0.001), self-efficacy (VT group: 39.27 to CT group: 43.38; t=6.39, p<0.001) and attitude (VT group: 108.86 to CT group: 133.23; t=9.27, p<0.001) scores between virtual teaching group and conventional teaching group. ANCOVA test revealed statistically significant differences in the mean scores of knowledge [F (1.11) = 86.61, p<0.001], self-efficacy [F (1.11) = 841.75, p<0.001] and attitude [F (1.11) = 82.92, p<0.001] between the groups, with higher means obtained in the CT group. Conclusion: Virtual Teaching programme and Conventional teaching both were effective in enhancing the knowledge, self-efficacy and attitude among Nursing Personnel regarding palliative care with conventional teaching being more effective.

Effectiveness of virtual teaching programme regarding palliative care on knowledge, self-efficacy and attitude of Nursing Personnel in North India / Efectividad de un programa de enseñanza virtual sobre cuidados paliativos en los conocimientos, la autoeficacia y la actitud del personal de enfermería en el norte de la India / Eficácia de um programa virtual de ensino de cuidados paliativos sobre conhecimento, autoeficácia e atitude da equipe de enfermagem no norte da Índia

Objective.To evaluate the effectiveness of Virtual Teaching (VT) Programme regarding palliative care on knowledge, self-efficacy and attitude among Nursing Personnel working in selected hospitals of North India. Methods. A quasi-experimental study with non-equivalent control group pre-test-post-test design was conducted on 121 Nursing Personnel, selected by convenient sampling technique. Knowledge, self-efficacy and attitude were assessed using structured knowledge questionnaire, Palliative Care Self-efficacy Scale, and Frommelt Attitudes toward care of dying scale respectively. Nursing personnel in experimental group received Virtual Teaching Programme regarding palliative care whereas those in comparison group received conventional teaching (CT). The study included a pre-test followed by the teaching (virtual/ conventional) on day one. The post-test was conducted on 15th day after the intervention. Results. The results showed that there was a significant difference in mean post-test knowledge (VT group: 17.11 to CT group: 25.05; t=9.25, p<0.001), self-efficacy (VT group: 39.27 to CT group: 43.38; t=6.39, p<0.001) and attitude (VT group: 108.86 to CT group: 133.23; t=9.27, p<0.001) scores between virtual teaching group and conventional teaching group. ANCOVA test revealed statistically significant differences in the mean scores of knowledge [F (1.11) = 86.61, p<0.001], self-efficacy [F (1.11) = 841.75, p<0.001] and attitude [F (1.11) = 82.92, p<0.001] between the groups, with higher means obtained in the CT group. Conclusion. Virtual Teaching programme and Conventional teaching both were effective in enhancing the knowledge, self-efficacy and attitude among Nursing Personnel regarding palliative care with conventional teaching being more effective.

Objetivo. Evaluar la efectividad de un programa de Enseñanza Virtual (EV) sobre cuidados paliativos en cuanto a conocimientos, autoeficacia y actitud entre el personal de enfermería que trabaja en hospitales seleccionados del norte de la India. Métodos. Se llevó a cabo un estudio cuasiexperimental con un diseño de grupo de control no equivalente. Se realizaron pre y post-prueba a 121 miembros del personal de enfermería, seleccionados mediante una técnica de muestreo por conveniencia. Se evaluaron los conocimientos, la autoeficacia y las actitudes mediante un cuestionario estructurado de conocimientos, una escala de autoeficacia en cuidados paliativos y una escala de actitudes de Frommelt hacia el cuidado de personas al final de su vida. El personal de enfermería del grupo experimental recibió un programa de EV sobre cuidados paliativos, mientras que el del grupo de comparación recibió enseñanza convencional (EC). El estudio incluyó una preprueba seguida de la enseñanza virtual o convencional el primer día y una prueba posterior al decimoquinto día después de la intervención. Resultados. Los resultados mostraron que había una diferencia significativa en las puntuaciones medias post-test entre los grupos en: conocimientos (EV: 17.11 y EC: 25.05; t=9.25, p<0.001), autoeficacia (grupo VT: 39.27 y grupo CT: 43.38; t=6.39, p<0.001) y actitud (grupo EV: 108.86 y grupo EC: 133.23; t=9.27, p=<0.001) La prueba ANCOVA también reveló diferencias estadísticamente significativas en las puntuaciones medias de conocimientos [F (1.11) = 86.61, p=<0.001], autoeficacia [F (1.12) =841.75, p=<0.001] y actitud [F (1.11) = 82.91, p<0.001] entre los grupos, obteniéndose medias más altas en el grupo CT. Conclusión. Tanto el programa de enseñanza virtual como la enseñanza convencional fueron efectivos para mejorar los conocimientos, la autoeficacia y la actitud del personal de enfermería en relación con los cuidados paliativos, siendo el beneficio mucho mayor la enseñanza convencional.

Objetivo. Avaliar a eficácia de um programa de Aprendizagem Virtual (VE) sobre cuidados paliativos em termos de conhecimento, autoeficácia e atitude entre a equipe de enfermagem que trabalha em hospitais selecionados no norte da Índia. Métodos. Um estudo quase experimental foi conduzido com um desenho de grupo controle não equivalente. Foram realizados pré e pós-testes em 121 membros da equipe de enfermagem, selecionados por meio de técnica de amostragem por conveniência. Foram utilizados os instrumentos: questionário de conhecimento estruturado, escala de autoeficácia em cuidados paliativos e escala de atitudes de Frommelt em relação ao cuidado de pessoas em fim de vida. A equipe de enfermagem do grupo experimental recebeu um programa de VE sobre cuidados paliativos, enquanto o grupo controle recebeu ensino convencional (CE). O estudo incluiu um pré-teste seguido de ensino virtual ou convencional no primeiro dia e um pós-teste no 15º dia após a intervenção. Resultados. Os resultados mostraram que houve diferença significativa nas médias dos escores pós-teste entre os grupos em: conhecimento (EV: 17.11 e EC: 25.05; t=9.25, p<0.001), autoeficácia (grupo VT: 39.27 e grupo CT: 43.38; t=6.39, p<0.001) e atitude (grupo EV: 108.86 e grupo EC: 133.23; t=9.27, p=<0.001). O teste ANCOVA também revelou diferenças estatisticamente significativas nas pontuações médias de conhecimento [F (1.11) = 86.61, p=<0.001], autoeficácia [F (1.12) =841.75, p=<0.001] e atitude [F (1.11) = 82.91, p<0.001] entre os grupos, obtendo maiores médias em o grupo CT. Conclusão. Tanto o programa de ensino virtual quanto o ensino convencional foram eficazes na melhoria do conhecimento, da autoeficácia e da atitude da equipe de enfermagem em relação aos cuidados paliativos, sendo o benefício muito maior com o ensino convencional.

Feasibility of Goal-Directed Fluid Therapy in Patients with Transcatheter Aortic Valve Replacement - An Ambispective Analysis.

INTRODUCTION: Goal-directed fluid therapy (GDFT) has been shown to reduce postoperative complications. The feasibility of GDFT in transcatheter aortic valve replacement (TAVR) patients under general anesthesia has not yet been demonstrated. We examined whether GDFT could be applied in patients undergoing TAVR in general anesthesia and its impact on outcomes. METHODS: Forty consecutive TAVR patients in the prospective intervention group with GDFT were compared to 40 retrospective TAVR patients without GDFT. Inclusion criteria were age ≥ 18 years, elective TAVR in general anesthesia, no participation in another interventional study. Exclusion criteria were lack of ability to consent study participation, pregnant or nursing patients, emergency procedures, preinterventional decubitus, tissue and/or extremity ischemia, peripheral arterial occlusive disease grade IV, atrial fibrillation or other severe heart rhythm disorder, necessity of usage of intra-aortic balloon pump. Stroke volume and stroke volume variation were determined with uncalibrated pulse contour analysis and optimized according to a predefined algorithm using 250 ml of hydroxyethyl starch. RESULTS: Stroke volume could be increased by applying GDFT. The intervention group received more colloids and fewer crystalloids than control group. Total volume replacement did not differ. The incidence of overall complications as well as intensive care unit and hospital length of stay were comparable between both groups. GDFT was associated with a reduced incidence of delirium. Duration of anesthesia was shorter in the intervention group. Duration of the interventional procedure did not differ. CONCLUSION: GDFT in the intervention group was associated with a reduced incidence of postinterventional delirium.

Feasibility of Goal-Directed Fluid Therapy in Patients with Transcatheter Aortic Valve Replacement - An Ambispective Analysis

ABSTRACT Introduction: Goal-directed fluid therapy (GDFT) has been shown to reduce postoperative complications. The feasibility of GDFT in transcatheter aortic valve replacement (TAVR) patients under general anesthesia has not yet been demonstrated. We examined whether GDFT could be applied in patients undergoing TAVR in general anesthesia and its impact on outcomes. Methods: Forty consecutive TAVR patients in the prospective intervention group with GDFT were compared to 40 retrospective TAVR patients without GDFT. Inclusion criteria were age ≥ 18 years, elective TAVR in general anesthesia, no participation in another interventional study. Exclusion criteria were lack of ability to consent study participation, pregnant or nursing patients, emergency procedures, preinterventional decubitus, tissue and/or extremity ischemia, peripheral arterial occlusive disease grade IV, atrial fibrillation or other severe heart rhythm disorder, necessity of usage of intra-aortic balloon pump. Stroke volume and stroke volume variation were determined with uncalibrated pulse contour analysis and optimized according to a predefined algorithm using 250 ml of hydroxyethyl starch. Results: Stroke volume could be increased by applying GDFT. The intervention group received more colloids and fewer crystalloids than control group. Total volume replacement did not differ. The incidence of overall complications as well as intensive care unit and hospital length of stay were comparable between both groups. GDFT was associated with a reduced incidence of delirium. Duration of anesthesia was shorter in the intervention group. Duration of the interventional procedure did not differ. Conclusion: GDFT in the intervention group was associated with a reduced incidence of postinterventional delirium.

The effect of interventional program underpinned by health belief model on awareness, attitude, and performance of nurses in preventing nosocomial infections: A randomized controlled trial study / Efecto de un programa de intervención basado en el modelo de creencias en salud sobre el conocimiento, la actitud y el desempeño del personal de enfermería en la prevención de las infecciones intrahospitalarias. Ensayo controlado aleatorizado / Efeito de um programa de intervenção baseado no modelo de crenças em saúde no conhecimento, atitude e atuação da equipe de enfermagem na prevenção de infecções hospitalares. Teste controlado e aleatório

Objective. The present study examined the effect of an interventional program underpinned by the Health Belief Model (HBM) on nurses' awareness, attitude, and performance in preventing nosocomialinfections.Methods. This randomized controlled trial study was performed on 60 clinical nurses in lar, Iran. Nurses were selected using the simple random sampling method and assigned to two experimental (n=30) and control (n=30) groups. Data collection tool included the valid and reliable questionnaire was developed by Soleimani et al. The research intervention consisted of five 90-min sessions based on the health belief model in preventing hospital infection for experimental group. Before the intervention, immediately and two months after the intervention, the two groups completed the questionnaire. The control group received no intervention. Results. Data analysis showed that the differences between the two groups was statistically significant immediately and two months after the intervention (p<0.05). In experimental group the changes in the mean score of knowledge, attitude and performance of nurses before, immediately and two months after the intervention were significant (p<0.05), but in the control group, only the changes in the mean score of performance were significant (p<0.05). Conclusion. The results showed that the HBM-based intervention is effective in promoting nurses' knowledge, attitude, and performance in preventing nosocomialinfections. hence, periodical and in-service HBM-based training programs on preventing nosocomialinfections are recommended to be held for nurses.

Objetivo. El presente estudio examinó el efecto de un programa de intervención basado en el modelo de creencias en salud (Health Belief Model -HBM-, en inglés sobre el conocimiento, la actitud y el desempeño de las enfermeras en la prevención de las infecciones intrahospitalarias. Métodos. Este ensayo controlado aleatorizado se realizó en 60 enfermeras clínicas de lar, Irán. Las enfermeras fueron seleccionadas mediante el método de muestreo aleatorio simple y asignadas a dos grupos experimental (n=30) y de control (n=30). La herramienta para la recogida de datos incluyó el cuestionario válido y fiable desarrollado por Soleimani et al.La intervención consistió en cinco sesiones de 90 minutos basadas en el modelo de creencias de salud para prevenir la infección intrahospitalaria en el grupo experimental. Antes de la intervención, inmediatamente y dos meses después de la intervención, los dos grupos completaron el cuestionario. El grupo de control no recibió ninguna intervención. Resultados. El análisis de los datos mostró diferencias estadísticamente significativas entre los dos grupos en los momentos inmediatamente y dos meses después de la intervención (p<0.05). En el grupo experimental, los cambios en la puntuación media de conocimientos, actitudes y rendimiento de las enfermeras se observaron en los momentos de antes, inmediatamente y dos meses después de la intervención (p<0.05); mientras que en el grupo de control solamente los cambios en la puntuación media de desempeño fueron significativos (p<0.05). Conclusión. Los resultados mostraron que la intervención basada en HBM fue eficaz para promover el conocimiento, la actitud y el rendimiento de las enfermeras en la prevención de las infecciones intrahospitalaria, por lo que se recomienda impartir a las enfermeras programas de formación periódicos y en servicio basados en HBM sobre la prevención de las infecciones intrahospitalarias.

Objetivo. Examinar o efeito de um programa de intervenção baseado no Modelo de Crenças em Saúde (MBH) no conhecimento, atitude e desempenho dos enfermeiros na prevenção de infecções hospitalares. Métodos. Este ensaio clínico randomizado foi conduzido em 60 enfermeiras clínicas de lar, Irã. Os enfermeiros foram selecionados pelo método de amostragem aleatória simples e distribuídos em dois grupos experimental (n=30) e controle (n=30). O instrumento de coleta de dados incluiu o questionário válido e confiável desenvolvido por Soleimani et al. A intervenção consistiu em cinco sessões de 90 minutos baseadas no modelo de crenças em saúde para prevenir infecção hospitalar no grupo experimental. Antes, imediatamente e dois meses após a intervenção, ambos os grupos responderam ao questionário. O grupo controle não recebeu nenhuma intervenção. Resultados.A análise dos dados mostrou diferenças estatisticamente significativas entre os dois grupos imediatamente e dois meses após a intervenção (p<0.05). No grupo experimental foram observadas alterações na pontuação média de conhecimentos, atitudes e desempenho dos enfermeiros antes, imediatamente e dois meses após a intervenção (p<0.05); enquanto no grupo controle apenas as alterações na pontuação média de desempenho foram significativas (p<0.05). Conclusão.Os resultados demonstraram que a intervenção baseada no HBM foi eficaz na promoção do conhecimento, atitude e desempenho dos enfermeiros na prevenção de infecções hospitalares, pelo que se recomenda proporcionar aos enfermeiros este tipo de programas de formação em serviço baseados no HBM.

Factors associated with family function in school children: Case-control study.

Background: Family functionality is that which promotes the integral development of its members, as well as a favorable state of health in them; fulfilling the basic parameters of adaptation, participation, growth, affection, and resources. Family dysfunction is understood as the failure to comply with any of these functions due to an alteration in one or more of the subsystems. Objective: There is little research on variables related to family functioning with a case-control design, for this reason, we present the family functioning of school students, identify variables found to be related to family functioning, and describe a model of variables related to family dysfunction. Materials and methods: Analytical study of cases and controls. The sample was made up of 290 students. The APGAR scale was used to identify family dysfunction. The statistical processing was done in Epi-Info 7.0 and STATA 14. The variables that were considered were: Municipality, area, age, sex, school grade, mother's age, disability, and displacement. Results: The factors associated with adequate family function were: displacement, (OR = 0.17, CI: 0.03-0.99). You are followed, your parents pay attention and listen to you (OR = 0.25, CI: 0.08-0.74), you talk to your mother every day (OR = 0.35 CI: 0.16-0.74), you spend free time with your parents (OR = 0.41, CI: 0.20-0.86), play sports at least once a week (OR = 0.42, CI = 0.20-0.91), and finally, attend religious services (OR = 0.51, CI: 0.29-0.90). While the factors associated with family dysfunction were: your parents punish you by forbidding you things (OR = 2.98, CI: 1.32-6.71) and you have friends close to where you live followed by an (OR = 2.60, CI: 1.13-5.96). Conclusions: Dysfunctionality was evident in the four municipalities of the Valley. Among the main factors associated with dysfunctionality was punishment by parents for forbidding things and having friends near the schoolchild's home.

The effect of interventional program underpinned by health belief model on awareness, attitude, and performance of nurses in preventing nosocomial infections: A randomized controlled trial study.

Objective: The present study examined the effect of an interventional program underpinned by the Health Belief Model (HBM) on nurses' awareness, attitude, and performance in preventing nosocomial infections. Methods: This randomized controlled trial study was performed on 60 clinical nurses in lar, Iran. Nurses were selected using the simple random sampling method and assigned to two experimental (n=30) and control (n=30) groups. Data collection tool included the valid and reliable questionnaire was developed by Soleimani et al. The research intervention consisted of five 90-min sessions based on the health belief model in preventing hospital infection for experimental group. Before the intervention, immediately and two months after the intervention, the two groups completed the questionnaire. The control group received no intervention. Results: Data analysis showed that the differences between the two groups was statistically significant immediately and two months after the intervention (p<0.05). In experimental group the changes in the mean score of knowledge, attitude and performance of nurses before, immediately and two months after the intervention were significant (p<0.05), but in the control group, only the changes in the mean score of performance were significant (p<0.05). Conclusion: The results showed that the HBM-based intervention is effective in promoting nurses' knowledge, attitude, and performance in preventing nosocomial infections. hence, periodical and in-service HBM-based training programs on preventing nosocomial infections are recommended to be held for nurses.

Effect of Benson's relaxation technique on caregiver burden in caregivers of hemodialysis patients. A Randomized Controlled Trial / Efecto de la técnica de relajación de Benson en la carga del cuidador de pacientes en hemodiálisis. Un entudio controlado aleatorizado / Efeito da técnica de relaxamento de Benson na sobrecarga do cuidador em pacientes em hemodiálise. Um estudo controlado randomizado

Methods. This is a randomized controlled trial study on 52 caregivers of hemodialysis patients referred an universitary hospital at Jahrom. The caregivers were randomly divided into intervention and control groups. In the intervention group, Benson's relaxation was performed twice a day for 15 minutes each time, and continued for one month. Data collection tools included demographic information questionnaire and standard Zarit Burden Interview questionnaire which was completed by all participants before the intervention and one month after it. Results. After the intervention, the mean caregiver burden of hemodialysis patients in the intervention group decreased significantly compared to the control group (p<0.001). The results of paired t-test showed that in the intervention group, the mean scores of caregiver burden after the intervention (14.46± 10.91) was significantly lower than before the intervention (38.33±16.94) (p=0.001). Conclusion. Benson's relaxation method can reduce caregiver burden in caregivers of hemodialysis patients.

Objetivo. Investigar el efecto de la técnica de relajación de Benson sobre la carga de los cuidadores de pacientes en hemodiálisis. Métodos. Estudio de intervención realizado con la participación de 52 cuidadores de pacientes en hemodiálisis remitidos a un hospital universitario de Jahrom (Iran). Los cuidadores fueron divididos aleatoriamente en los grupos de intervención y de control. En el grupo de intervención, se realizó la técnica de relajación de Benson dos veces al día durante 15 minutos cada vez, y se continuó durante un mes. Las herramientas de recogida de datos incluían un cuestionario de información demográfica y la entrevista de percepción de carga del cuidador "Zarit Burden Interview" que fue completado por todas participantes antes de la intervención y un mes después de terminada la misma. Resultados. Después de la intervención, la carga media de los cuidadores de pacientes en hemodiálisis en el grupo de intervención disminuyó significativamente en comparación con el grupo de control (p<0.001). Los resultados de la prueba t pareada mostraron que en el grupo de intervención, las puntuaciones medias de la carga del cuidador después de la intervención (14.46±10.91) fueron significativamente menores que antes de la intervención (38.33±16.94) (p=0.001). Conclusión. El método de relajación de Benson puede reducir la carga de los cuidadores de pacientes en hemodiálisis.

Objetivo. Investigar o efeito do relaxamento de Benson na sobrecarga do cuidador em cuidadores de pacientes em hemodiálise na cidade de Jahrom. Métodos. Este é um estudo controlado randomizado envolvendo 52 cuidadores de pacientes em hemodiálise encaminhados a um hospital afiliado à Jahrom University of Medical Sciences. Os cuidadores foram divididos aleatoriamente em grupos intervenção (n=24) e controle (n=24). No grupo intervenção, os cuidadores realizaram o relaxamento de Benson duas vezes ao dia por 15 minutos cada, e foi continuado por um mês. A coleta de informações incluiu um questionário de informações demográficas e o questionário padrão Zarit que foi preenchido por todos os participantes antes da intervenção e um mês após o seu preenchimento. Resultado S. A maioria dos cuidadores nos grupos intervenção (79.2%) e controle (64.3%) eram mulheres. Após a intervenção, a sobrecarga média dos cuidadores de pacientes em hemodiálise no grupo intervenção diminuiu significativamente em relação ao grupo controle (p<0.001). Os resultados do teste t pareado mostraram que, apenas no grupo intervenção, os escores médios de sobrecarga do cuidador após a intervenção (14.46 ±10.1) foram significativamente menores do que antes da intervenção (38.33) ±16.94) com p <0.001. Conclusão. O método de relaxamento de Benson demonstrou ser eficaz na redução da sobrecarga dos cuidadores de pacientes em hemodiálise.

Effect of Benson's relaxation technique on caregiver burden in caregivers of hemodialysis patients. A Randomized Controlled Trial.

METHODS: This is a randomized controlled trial study on 52 caregivers of hemodialysis patients referred an universitary hospital at Jahrom. The caregivers were randomly divided into intervention and control groups. In the intervention group, Benson's relaxation was performed twice a day for 15 minutes each time, and continued for one month. Data collection tools included demographic information questionnaire and standard Zarit Burden Interview questionnaire which was completed by all participants before the intervention and one month after it. RESULTS: After the intervention, the mean caregiver burden of hemodialysis patients in the intervention group decreased significantly compared to the control group (p<0.001). The results of paired t-test showed that in the intervention group, the mean scores of caregiver burden after the intervention (14.46± 10.91) was significantly lower than before the intervention (38.33±16.94) (p=0.001). CONCLUSIONS: Benson's relaxation method can reduce caregiver burden in caregivers of hemodialysis patients.

The New Surface Landmarks for Blind Axillary Vein Puncture.

OBJECTIVE: To compare the efficacy of blind axillary vein puncture utilizing the new surface landmarks for the subclavian method. METHODS: This prospective and randomized study was performed at two cardiology medical centers in East China. Five hundred thirty-eight patients indicated to undergo left-sided pacemaker or implantable cardioverter defibrillator implantation were enrolled, 272 patients under the axillary access and 266 patients under the subclavian approach. A new superficial landmark was used for the axillary venous approach, whereas conventional landmarks were used for the subclavian venous approach. We measured lead placement time and X-ray time from vein puncture until all leads were placed in superior vena cava. Meanwhile, the rate of success of lead placement and the type and incidence of complications were compared between the two groups. RESULTS: There were no significant differences between the two groups in baseline characteristics or number of leads implanted. There were high success rates for both strategies (98.6% [494/501] vs. 98.4% [479/487], P=0.752) and similar complication rates (14% [38/272] vs. 15% [40/266], P=0.702). Six cases in the control group developed subclavian venous crush syndrome and five had pneumothorax, while neither pneumothorax nor subclavian venous crush syndrome was observed in the experimental group. CONCLUSION: We have developed a new blind approach to cannulate the axillary vein, which is as effective as the subclavian access, safer than that, and also allows to get this vein without the guidance of fluoroscopy, contrast, or echography.

The new surface landmarks for blind axillary vein puncture

Abstract Objective: To compare the efficacy of blind axillary vein puncture utilizing the new surface landmarks for the subclavian method. Methods: This prospective and randomized study was performed at two cardiology medical centers in East China. Five hundred thirty-eight patients indicated to undergo left-sided pacemaker or implantable cardioverter defibrillator implantation were enrolled, 272 patients under the axillary access and 266 patients under the subclavian approach. A new superficial landmark was used for the axillary venous approach, whereas conventional landmarks were used for the subclavian venous approach. We measured lead placement time and X-ray time from vein puncture until all leads were placed in superior vena cava. Meanwhile, the rate of success of lead placement and the type and incidence of complications were compared between the two groups. Results: There were no significant differences between the two groups in baseline characteristics or number of leads implanted. There were high success rates for both strategies (98.6% [494/501] vs. 98.4% [479/487], P=0.752) and similar complication rates (14% [38/272] vs. 15% [40/266], P=0.702). Six cases in the control group developed subclavian venous crush syndrome and five had pneumothorax, while neither pneumothorax nor subclavian venous crush syndrome was observed in the experimental group. Conclusion: We have developed a new blind approach to cannulate the axillary vein, which is as effective as the subclavian access, safer than that, and also allows to get this vein without the guidance of fluoroscopy, contrast, or echography.

The interactive effect of preoperative consultation and operating room admission by a counselor on anxiety level and vital signs in patients undergoing Coronary Artery Bypass Grafting surgery. A clinical trial study.

OBJECTIVES: The purpose of this study was to provide appropriate preoperative supportive conditions to improve anxiety and vital signs for patients undergoing Coronary Artery Bypass Grafting -CABG- surgery. METHODS: This clinical trial study was performed on 90 patients undergoing CABG surgery in Farshchian Hospital of Hamadan, Iran in 2019. Sample was selected by convenience and were randomly divided into three groups: control (n=30), intervention1 (n=30), and intervention2 (n=30). The control group received only the routine preoperative counseling of ward and admitted to the operating room as usual; the intervention1 and intervention2 groups in addition received another two counseling sessions, then the intervention1 group was admitted in the operating room as usual, but the intervention2 group was admitted by the counselor in the operating room. Data were collected using a three-part questionnaire including demographic characteristics, vital signs chart, and the Spielberger's State-Trait Anxiety Inventory. RESULTS: The results showed that there was a significant difference in the mean anxiety of the three groups after admission in the operating room (intervention2 was lower than intervention1 and control groups, p<0.001; and intervention 1 group was lower than control group, p<0.001) and also there was a significant difference between the mean systolic blood pressure, heart rate and respiratory rate of the three groups (p <0.001) but the mean of the variables of temperature and diastolic blood pressure in the three groups were not significantly different (p=0.59 and p=0.225, respectively). CONCLUSIONS: Our results revealed preoperative consultation and admission in the operating room by the consultant can reduce the level of anxiety and stability of vital signs of patients undergoing CABG.

Nursing Guidelines on Cardiac Surgery and Parents' Anxiety: Randomized Clinical Trial.

OBJECTIVE: The preparation of parents of children who should undergo cardiac surgery requires special treatment such as the explanations about the event. This study aims to compare the effects of standardized nursing guidelines with routine institutional orientation on the anxiety of parents of children undergoing cardiac surgery. METHODS: Randomized clinical trial. The sample consisted of parents of children who underwent cardiac surgery from December 2010 to April 2011. Twenty-two parents were randomized to the intervention group (IG) and received the standard nursing guidelines and 22 participated in the control group (CG) and received the routine guidelines from the institution. Anxiety was assessed by the State-Trait Anxiety Inventory (STAI) applied in the preoperative period, between 12 and 20 hours before surgery and before receiving standard or institutional guidelines and 48 hours after surgery. The analysis of variance (ANOVA) for repeated measures was performed to evaluate the differences between the variations in STAI scores between the groups during the studied period. The level of significance was 0.05. RESULTS: There were no significant differences in baseline anxiety scores between groups with regard to trait anxiety as well as state anxiety: STAI-trait (CG 42.6±4.9 vs. IG 41.4±6.0, P=0.48); STAI-state (CG 42.3±5.7 vs. IG 45.6±8.3, P=0.18). Likewise, the variation in score after 48 hours was similar between groups (STAI-trait P=0.77; STAI-state P=0.61). CONCLUSION: There were no significant differences in the parents' anxiety levels when comparing the two types of guidelines: the standard nursing and the institutional orientation.

Nursing guidelines on cardiac surgery and parents anxiety: randomized clinical trial

Abstract Objective: The preparation of parents of children who should undergo cardiac surgery requires special treatment such as the explanations about the event. This study aims to compare the effects of standardized nursing guidelines with routine institutional orientation on the anxiety of parents of children undergoing cardiac surgery. Methods: Randomized clinical trial. The sample consisted of parents of children who underwent cardiac surgery from December 2010 to April 2011. Twenty-two parents were randomized to the intervention group (IG) and received the standard nursing guidelines and 22 participated in the control group (CG) and received the routine guidelines from the institution. Anxiety was assessed by the State-Trait Anxiety Inventory (STAI) applied in the preoperative period, between 12 and 20 hours before surgery and before receiving standard or institutional guidelines and 48 hours after surgery. The analysis of variance (ANOVA) for repeated measures was performed to evaluate the differences between the variations in STAI scores between the groups during the studied period. The level of significance was 0.05. Results: There were no significant differences in baseline anxiety scores between groups with regard to trait anxiety as well as state anxiety: STAI-trait (CG 42.6±4.9 vs. IG 41.4±6.0, P=0.48); STAI-state (CG 42.3±5.7 vs. IG 45.6±8.3, P=0.18). Likewise, the variation in score after 48 hours was similar between groups (STAI-trait P=0.77; STAI-state P=0.61). Conclusion: There were no significant differences in the parents' anxiety levels when comparing the two types of guidelines: the standard nursing and the institutional orientation.

Ensaio clínico randomizado: padrão ouro de desenhos experimentais - importância, vantagens, desvantagens e preconceitos / Randomized clinical trial: gold standard of experimental designs - importance, advantages, disadvantages and prejudice

Ensaios clínicos randomizados (ECR) são o padrão ouro para desenho experimental de estudo ou ensaio clínico. Apenas por meio de uma investigação do tipo ECR é possível avaliar e demonstrar a relação de causa-e-efeito entre um conjunto de variáveis independentes e dependentes. O ECR adicionou vantagens em relação aos outros modelos experimentais, principalmente devido à presença de um grupo controle. Existem várias críticas à validade interna das pesquisas em saúde, incluindo preconceitos e desvantagens que são apontadas para seu descrédito. OBJETIVO: O objetivo do presente estudo é informar características, vantagens, desvantagens e desvios deste método científico. MATERIAL E MÉTODOS: Análise crítica de método científico com base em revisão narrativa da literatura. Foi consultada a base de dados Medline por meio dos portais PubMed e Scopus, sem data de início e até julho de 2020, para extração das informações relativas aos ECR. Apenas artigos de língua inglesa foram incluídos, usando as palavras-chave "estudo randomizado controlado", "ensaio clínico randomizado", "projeto experimental" e "estudo experimental", intercaladas pelos operadores booleanos "AND ," "OR" e "NOT". Anais de conferências e resumos não foram considerados para a análise dos dados. RESULTADOS: Dos ECR selecionados, foram extraídas características, vantagens, desvantagens, importância e vantagens dos controles em pesquisa, o princípio de equilíbrio, ensaios clínicos randomizados na população pediátrica, ECR na população geriátrica, ameaças à validade interna e medidas para minimização de viéses e preconceitos em ECR. CONCLUSÃO: Tópicos relevantes dos ECR foram explicados nesta revisão que devem guiar pesquisadores clínicos.

Randomized controlled trial (RCT) is the gold standard of experimental design or clinical trial design. Only by RCT in research, the cause-and-effect relationship between a set of independent and dependent variables could be demonstrated. RCT has added advantages over other experimental designs due to the presence of the control group. The importance of control in health research trials and its advantages to be elaborated. Though various threats to internal validity in health research trials could be minimized by RCT, various biases in RCT and disadvantages add to its discredit. OBJECTIVE: The aim of the present narrative review is to brief the characteristics, advantages, disadvantages, and various biases in RCT. METHODS: This review does not follow the PRISMA statement, as it was a narrative review. Two databases, namely, Medline through PubMed and Scopus, were searched from inception to July 2020 for the information pertaining to RCTs and included in this narrative review. Only English language articles were searched with the keywords, "Randomized controlled trial," "Randomized clinical trial," "experimental design," and "experimental study." These keywords are linked together by the Boolean words, "AND," "OR" and "NOT." Conference proceedings and only abstracts were not considered for the review. RESULTS: RCTs were explained under characteristics, advantages, disadvantages, importance, and advantages of controls in research, the principle of equipoise, RCTs in the pediatric population, RCTs in the geriatric population, threats to internal validity and steps to minimize them and various biases in RCTs. CONCLUSION: The narrative presentation of RCTs under various important topics have been explained in this review.

Stages of Behavior Change for Physical Activity in Airport Staff: a quasi-experimental study.

OBJECTIVES: This work sought to determine the effect of an educational intervention based on the stages of change in promoting physical activity in employees in the Mashhad airport in Iran. METHODS: This was a quasi-experimental study conducted with the participation of 60 volunteers (30 in the intervention group and 30 in the control group) who were in the stages of contemplating or preparing for change in physical activity. The intervention consisted in educational activities provided during home visits, telephone calls, group training sessions, and delivery of printed material. To gather the information, the study used five questions on the stage in which they were for behavioral change in physical activity, according to the Theoretical Model by Marcus et al., (1. pre-contemplation, 2. contemplation, 3. preparation, 4. action, and 5. maintenance), and the International Questionnaire on Physical Activity. Changes in the stages were evaluated during three moments: upon entering the study, at the end of the intervention (8th month), and two months after the second evaluation (10th month). RESULTS: During the 10th month evaluation, it was noted that 26.7% of the subjects from the intervention group versus 3.3% from the control group improved their physical activity and were in the action stage (p < 0.01). CONCLUSIONS: The educational intervention based on stages of change is effective in promoting physical activity in the participants and may be used in educational programs that seek to improve physical activity in the employees studied.

Comparative evaluation of micronuclei in saudi smokers and non-smokers without any visible oral lesions: a pilot study / Evaluación comparativa de micronúcleos en fumadores y no fumadores sauditas sin lesiones orales visibles: un estudio piloto

Objectives: A systematic review was conducted to evaluate effectiveness and safety of beta carotenes for the treatment of oral leukoplakia regarding clinical resolution and prevention of malignant transformation. Material and Methods: The systematic search was conducted in three electronic databases and the study's selection was performed according to pre-set eligibility criteria. Four studies evaluating the efficacy of beta carotenes in oral leukoplakia compared to placebo were included in the review; three of which were assigned for quantitative analysis. Data were extracted, tabulated, quality assessed and statistically analyzed. Results: The meta-analysis revealed that when comparing clinical resolution the beta carotene group favored was favored compared to placebo, with statistically significant difference. However, a meta-analysis comparing beta carotene and placebo groups regarding malignant transformation as a primary outcome failed to show any significant benefit. Furthermore, results showed evidence of beta carotene safety. Conclusion: the overall quality of evidence about efficacy of beta carotene in oral leukoplakia treatment was not high. However, given the obvious safety of this agent, data suggests it could have a promising effect in clinical improvement of oral leukoplakia lesions. However, no evidence supporting its benefits in reducing risk of malignant transformation in these lesions was found. Therefore, further long term, well designed randomized clinical trials are highly recommended.

Introducción: el cáncer oral es un problema grave con alta mortalidad y morbilidad, a pesar de la disponibilidad de los mejores tratamientos. Uno de los factores más importantes para una mortalidad tan alta es su diagnóstico tardío. La mejor manera de enfrentar un problema de este tipo es evitar su aparición creando conciencia entre la población y tenendo un diagnóstico más temprano. El cáncer oral es una enfermedad multifactorial, donde el daño genómico tiene un papel. Se ha demostrado que los micronúcleos (MNi) son un biomarcador importante y en este estudio se utilizó como una herramienta para crear conciencia sobre el riesgo de cáncer oral. Objetivo: evaluar y comparar la frecuencia de MNi en fumadores sin ninguna lesión oral visible (Grupo I) y no fumadores sanos (Grupo II). Materiales y métodos: se obtuvieron citoestimuladores de fumadores sauditas (n = 15, Grupo I) sin ninguna lesión oral visible y no fumadores sanos (n = 15, control, Grupo II) y se tiñeron con hemotoxilina y eosina para evaluar la frecuencia de MNi y las observaciones fueron sometidas a análisis estadístico utilizando la prueba t de Student. Resultados: La frecuencia media de MNi en el Grupo I fue significativamente mayor (p<0.05) que en el Grupo II. El estudio ayuda a educar, motivar y crear conciencia, alentando así a los pacientes a dejar de fumar, y evitando así el cáncer oral antes de su inicio.

Effect of the manual manipulation of composite resin with latex gloves / Efecto de la manipulación manual de resina compuesta con guantes de látex

Purpose: This in vitro study aimed to evaluate the influence of the manual manipulation of two composite resins: Filtek™ Z350XT (3M ESPE) and Herculite Précis® (Kerr), with latex gloves contaminated with powder, human saliva and alcohol, on the microhardness values. Material and Methods: Manual manipulation was evaluated using latex gloves with powder, latex gloves without powder, latex gloves without powder with saliva, latex gloves without powder with alcohol, and without hand manipulation or contaminants (control). Each resin was manually manipulated for 10 seconds and photoactivated for 20 seconds with a light intensity of 1000mW/cm2 using a VALO ­Ultradent LED light­ cured unit, and then each sample was evaluated on the microhardness Vickers tester Leitz (Wetzlar). The collected data were analyzed using Kruskal ­Wallis and Mann ­ Whitney post-test (p<0.05). Results. Microhardness values showed a significant difference between the evaluated and control groups, showing lower microhardness values in the group of latex glove with powder for Filtek™ Z350XT and the group of latex glove without powder with saliva for Herculite Précis®. Conclusion. The manual manipulation of composite resins decreases their surface microhardness.

Propósito: Este estudio in vitrotuvo como objetivo evaluar la influencia de la manipulación manual de dos resinas compuestas: Filtek ™ Z350XT (3M ESPE) y Herculite Précis® (Kerr), con guantes de látex contaminados con polvo, saliva humana y alcohol, sobre los valores de microdureza. Material y Métodos: La manipulación manual se evaluó utilizando guantes de látex con polvo, guantes de látex sin polvo, guantes de látex sin polvo con saliva, guantes de látex sin polvo con alcohol, y sin manipulación manual o contaminantes (control). Cada resina fue manipulada manualmente durante 10 segundos y fotoactivada durante 20 segundos con unaintensidad de luz de 1000mW/cm2 usando una unidad de fotocuración LED VALO - Ultradent, y luego cada muestra fue evaluada en el tester de microdureza Vickers Leitz (Wetzlar). Los datos recopilados se analizaron utilizando Kruska ­Wallis y post-test Mann­ Whitney (p<0.05). Resultados: Se observó una diferencia significativa en los valores de microdureza entre los grupos evaluados y el grupo control, con valores más bajos de microdureza en el grupo de guantes de látex con polvo para Filtek™ Z350XT y el grupo de guantes de látex sin polvo con saliva para Herculite Précis®. Conclusión. La manipulación manual de resinas compuestas disminuye su microdureza superficial.

The Effect of Aerobic Exercise on Occupational Stress of Female Nurses: A Controlled Clinical Trial.

OBJECTIVES: This work sought to determine the effectiveness of an aerobic exercise program on the occupational stress of nurses. METHODS: Prevention-type controlled clinical trial carried out with the participation of 60 nurses working in hospitals affiliated to Shahrekord University of Medical Sciences in Iran. Randomly, the nurses were assigned to the experimental group or to the control group. The intervention consisted in an aerobic exercise program lasting three months with three weekly sessions one hour each. The Health and Safety Executive (HSE) questionnaire measured occupational stress with 35 questions, each with five Likert-type response options, which can have a maximum score of 175 points; higher scores meant lower levels of occupational stress. The HSE was evaluated during three moments: upon registering, after finishing the exercise program (week 8), and two months after terminating the intervention (week 16). RESULTS: The level of occupational stress was the same in the experimental and control groups during registration (86.2 vs. 86.3). Upon finishing the aerobic exercise program (week 8), the experimental group showed a higher score than the control group (119.7 vs. 86.2, p<0.01), with this score diminishing after two months of having ended the intervention (91.4 vs. 85.8, p=0.061). CONCLUSIONS: The aerobic exercise program was associated to decreased work stress of nurses in the experimental group compared to the control group at eight weeks, but this difference did not persist when the experimental group did not continue with the program.

Effectiveness of a Nursing Intervention to Diminish Preoperative Anxiety in Patients Programmed for Knee Replacement Surgery: Preventive Controlled and Randomized Clinical Trial.

OBJECTIVES: This work was conducted to determine the effectiveness of a nursing intervention, based on the motivational interview, to diminish preoperative anxiety in patients programmed for knee replacement surgery. METHODS: Preventive type controlled and randomized clinical trial, on a sample of 56 patients programmed for knee replacement surgery in a clinic in Girardot (Colombia). Random assignment was made: an intervention group (n=28) and a control group (n=28). The six-question Amsterdam Preoperative Anxiety and Information Scale was applied before and after the intervention. The scale has a total score ranging from 5 to 30; the higher the score, the greater the preoperative anxiety. The nursing intervention was conducted in three sessions of motivational interview each lasting 40 min, during the six weeks prior to the surgical procedure; the control group received conventional management of education in the health institution. RESULTS: The mean score of preoperative anxiety was equal in the pre-intervention evaluation in both groups (19.76 in the experimental versus 22.02 in the control =22.02; p<0.226), while during the post-intervention, the anxiety score was lower in the intervention group compared with the control group (15.56 and 20.30, respectively; p <0.013). CONCLUSIONS: Nursing intervention based on the motivational interview was effective in diminishing preoperative anxiety in patients programmed for knee replacement surgery.