Assessment and management of neonatal pain: a best practice implementation project.

BACKGROUND AND AIMS: Neonates are exposed to varying degrees of pain during their hospitalization, which are going to have a profound impact on their lives. Interventions to alleviate neonatal pain are inadequate and inconsistent. The project aims to promote evidence-based practice (EBP) for the assessment and management of neonatal patients with acute pain and to evaluate the impact of these practices on neonatal pain in hospital. METHODS: The current project was conducted in the neonatal department of a tertiary hospital in China. Five audit criteria were developed for baseline and follow-up audits. The project used the JBI PACES software and JBI's Getting Research into Practice audit and feedback tool to take evidence-based healthcare into practice. A total of 100 neonates with acute pain procedures were evaluated at baseline and follow-up audit. RESULTS: The results showed a poor compliance of the five audit indicators in the baseline audit and a significantly improved compliance of the five audit indicators in the follow-up audit. Compared to the baseline audit, audit criterion 1 increased from 0% to 86.1%, audit criterion 2 increased from 36.1% to 82.5%, audit criterion 3 increased from 12% to 61%, audit criterion 4 increased from 0% to 66%, and audit criterion 5 increased from 6% at baseline to 71% in the follow-up audit. CONCLUSION: The project found that EBP can help nursing staff effectively manage neonatal patients who are experiencing acute painful operations. Further studies are necessary to ensure the sustainability of the criteria in the project.

Randomized Clinical Study on the Efficacy of Direct Anterior Approach Combined With Tendon Release and Repair After Total Hip Arthroplasty.

Background: To study the effect of reconstruction of the joint capsule and conjoint tendon on the functional recovery of the hip joint during direct anterior approach (DAA) total hip arthroplasty. Methods: A total of 60 patients who underwent their first total hip arthroplasty surgery were selected. According to the set criteria, the selected patients were divided into observation group A (n = 30) and control group B (n = 30). In group A, the joint capsule and conjoint tendon (superior muscle, internal obturator muscle, and inferior muscle) were repaired in situ, while in group B, only the joint capsule was repaired in situ, and the conjoint tendon was not repaired. The surgical indicators, including hip joint function and clinical efficacy of the two groups, were compared. Results: After 6 months of follow-up in groups A and B, no dislocation occurred. The Harris Hip scores of group A were higher than those of group B at 1-month post-operation, i.e., p < 0.05, as well as the valid muscle strength and conjoint tendon valid tension, were higher in group A than group B at 1-month postoperative follow-up, i.e., p < 0.05. Conclusion: DAA for total hip arthroplasty on the premise of reconstructing the joint capsule structure can rebuild the tension of the conjoint tendon, enhance its muscle strength, and significantly improve the joint stability and function of the patient early stage. It is beneficial for the patient's rapid recovery and is worth implementing.

Enhanced mechanical, thermal and biocompatible nature of dual component electrospun nanocomposite for bone tissue engineering.

Traditionally, in the Asian continent, oils are a widely accepted choice for alleviating bone-related disorders. The design of scaffolds resembling the extracellular matrix (ECM) is of great significance in bone tissue engineering. In this study, a multicomponent polyurethane (PU), canola oil (CO) and neem oil (NO) scaffold was developed using the electrospinning technique. The fabricated nanofibers were subjected to various physicochemical and biological testing to validate its suitability for bone tissue engineering. Morphological analysis of the multicomponent scaffold showed a reduction in fiber diameter (PU/CO-853 ± 141.27 nm and PU/CO/NO-633 ± 137.54 nm) compared to PU (890 ± 116.911 nm). The existence of CO and NO in PU matrix was confirmed by an infrared spectrum (IR) with the formation of hydrogen bond. PU/CO displayed a mean contact angle of 108.7° ± 0.58 while the PU/CO/NO exhibited hydrophilic nature with an angle of 62.33° ± 2.52. The developed multicomponent also exhibited higher thermal stability and increased mechanical strength compared to the pristine PU. Atomic force microscopy (AFM) analysis depicted lower surface roughness for the nanocomposites (PU/CO-389 nm and PU/CO/NO-323 nm) than the pristine PU (576 nm). Blood compatibility investigation displayed the anticoagulant nature of the composites. Cytocompatibility studies revealed the non-toxic nature of the developed composites with human fibroblast cells (HDF) cells. The newly developed porous PU nanocomposite scaffold comprising CO and NO may serve as a potential candidate for bone tissue engineering.

Current Updates on Bone Grafting Biomaterials and Recombinant Human Growth Factors Implanted Biotherapy for Spinal Fusion: A Review of Human Clinical Studies.

BACKGROUND: Owing to their great promise in the spinal surgeries, bone graft substitutes have been widely investigated for their safety and clinical potential. By the current advances in the spinal surgery, an understanding of the precise biological mechanism of each bone graft substitute is mandatory for upholding the induction of solid spinal fusion. OBJECTIVE: The aim of the present review is to critically discuss various surgical implications and level of evidence of most commonly employed bone graft substitutes for spinal fusion. METHOD: Data was collected via electronic search using "PubMed", "SciFinder", "ScienceDirect", "Google Scholar", "Web of Science" and a library search for articles published in peer-reviewed journals, conferences, and e-books. RESULTS: Despite having exceptional inherent osteogenic, osteoinductive, and osteoconductive features, clinical acceptability of autografts (patient's own bone) is limited due to several perioperative and postoperative complications i.e., donor-site morbidities and limited graft supply. Alternatively, allografts (bone harvested from cadaver) have shown great promise in achieving acceptable bone fusion rate while alleviating the donor-site morbidities associated with implantation of autografts. As an adjuvant to allograft, demineralized bone matrix (DBM) has shown remarkable efficacy of bone fusion, when employed as graft extender or graft enhancer. Recent advances in recombinant technologies have made it possible to implant growth and differentiation factors (bone morphogenetic proteins) for spinal fusion. CONCLUSION: Selection of a particular bone grafting biotherapy can be rationalized based on the level of spine fusion, clinical experience and preference of orthopaedic surgeon, and prevalence of donor-site morbidities.