Non-pharmacological therapies for pain management in paediatric intensive care units: a protocol for a scoping review.

INTRODUCTION: In critically ill children, pain management is complex owing to cognitive development and the nature of hospitalisation in paediatric intensive therapy units. Although there are many protocols and guidelines for pain control via pharmacological interventions, non-pharmacological practices should also be explored and disseminated for their potential benefit. METHODS AND ANALYSIS: A systematic literature search will be performed using the following databases: Academic Search Premier, Cumulative Index to Nursing and Allied Health Literature, Cochrane Library, Excerpta Medica Database, Virtual Health Library, Medical Literature Analysis and Retrieval System Online, ScienceDirect, Scopus, Web of Science Core Collection, Theses from Coordenação de Aperfeiçoamento de Pessoal de Nível Superior, Dart Europe, Open Access Theses and Dissertations and grey literature from Google Scholar. The research will consider quantitative and qualitative studies, mixed-method studies, systematic reviews, text articles, opinion articles, letters to editors and editorials in any language and from any database. The following will be eligible for inclusion: (1) newborns, infants, children and adolescents; and (2) non-pharmacological therapies used for pain in paediatric intensive care. ETHICS AND DISSEMINATION: This study does not require ethical approval. The results of this research will be disseminated through social media channels and podcasts about pain in children. TRIAL REGISTRATION NUMBER: This protocol has been registered with the Open Science Framework (DOI 10.17605/OSF.IO/DZHKT).

Use of a menthol popsicle in managing postoperative thirst in patients undergoing radical prostatectomy: A randomized clinical trial.

Background and aim: Thirst is a real bother that most patients feel in the immediate postoperative period when they still need to fast. Many approaches regarding symptomatic relief strategies have been described in the literature, but strategies with cold water and/or menthol are effective in quenching thirst, as they act on pre-absorptive mechanisms. This study aims to evaluate the effectiveness of using menthol popsicles in relieving postoperative thirst in patients undergoing radical prostatectomy. Material and methods: This is a randomized controlled clinical trial with a quantitative approach. In all, 44 patients were evaluated in the immediate postoperative period of radical prostatectomy, with the intensity and discomfort of thirst being evaluated initially and subsequently. The study consisted of two groups: (1) the placebo group, popsicles without the addition of menthol substrates and (2) the experimental group, popsicles with the addition of 0.05% minty substrates. Results: The results demonstrate that the sociodemographic and clinical characteristics were homogeneous at the α = 5% significance level, except the occupation variable. The test detected changes in the intensity and discomfort of thirst in relation to the pre- and post-intervention times for the primary outcome when the groups were analyzed separately and for the interaction of the group versus time, there was no statistical difference between the groups. Conclusion: It was possible to prove that both the menthol popsicle and the popsicle without the addition of menthol were effective in relieving postoperative thirst in patients undergoing radical prostatectomy, but there was no statistically significant difference when comparing the two groups. Trial registration: The Brazilian Registry of Clinical Trials (RBR-8c3chr7).

Effectiveness of techniques for insertion of nasoenteral probe in critical patients: Randomized clinical trial.

INTRODUCTION: despite being a common procedure, nasally placed small-bowel feeding tube insertion is not risk-free and can compromise patient safety. Due to the fact that nasally placed small-bowel feeding tube is commonly inserted '"blindly," with the patient head in the neutral position, sometimes the process becomes difficult and traumatic, and may present higher level of complexity in physiological or induced coma and intubated patients. Therefore, adverse events (AEs) route errors can occur during this procedure. This study aimed to determine the effectiveness of different nasally placed small-bowel feeding tube insertion techniques in coma and intubated patients, in comparison with conventional method. METHODS: A prospective, randomized and controlled clinical trial will be carried out with coma and intubated patients admitted to the Intensive Care Unit (ICU). Thirty-nine patients will be randomly divided into 3 groups: group who will have the tube inserted in a conventional manner with the head in the neutral position, group with the head positioned laterally to the right, and, finally, with the head in the neutral position, with assistance of a laryngoscope. The primary endpoint will be: first, second and total attempt success rate; and time required for the first successful attempt and the sum of all attempts. Complications during insertion included tube bending, twisting, knotting, mucosal bleeding, and insertion into the trachea. Patient vital signs will be measured.

A 3-year prospective cohort on the incidence of prosthodontic complications associated with three implant treatment options for the edentulous mandible.

OBJECTIVE: This prospective study assessed the number and reasons for post-treatment visits due to prosthodontic complications in patients treated with three types of implant treatment for the edentulous mandible. METHODS: Study groups comprised patients treated with single-implant overdenture (G-I; n = 11), 2-implant overdenture (G-II; n = 13), and 4-implant fixed prosthesis (G-III; n = 13). Programmed recall visits occurred at the 6-, 12- and 36-month follow-ups. The management of prosthodontic complications occurred continuously in unscheduled appointments. Data analysis included calculation of incidence rates, chi-square and Kruskal-Wallis tests, and Poisson regression with robust error variance to model the occurrence of visits due to prosthodontic complications. RESULTS: There were 89 unscheduled appointments during the entire follow-up period, ranging from 0 to 7 (mean = 2.41; SD = 2.2) per patient. No between-group differences were found regarding the frequency of unscheduled visits. However, the duration of the appointments (scheduled and unscheduled) was significantly higher for G-III (p < .001). The length of follow-up was the only predictor of the number of post-insertion visits (p = .004). The frequency of prosthodontic events was higher for G-I and G-II compared to G-III (p < .001). Nearly half of the events in G-I and G-II were matrix replacements, and artificial teeth fracture was more frequent in G-III. CONCLUSIONS: All patients were at risk of post-delivery prosthodontic complications and required regular recall visits to achieve satisfactory function and to prevent further problems. Overdentures required higher rates of maintenance visits, particularly for replacement of the retentive inserts, while fixed implant prostheses required longer clinical times for management of complications when compared to overdentures.

Cost-effectiveness of three different concepts for the rehabilitation of edentulous mandibles: Overdentures with 1 or 2 implant attachments and hybrid prosthesis on four implants.

BACKGROUND: There are scarce data regarding the combined assessment of the costs and effects of implant treatments for edentulous patients when multiple options are available. AIM: This randomised clinical trial aimed to assess the cost-effectiveness of three different concepts for treatment: mandibular overdenture retained by a single (Group I; n = 11) or two implants (Group II; n = 13) and fixed hybrid prosthesis on four implants (Group III; n = 13). METHODS: Treatment effectiveness was measured as the 1-year before-after changes in patient satisfaction with the mandibular prosthesis. Costs were prospectively quantified from the perspective of the health provider, including all direct cost items attributed to the delivery of treatments and up to the 1-year follow-up, using a "bottom-up" costing estimation method. RESULTS: Patient satisfaction after treatment improved significantly for the three groups. The overall costs were R$ 2370.66, R$ 3185.21 and R$ 5739.52 for Groups I, II and III, respectively (P < .001). Analysis of incremental cost-effectiveness ratios suggested that the overdentures retained by one or two implants were more cost-effective than the fixed implant treatment, considering the mean cost and effectiveness values and the ±20% one-way sensitivity analysis. CONCLUSION: This study suggests that the incremental costs for the fixed hybrid prosthesis, compared to the overdenture treatments, is not proportional to the respective gain in effectiveness. Therefore, although all treatment options had satisfactory outcomes, the use of implants to retain a mandibular overdenture, irrespective of the use of one or two implants, is more cost-effective than the fixed implant treatment for the edentulous mandible.

Individual factors associated with masticatory performance of complete denture wearers: A cross-sectional study.

AIM: The aim of this study was to assess whether differences in inter-individual clinical and prosthodontic variables affect masticatory performance (MP) of edentulous subjects who received new complete dentures. MATERIALS AND METHODS: There were 204 edentulous participants who received new maxillary and mandibular complete dentures between October 2014 and March 2018 at a university clinic. MP was measured by a mixing ability test with a two-coloured chewing gum for 20 and 50 chewing cycles. The outcome variable was the degree of colour mixing of the chewed gum, expressed by the variation of hue (VOH) and measured by electronic colourimetric analysis. Explanatory variables included gender and age, quality of the dentures, classification of edentulous ridges and prognostic features, time since the insertion of the new dentures and patient-reported outcomes related to complete denture treatment. Bivariate correlation tests, multiple linear regression and a linear mixed model were used for data analysis. RESULTS: Mean VOH values were 0.57 (±0.13) and 0.43 (±0.16) for 20 and 50 chewing cycles, respectively. Mixing ability was higher in females than in males for 20 (P = 0.036) and 50 (P = 0.006) chewing cycles. No effects on the patient-reported outcome measures were observed. The time since denture delivery, gender, age and Prosthodontic Diagnostic Index (PDI) score were independently associated with masticatory performance at 20 and/or 50 chewing cycles. Overall masticatory performance tested by the linear mixed-effect model confirmed that VOH value was negatively influenced by male gender, older age and shorter time since denture delivery. CONCLUSION: Masticatory performance seems to be improved with the continuous use of newly inserted dentures and negatively influenced by advanced age.