The Scottish prostate cryotherapy service-the role of the clinical nurse specialist.

This article outlines the role of the clinical nurse specialist in establishing a Scotland-wide national designated service for prostate cryotherapy for patients with radiation-recurrent prostate cancer. The service was established in 2009 and provides prostate cryotherapy across Scotland. This article reviews and discusses the challenges involved in setting up a new service for tertiary treatment as well as highlighting the key achievements of the service. The challenges have included introducing the cryotherapy procedure in a safe and quality assured manner, developing and refining the referral process, educating both primary and secondary care teams on salvage prostate cryotherapy as a treatment modality and surgical procedure, as well as managing of complications following salvage prostate cryotherapy. The article also outlines the achievements of both the service and the treatment as well as how the service has developed since 2009.

Effective therapy to reduce edema after total knee arthroplasty Multi-layer compression therapy or standard therapy with cool pack - a randomized controlled pilot trial / Lymphologischer Kompressionsverband oder Standardbehandlung mit Kältepackung zur Schwellungsreduktion nach Knietotalprothesen-Operation. Eine randomisiert-kontrollierte, einfach verblindete Pilotstudie

Background: After total knee arthroplasty (TKA) efficient control and reduction of postoperative edema is of great importance. Aim: The aim of this pilot study (EKNZ 2014 ­ 225 DRKS00006271) was to investigate the effectiveness of multi-layer compression therapy (MLCT) to reduce edema in the early period after surgery compared to the standard treatment with Cool Pack. Methods: In this randomized controlled pilot trial, sixteen patients after TKA were randomized into an intervention group (IG) or a control group (CG). Circumferential measurements were used to assess edema. Secondary outcomes were range of motion (ROM), pain (numeric rating scale, NRS) and function as measured with the fast Self Paced Walking Test (fSPWT). Results: Clinically relevant differences in edema reduction between the two groups were found in the early postoperative period and at the six weeks follow up. Six days postoperatively the group time interaction (IE) in favor of the IG were −3.8 cm (95 % CI: −5.1; −2.4) when measured 10 cm proximal to the joint space and −2.7 cm (CI: −4.1; −1.3) when measured 5 cm proximally. We further observed differences in secondary outcomes in favor of the CG. Six days postoperatively the IE for knee flexion was ­8.3 ° (CI: −22.0; 5.4) and for the fSPWT it was 12.8 seconds (CI: −16.4; 41.3). Six weeks postoperatively these differences diminished. Conclusions: The findings suggest that MLCT could be an alternative treatment to reduce postoperative edema in patients after total knee arthroplasty. Eventually possible negative effects on early knee flexion and function must be considered.

[The non-pharmacological management of chronic pain]. / La prise en charge non médicamenteuse de la douleur chronique.

Pain management is not limited to the putting in place of pharmacological, surgical, physiotherapy or psychological strategies. Non-pharmacological therapies can also be proposed, notably in relation to chronic pain. Appreciated by patients and developed by caregivers, they require appropriate regulatory guidelines and specific training in order for them to be implemented safely.

Prophylaxis for mucositis induced by ambulatory chemotherapy: systematic review.

AIM: The aim of this study was to perform a systematic review of clinical trials covering interventions used as prophylaxis for oral mucositis induced by ambulatory antineoplastic chemotherapy. BACKGROUND: Oral mucositis in patients undergoing chemotherapy is a side effect that can impact the quality of treatment and can interfere with eating and therapeutic adherence. DESIGN: Quantitative systematic review. DATA SOURCES: Relevant databases were searched, from January 2002-July 2013, by using the combination of the keywords mucositis, stomatitis, neoplasms, antineoplastic agents, drug therapy, prevention and control and chemotherapy. REVIEW METHODS: Two researchers independently read the titles and abstracts from every cross-reference. The quality of the included studies was analysed by the Jadad Scale and the Cochrane Collaboration Risk of Bias Tool. Data were extracted from the selected studies with a data collection form developed specifically for this purpose. RESULTS: Of the 23 controlled clinical trials that were identified in this study, five articles evaluated the use of oral cryotherapy to prevent oral mucositis and three studies analysed the prophylactic use of glutamine. Interventions of protocols for oral care, palifermin, allopurinol and chlorhexidine were evaluated by two articles each. Interventions of zinc sulphate, amifostine, chewing gum, sucralfate, recombination human intestinal trefoil factor, kefir and vitamin E were evaluated by one article each. CONCLUSION: There is strong evidence that cryotherapy can prevent oral mucositis arising from ambulatory treatment with 5-flurouracil chemotherapy. Other interventions, although showing positive results in preventing oral mucositis, require further study to confirm their conclusions.

Effectiveness of external cold and vibration for procedural pain relief during peripheral intravenous cannulation in pediatric patients.

The aim of this study was to investigate the effect of external cold and vibration stimulation via Buzzy on the pain and anxiety level of children during peripheral intravenous (IV) cannulation. This study was a prospective, randomized controlled trial. The sample consisted of 176 children ages 7 to 12 years who were randomly assigned to two groups: a control group that received no peripheral IV cannulation intervention and an experimental group that received external cold and vibration via Buzzy. The same nurse conducted the peripheral IV cannulation in all the children, and the same researcher applied the external cold and vibration to all the children. The external cold and the vibration were applied 1 minute before the peripheral IV cannulation procedure and continued until the end of the procedure. Preprocedural anxiety was assessed using the Children's Fear Scale, along with reports by the children, their parents, and an observer. Procedural anxiety was assessed with the Children's Fear Scale and the parents' and the observer's reports. Procedural pain was assessed using the Wong Baker Faces Scale and the visual analog scale self-reports of the children. Preprocedural anxiety did not differ significantly. Comparison of the two groups showed significantly lower pain and anxiety levels in the experimental group than in the control group during the peripheral IV cannulation. Buzzy can be considered to provide an effective combination of coldness and vibration. This method can be used during pediatric peripheral IV cannulation by pediatric nurses.

Evaluation of the outcomes of ice application for the control of pain associated with chest tube irritation.

The aim of this study was to evaluate the effectiveness of the use of ice for the control of pain associated with chest tube irritation. The randomized and single-blinded study consisted of 40 patients (20 in the control and 20 in the study group) who underwent thoracotomy with chest tube placement. The same general anesthesia protocol was used for all patients, and the procedure was performed by the same surgery team. Procedures such as decortication and thoracic wall resection were not included in the study. Standard postoperative analgesic methods were applied to all patients. Additionally, ice (in flexible and bendable cold gel packs wrapped in fine cloth sheaths) was applied to the chest tube insertion site at the 24th, 28th, 36th, and 40th postoperative hours for 20 minutes. To assess the effectiveness of ice application, Verbal Category Scale and Behavioral Pain Scale methods were used to measure the severity of pain. Average pain severity scores during the mobilization activities, including coughing and walking, were compared and found to be significantly lower in the study group patients who received cold therapy than in the control group patients (p < .05). Additionally, analgesic consumption was lower in the study group than in the control group patients (p < .05). As a result, the application of ice to the chest tube insertion site reduced pain associated with irritation along with the need for analgesics.

Crioterapia: tecnologia não-invasiva de cuidado da enfermeira obstétrica para alívio da dor em parturientes / Cryotherapy: non-invasive technology of midwife care for pain relief in parturients

Pesquisa piloto de intervenção com dados prospectivos, grupo único de intervenção, cujo desfecho é a medida da dor de mulheres em trabalho de parto. Apresenta como objetivo discutir os efeitos da crioterapia no alívio da dor das parturientes. Como referencial teórico este trabalho apresentou o descrito por Soares e Low, onde se encontra que os mecanismos de ação do gelo para alívio da dor propiciam o decréscimo da transmissão das fibras de dor, a diminuição da excitabilidade nas terminações livres, a redução no metabolismo tecidual aumentando o limiar das fibras de dor e a liberação de endorfinas. Baseou-se ainda nos princípios da desmedicalização e do emprego de tecnologias não-invasivas de cuidado de enfermagem obstétrica conforme descritos por Vargens e Progianti. A pesquisa foi realizada no Centro Obstétrico do Hospital Municipal Maternidade Carmela Dutra, no Rio de Janeiro de abril a agosto de 2011. O gelo foi aplicado, utilizando-se para tal uma bolsa-cinta ajustável à região tóraco-lombar de 36 gestantes. A bolsa/cinta é descartável, de tecido TNT, com abertura na parte superior para introdução de gelo picado envolto em plástico. As aplicações se deram aos cinco centímetros de dilatação do colo uterino; e/ou aos sete centímetros de dilatação do colo uterino; e/ou aos nove centímetros de dilatação uterina, totalizando ao final das três aplicações um tempo de 60 minutos, que corresponde ao somatório de 20 minutos para cada uma. O gelo foi produzido em fôrma exclusiva para o projeto, em freezer da unidade. Os dados referentes à avaliação da dor foram coletados através de entrevista estruturada guiada por formulário previamente elaborado...

This pilot intervention study, with prospective data and a single intervention group, the outcome of which was the pain measured in women in labour, was designed to discuss the pain relief effects of cryotherapy in childbirth. The theoretical framework for this study was as described by Soares & Low, in which the mechanisms of the pain-relief action of ice foster decreased pain fibre transmission, reduced free nerve ending excitability, reduced tissue metabolism, increased pain fibre threshold and release of endorphins. It also drew on the principles of de-medicalisation and non-invasive obstetric nursing techniques as described by Vargens & Progianti. The study was conducted at the Obstetrics Centre of the Carmela Dutra Municipal Maternity Hospital, in Rio de Janeiro, from April to August 2011. Ice was applied using an adjustable belt-bag to the lumbar/thoracic region of 36 expectant mothers. The disposable TNT fabric belt-bag has an opening at the top for introducing plastic-wrapped ground ice. Applications were given at five centimetres cervical dilation; and/or at seven centimetres cervical dilation; and/or at nine centimetres cervical dilation: to a total of three applications over a 60-minute timespan, corresponding to the sum of 20 minutes each. The ice was produced exclusively for the project in the unit’s freezer. Pain assessment data were collected by structured interview guided by a previously prepared script...

Hipotermia. La modificación de la temperatura corporal como terapéutica clínica / Modification of body temperature as clinical therapeutics. Hypothermia

La aplicación del frío como terapéutica se denomina termoterapia. Se pueden diferenciar dos grandes modalidades: local y general. A nivel local es muy utilizada en el campo de la rehabilitación física, reumatología, y en diversas especialidades quirúrgicas. No obstante, la evidencia existente sobre aspectos relacionados con sus posibles beneficios, razón fisiológica que fundamenta su acción, o forma de aplicación no está suficientemente respaldada. Respecto a las técnicas de aplicación de frío, las mayores expectativas se centran en la hipotermia inducida o terapéutica, por sus importantes efectos neuroprotectores tras isquemia secundaria a parada cardiorrespiratoria. El interés por la hipotermia comienza en el tercer decenio del siglo xx; el primer informe científico sobre la hipotermia inducida fue publicado en 1945 y describía su aplicación en pacientes con TCE. En las siguientes décadas aparecieron decisivas investigaciones sobre su aplicación, pero también grandes sombras sobre sus beneficios. El desarrollo de protocolos y los grandes avances en los cuidados prestados en las UCI, han aumento la capacidad de prevenir y controlar los efectos secundarios de la aplicación de esta terapéutica. Basándonos en la revisión de la bibliografía, se describirán los principales usos de la hipotermia terapéutica, las principales indicaciones de estás técnicas así como la evidencia existente sobre sus beneficios y las complicaciones que se derivan de su manejo(AU)

The application of cold therapy is called thermotherapy. Can distinguish two major forms: local and general. At the local level is widely used in the field of physical rehabilitation, rheumatology, and various surgical specialties. However, the evidence on issues relating to its potential benefits, physiological reason underlying its action, or application form is not sufficiently supported. Regarding the application of cold techniques, higher expectations are focused on hypothermia induced or therapeutic, for its significant neuroprotective effects after ischemia secondary to cardiac arrest. Interest in hypothermia begins in the third decade of the twentieth century, the first scientific report on induced hypothermia was published in 1945 and described its application in patients with TBI. In the following decades appeared critical research on their application, but also great shadows of its benefits. The development of protocols and the great advances in the care provided in ICUs, have increased the capacity to prevent and control the side effects of the application of this therapy. Based on the literature review, describing the main uses of therapeutic hypothermia, the major indications of these techniques and the evidence of its benefits and complications arising from their use(AU)

The effect of cold application in combination with standard analgesic administration on pain and anxiety during chest tube removal: a single-blinded, randomized, double-controlled study.

The aim of this study was to investigate the effect of cold application on pain and anxiety during chest tube removal (CTR) in patients who had undergone cardiac surgery. A single-blinded randomized design was used in this study. Ninety patients aged 18-74 years, hospitalized in the intensive care unit (ICU), who had a chest tube for a duration of at least 24 hours were used for this convenience sample. The application of cold, placebo, or control therapies was randomized into three different groups. Sixty minutes before CTR was scheduled, an ICU nurse administered 10mg/kg paracetamol intravenously to all study subjects. Cold and warm packs covered with gauze dressing were applied to the area surrounding the chest tubes for 20 minutes. Pain intensity, pain quality and situational anxiety for CTR were measured. Variance analysis and the latent growth model were used in the analysis of the data. Patients in the cold group had significantly lower pain intensity than the placebo group. The perception of pain intensity measured by visual analog scores of patients in the cold group showed the least variation. There was no statistically significant difference in McGill Melzack Pain Questionnaire scores or in change of anxiety level between the three groups. The application of cold prolonged the length of time until analgesics were needed after CTR. Results showed that cold application reduced patients' intensity of pain due to CTR but did not affect anxiety levels or the type of pain. Cold application is recommended as a pain-relieving technique during CTR.

How to ensure patient observations lead to effective management of patients with pyrexia.

Pyrexia is defined by the National Institute for Health and Clinical Excellence as an elevation of body temperature above the normal daily variation. A sudden rise in temperature usually indicates infection, although there are many other noninfectious causes. This article outlines the causes of pyrexia and discusses management options.

Managing pain using heat and cold therapy.

Evidence supports the use of superficial heating and cooling of tissues to provide pain relief in low to moderate levels of acute and chronic pain in adults, but there are no standards or guidelines in children's centres across the UK for administering these modalities in children, so a project was undertaken to develop these locally. Evidence from the literature was used to identify best practice in relation to equipment, safety and infection control. Implementation was supported by educational input and a detailed protocol for assessment and application of the devices. Three years after their introduction a review of the guidelines and an audit demonstrated that these modalities have been beneficial, providing cost-effective, holistic care for children experiencing pain in hospital.

Cabbage leaves vs hot and cold compresses in the treatment of breast engorgement.

This study was conducted to evaluate the effect of cold cabbage leaves and alternate hot and cold compresses in decreasing breast engorgement and pain in post-natal mothers admitted in AIIMS, New Delhi.

A crioterapia como estratégia para alívio da dor no trabalho de parto: um estudo exploratório / Criotherapy as a strategy for pain relief in chidbirth: an exploratory study

Estudo exploratório cujo objeto foi a crioterapia como prática aplicada de enfermagem obstétrica e estratégia de alívio da dor no parto. Foi desenvolvido com 21 parturientes acompanhadas por enfermeira obstétrica no Hospital Maternidade Carmela Dutra, no Rio de Janeiro, em 2004. Teve como objetivos identificar os sintomas referidos durante o uso de gelo como recurso para alívio da dor e verificar possíveis efeitos sobre a evolução do trabalho de parto e perfil biofísico do feto. Os resultados mostraram que o uso da crioterapia proporcionou o relaxamento geral das parturientes, permitindo a algumas dormirem profundamente em plena fase ativa do trabalho de parto. Não foram evidenciados efeitos indesejados sobre o perfil biofísico do feto, pois todos os recém-nascidos alcançaram APGAR superior a sete no primeiro e quinto minutos de vida. Concluiu-se que a crioterapia pode ser aplicada para alívio da dor no parto, sendo necessário, no entanto, estudos que aprofundem e ampliem o conhecimento sobre seu emprego nessa situação.

Exploratory study on the procedure of criotherapy in obstetric nursing as a strategy for pain relief in childbirth. It was performed on 21 women during labor, accompanied by the obstetric nurse in the Hospital Maternidade Carmela Dutra, Rio de Janeiro - Brazil, in 2004. The study aimed both at identifying the symptoms described upon the use of ice as resource for pain relief and at verifying the effects of the criotherapy on labor and on the biophysical profile of the fetus. The results showed that the use of the criotherapy provided overall relaxation for women in labor, allowing some of them to sleep deeply during the active phase of childbirth. Unexpected effects were not evidenced on the fetus’s biophysical profile. All the newborn reached APGAR scores higher than seven at the first and the fifth minutes of life. It was concluded that criotherapy can be used by obstetric nurses for pain relief in childbirth. However, studies that deepen and enlarge the findings on its employment in this specific situation are required.

Estudio exploratorio cuyo objeto fue la crioterapia como práctica aplicada de enfermería obstétrica y estrategia de alivio del dolor en el parto. Desarrollado con 21 parturientes acompañadas por enfermera obstétrica en el Hospital Maternidad Carmela Dutra, en Río de Janeiro – Brasil, en 2004. Tuvo como objetivos identificar los síntomas referidos durante el uso de hielo como recurso para el alivio del dolor y verificar los efectos de la crioterapia en la evolución del parto y del perfil biofísico del feto. Los resultados mostraron que el uso de la crioterapia proporcionó un relajamiento general de las parturientes, lo que permitió a algunas de ellas duermir profundamente durante la fase activa del parto. No se evidenciaron efectos indesejados en el perfil biofísico del feto. Los escores de APGAR alcanzados por todos los recién nacidos fueron superiores a siete en el primero y quinto minutos de vida. Se concluyó que la crioterapia puede ser aplicada para el alivio del dolor en el parto. Sin embargo, son necesarios estudios que ahonden y agranden el conocimiento sobre su empleo en esa situación.