Cold cabbage application and postnatal mothers' perceptions of breast engorgement: A mixed method study.

Background:Treatments for cosmetically unpleasing periocular and lateral temporal veins are limited. The purpose of this study was to test the hypothesis that the application of topical lidocaine before the cosmetic treatment of periorbital and lateral temporal veins with a neodymium-doped yttrium aluminum garnet (ND:YAG) laser will result in a significant reduction in subjective pain compared with placebo as assessed using a visual analogue scale.Methods:Twenty patients who required bilateral treatment of facial veins were randomly assigned to receive either placebo or 30% lidocaine gel applied topically over the veins, a split-body design. Both the investigator and the patient were blinded to the treatment. An ND:YAG laser was used to treat the veins. Patients completed a visual analogue scale to assess the pain on each side of the face. Data were analyzed using nonparametric data testing.Results:There was a 64.0% reduction in pain on the treatment side compared with the placebo side (P < 0.001). There was no significant difference in patient-assessed subjective efficacy between sides (P = 0.2). Complications were minimal and mild.Conclusions:Patients undergoing periorbital and temporal vein ablation using ND:YAG laser should be offered topical lidocaine as the pain levels are moderate. The use of topical 30% lidocaine results in a significant reduction in pain levels.

ObjectiveThe aim of this study was to evaluate the efficacy and safety of a 60‐day peripheral nerve stimulation (PNS) treatment targeting the occipital nerves for reducing pain and improving function in individuals diagnosed with cervicogenic headache or occipital neuralgia.BackgroundHeadache conditions are prevalent and commonly disabling, and conventional therapeutic strategies are often insufficient. Development of a percutaneous 60‐day PNS treatment has created new opportunities to evaluate PNS of the occipital nerves.MethodsThis study was an institutional review board‐approved, multicenter, prospective, single‐arm study that enrolled participants from October 2022 to March 2024. Participants with cervicogenic headache or occipital neuralgia received a 60‐day PNS treatment targeting the occipital nerves. The primary endpoint was the proportion reporting clinically significant (≥30%) reductions in average pain and/or pain interference at end of treatment (EOT). Additional analysis included the proportion of participants with ≥50% reduction in average pain intensity and/or pain interference and additional outcomes including Patient Global Impression of Change, six‐item Headache Impact Test, and Neck Disability Index.ResultsAt EOT, 90% of participants (18/20) met the primary endpoint. Further, 85% (17/20) and 83% (15/18) reported ≥50% reductions in pain and/or pain interference at EOT and 3 months, respectively. Clinically meaningful improvements were observed in functional and headache‐related disability and quality‐of‐life measures. All study‐related adverse events were non‐serious.ConclusionMost participants reported significant reductions in pain and/or pain interference following 60‐day PNS targeting the occipital nerves. Outcomes through 3 months demonstrate how 60‐day PNS offers an effective approach for the treatment of headache.

Background &amp; Aim: Prematurity is the leading cause of death among children under five years of age globally. Alarmingly, in low-income countries, more than 90% of extremely preterm-born babies die within the first few days of life. Kangaroo care is an effective method in the management of preterm babies. The study aimed to explore perceptions and experiences of postnatal mothers on Kangaroo care at a selected hospital in Sri Lanka. Methods &amp; Materials: This exploratory descriptive qualitative study was carried out with seventeen purposively selected postnatal mothers who were practicing Kangaroo care in the Neonatal Care Unit at District General Hospital in Kalutara, Sri Lanka. Data collection was done through in-depth interviews using an interview guide between the period of July 2021 and November 2021. The interviews were recorded and transcribed verbatim. The inductive content analysis method described by Graneheim and Lundman was employed for data analysis. Results: Participants were mainly Sinhalese, married, and aged between 20-40 years. The analysis revealed one overarching theme: ‘Despite the obstacles, Kangaroo care is a blessing,’ which was further characterized by two main categories: positive perceptions and experiences, and negative perceptions and experiences. Positive perceptions and experiences are described under good practice, supportive role, and benefits. Negative perceptions and experiences are described under separation and obstacles. Conclusion: The participating mothers’ perceptions and experiences of Kangaroo care blended with both positive and negative dimensions, which were shaped by contextual factors; hence, addressing these factors is imperative for the successful implementation of Kangaroo care.

The purpose of this study was to identify nursing interventions for the postpartum breast care of mothers and determine the effectiveness of interventions for breast pain and engorgement by systematic review. Eight national and international databases were reviewed to retrieve and collect randomized controlled trial and controlled clinical trial literature published up to March 2015. Two reviewers independently selected the studies and performed data abstraction and validation. The risk of bias was assessed using Cochrane criteria. A meta-analysis of the studies was performed to analyze the data. The meta-analysis showed that breast massage, along with routine breast care, resulted in a 3.52-point reduction in pain on a 10-point visual analogue scale. Meta-analysis of therapy with cold cabbage leaves and routine breast care showed a pain reduction of 0.54 points. Meta-analysis of cold cabbage leaf application in the experimental group versus cold compress therapy in the comparison group showed a pain reduction of 0.44 points. Meta-analysis of cold cabbage leaf application and routine breast care showed an engorgement reduction of 0.67 points. The results of the analysis of 12 articles showed that hot and cold compresses, breast massage, and cabbage application were effective for postpartum breast pain and engorgement.

BACKGROUND: The erector spinae plane block (ESPB), which was introduced to manage the thoracic pain, is an ultrasound-guided technique that is relatively easy, less invasive, and safer. In spite of its technical ease and safety of ESPB, few studies have explored the analgesic efficacy and the exact spread level of injected local anesthetics. OBJECTIVES: The purpose of this study is to compare the analgesic efficacy and spread level of the upper and lower lumbar ESPBs . STUDY DESIGN: Prospective, randomized design. SETTING: The pain clinic of a tertiary university hospital. METHODS: This study included 84 patients with low back pain with or without leg pain who received lumbar ESPB at L2 (L2 ESPB group) or L4 (L4 ESPB group) using 10 mL of 0.2% ropivacaine mixed with 10 mL of the contrast medium. After finishing 20 mL of the local anesthetic mixture injection, a fluoroscopic examination was performed to evaluate the spread level. Analgesic efficacy was assessed using an 11-point Numeric Rating Scale (NRS-11) and a Back Pain Functional Scale. RESULTS: The number of patients who showed excellent-to-moderate low back pain relief was 35 (83.3%) and 36 (78.5%) in the L2 and L4 ESPB groups, respectively. Significant reductions in pain on the NRS-11 and improvements in disability were found in both groups. The total number of vertebral segments to which the anesthetic drugs spread was significantly higher in the L2 ESPB group than in the L4 ESPB group (2.7 ± 0.5 vs 2.0 ± 0.2, P = 0.002). LIMITATIONS: The analgesic efficacy of lumbar ESPB was evaluated with only short-term outcomes. CONCLUSIONS: Both the L2 and L4 ESPB groups demonstrated a significant reduction in low back pain and improvement in disability. The L2 ESPB group demonstrated a significantly increased spread level compared to the L4 ESPB group. KEY WORDS: Erector spinae plane block, spread level, low back pain, analgesic efficacy

Traumatized Immature Teeth Treated with 2 Protocols of Pulp Revascularization

This study aimed to compare the effectiveness of exercises performed on «Respine» device with and without the additional breathing exercises in patients with chronic low back pain (LBP). Chronic low back pain affects 23% of adults worldwide, with a recurrence rate of 24–80% per year, posing a significant healthcare challenge. The study involved 44 subjects with chronic nonspecific lower back pain, randomly assigned to two groups: a control group (n=22) receiving a standard exercise program on «Respine» device, and a study group (n=22) following the same program with additing specialized breathing exercises. The intervention lasted 6 weeks with a frequency of 4 sessions per week. Assessments were made using Numeric Rating Scale (NRS), Revised Oswestry Low Back Pain Disability Scale questionnaire, measurement of the number of breaths per minute, analysis of breathing track and lower rib mobility. At the end of the study, a significant reduction in pain was observed in both groups with no significant difference between them (control group: from 4.47 to 1.72; study group: from 4.55 to 2.22 on NRS scale). However, the study group showed better scores on Oswestry Low Back Pain Disability Scale (down from 11.48% to 4.76%) compared to the control group (down from 26.36% to 10.1%). The study group also showed more favorable changes in respiratory parameters: increased of percentage patients breathing in the diaphragmatic track (from 40.91% to 54.55%) and a decrease in respiratory rate per minute. The results indicate that exercises on «Respine» device alone or with the additional breathing exercises lead to clinically significant reductions in lower back pain. Adding breathing exercises to a rehabilitation program using «Respine» device may provide greater functional improvement. This study demonstrated effectiveness of «Respine» device in reducing pain and breathing exercises as an additional method of improving functional status in the treatment of chronic low back pain.

Background: Breastfeeding residue the most healthy, simple and a feeding method that is least expensive and fulfils the needs to new born. During initial 2 days once baby is born as a part of normal process, breasts of women get accumulated with milk. Due to this reason, breasts get heavy and swollen, however this process is generally not very painful and hard under normal scenarios. In around 70% – 80% of mothers breast engorgement is seen. It is a condition which causes pain and also puts an effect on majority of mothers. It may be very stressful situation for mothers especially when they are fulfilling the needs of baby. This condition also hinders the process of smooth breast feeding, which further leads to early closure of breastfeeding and is related to other extreme conditions including infection in breast. Methods: A quantitative research approach was done on 50 postnatal mothers who were admitted at Queen Mary Hospital, KGMU, Lucknow. A purposive sampling technique was used. Socio-demographics data were obtained by the tool “Demographic Variables”; Level of breast engorgement was assessed by the tool “Six Point Breast Engorgement Scale” and Level of breast feeding was assessed by “Bristol Breastfeeding Assessment Tool”. Results: Results revealed that significant level of breast engorgement was present among postnatal mothers in both experimental &amp; control groups during pretest. Similarly, many (around 68%) mothers in experimental group &amp; 64% mothers in control group had poor level of breast feeding before applying the test. However, after the application of reverse pressure softening technique, there was significant amount of benefit to postnatal mothers considering breast engorgement (52% mothers had soft breast, 40% had slight firmness only) and breast feeding (80% mothers had good level of breast feeding). Also, an association was observed between demographic variables and level of breast engorgement &amp; breast feeding. Conclusions: It can be concluded that Reverse Pressure Softening Technique helps to reduce level of breast engorgement &amp; improve breast feeding

ObjectiveTo develop a mapping and umbrella review with a meta‐meta‐analysis (MMA) to critically evaluate the current evidence of motor imagery (MI), action observation and mirror therapy (MT) on pain intensity.MethodsThe study involved a systematic search of PubMed, PEDro, Scielo, EBSCO and Google Scholar.ResultsTen systematic reviews were included in the qualitative synthesis, 70% of which showed high methodological quality. Three reviews found a significant reduction in chronic musculoskeletal pain as the result of applying movement representation methods (MRM) plus usual‐care (UC), with a large clinical effect (standardized mean difference [SMD] of −1.47; 95% CI −2.05 to −0.88; heterogeneity Q = 1.66; p = 0.44; I2 = 0%). However, two reviews showed no statistically significant reduction in acute and postsurgical pain as a result of applying MI plus UC. Four reviews showed no significant reduction in phantom limb pain (PLP) as a result of applying MT plus UC interventions. In four reviews, the MMA showed a significant reduction in complex regional pain syndrome (CRPS) as a result of applying MT plus UC, with a large clinical effect (SMD −1.27; 95% CI −1.87 to −0.67; heterogeneity Q = 3.95; p = 0.27; I2 = 24%). In two reviews, the MMA showed no significant differences in poststroke pain as a result of applying MT plus UC.ConclusionResults show that MRM could be effective for chronic musculoskeletal pain, with low to moderate‐quality evidence. The results also show a reduction in pain intensity through MT interventions in patients with CRPS, although these results were not found in patients with PLP or poststroke pain.SignificanceThis umbrella review analysed systematic reviews evaluating movement representation techniques, with the aim of synthesizing the available evidence regarding motor imagery, action observation and mirror therapy on pain. The results provide relevant information about the potential clinical use of movement representation techniques in different types of patients with painful conditions.

BackgroundBreastfeeding, acknowledged for its critical health benefits for both infants and mothers, remains markedly underutilized in Ireland, which reports the lowest breastfeeding rates in Europe. Recent data indicate that fewer than 60% of Irish mothers initiate breastfeeding at birth, with this rate precipitously declining in the subsequent weeks postpartum. Various sociocultural, psychological, and educational elements, such as prenatal breastfeeding education, influence this persistently low prevalence. This descriptive qualitative study explores the perspectives of mothers and healthcare professionals, specifically midwives and lactation consultants, on prenatal breastfeeding education classes in Ireland and how they influence mothers’ breastfeeding decisions.MethodsA qualitative descriptive methodology was employed, utilizing online semi-structured interviews with midwives, lactation consultants (n = 10), and postnatal mothers (n = 20) from four tertiary hospitals in the Republic of Ireland. The data were subjected to reflexive thematic analysis, adhering to the six-step process of thematic analysis, to extrapolate and analyse the interview transcriptions. NVivo software was used to facilitate this analysis, given its robust capabilities in organizing, coding, and retrieving qualitative data efficiently. Four criteria for qualitative research were also used to enhance analytical rigor.ResultsPrenatal breastfeeding education in Ireland often presents breastfeeding in an idealized way, resulting in a gap between mothers’ expectations and their actual experiences. Participants needed practical content that included realistic scenarios and breastfeeding benefits. Additionally, findings indicate a desire for a more interactive and personalized educational model to address expectant mothers’ unique needs better. Limitations of the virtual class format were also highlighted, with participants noting the potential for technology to improve engagement and personalization. The data further underscore the need for consistency and accuracy in breastfeeding education, with participants identifying standardized approaches and awareness of socio-cultural dynamics, including partner involvement, as essential elements in effective prenatal breastfeeding education.ConclusionThis study underscores the necessity for a more realistic, interactive, and standardized approach to prenatal breastfeeding education in Ireland. Current classes often set idealized expectations that may leave mothers feeling unprepared for breastfeeding’s real-life challenges. Addressing these gaps by integrating practical scenarios, enhancing technological tools for virtual classes, and incorporating socio-cultural considerations could improve breastfeeding education and maternal outcomes. This qualitative descriptive study highlights a disconnect between educational objectives and mothers’ actual experiences, advocating for a holistic approach that includes personalized, culturally sensitive support and comprehensive training for healthcare providers.

Background: Disrespect or abuse is a mistreatment of women during pregnancy, childbirth or postpartum period. It is one of the contributing factors of low uptake of institutional delivery. In Ghana, there is little information about disrespect or abuse during childbirth in public health facilities. The objective is to identify factors associated with disrespect and abuse during facility-based childbirth in Tamale metropolis. Methods: The study employed a descriptive cross-sectional study design with a mixed methods approach. The study was conducted in the Northern Regional Hospital and the Tamale West Hospital, both in the Tamale Metropolis. The study population comprised women who had given birth in the selected health facilities within northern Ghana. Participants were chosen using a systematic random sampling technique. The total study participants for this study were 424 as the final sample size. Data collection was facilitated using a computerized instrument deployed on tablets. The data were downloaded from the Google Form into Microsoft Excel, cleaned, coded, imported, and analysed by employing the Statistical Package for the Social Sciences (SPSS) version 24. Results: The result showed that the majority of the respondents (53%) agreed that lack of healthcare provider training in respectful maternity care can lead to disrespect and abuse. Respondents strongly agree (52.0%) that cultures that normalize disrespect and abuse during childbirth contribute to disrespect and abuse. Respondents (56.4%) were aware of any efforts or initiatives in their area to raise awareness and address disrespect and abuse during childbirth. Moreover, respondents (49.0%) agree that lack of nurses and midwives’ adherence to the patient’s charter of Ghana Health Service can lead to disrespect and abuse. Conclusion: The occurrence of disrespect and abuse during facility-based childbirth is determined by an intricate interaction of elements associated with the health system, provider attitudes, training, sociocultural norms, and health regulations. To tackle these concerns, a thorough strategy is needed that encompasses enhancing health systems, training providers, and tackling societal attitudes and practices that contribute to disrespect and abuse.

Purpose of the study: Use of controlled release morphine for chronic non-cancer pain has risen greatly during the last decade. The literature provides evidence of its efficacy in the short term but is more equivocal for long-term use. In the light of the limited evidence base, the potential problems associated with long term opioid use, the placebo responsiveness of pain, and the difficulty of generalizing randomised controlled trials on heterogenous populations to individual patients, the authors felt that single subject (N of 1) trials may be a useful means by which patients and health professionals could make clinical judgements. We also felt that conducting N of 1 trials with multiple crossovers on a medication with frequent side effects and abstinence symptoms presented specific methodological challenges worthy of review. Methods: Patients taking regular opioids prior to the trial were withdrawn in an open label fashion and were opioid free for a minimum of 2 weeks prior to a single crossover open label trial. This was followed by a titration phase in which patients were commenced at 10 mg twice daily of controlled release morphine (MS Contin) and were allowed to increase the dose to as high as 50 mg twice daily, to a level at which clinical improvements were noted without significant side effects. The open and double blind trials were then conducted at this dose. Pain, sleep, an overall measure of helpfulness, depression, anxiety, stress and activity interference were all measured during the second of each two-week period. In those with significant improvements on the open label trial, a four crossover, double blind randomized controlled trial, lasting a total of 16 weeks, was undertaken, with measures taken in the second week of each period. Patients, naive to regular opioid use prior to the study, moved straight to the open label trial. Results: Seventeen patients were enrolled in the study, and ten completed the randomized controlled trial. Three patients, one of whom was taking regular opioids prior to the commencement of the study, withdrew from the trial after the open label crossover because of a lack of benefits on the controlled release morphine and side effects. A further four patients withdrew during the double blind component of the single subject trial, two because of recurrent abstinence symptoms with each rotation to placebo, one because of increased pain levels on placebo, and one because of side effects as well as unrecognised recurrent withdrawals. A further three, of the ten patients who completed the trial suffered from significant withdrawal symptoms with each rotation placebo. In each case of recurrent withdrawals the patients had been taking regular opioids for prolonged periods prior to entering the study. Four of the six patients did not recognize their withdrawal symptoms as such, including abstinence related pain. All results of the double blind trials were recorded at significant levels of greater than .01 because of the multiple outcomes and comparisons. In spite of the universal use of stool softeners, seven of the ten patients who completed the trial had more side effects on the active rotations compared to placebo. The combination of withdrawal symptoms and side effects meant that nine of the ten (90%) subjects who completed the trial were effectively unblinded. Seven of the ten (70%) patients had significant reductions in pain, of whom six chose to continue on opioids. One chose to withdraw because of significant side effects demonstrated in the trial, although the difference only reached the .05 level. Five of the ten (50%) showed significant improvements in sleep. In all cases those patients with improved sleep also showed significant reductions in pain. Seven out of the ten patients had significant improvements in overall measures of helpfulness (the same patients who had significant reductions in pain). Conclusions: Whilst the general principles of N of 1 trials can usefully be applied to opioid use in chronic non-cancer pain a number of limitations have been demonstrated. Firstly, in the absence of an “active” placebo blinding is limited because of side effects. Secondly, abstinence symptoms were common in spite of the multiple crossovers and the limited time on the opioid using this study design. Both issues would potentially favour positive results in the trial. Despite explanation of the possibility of abstinence symptoms, as part of the consenting process to the study, subjects commonly attributed them to unrelated illness or underlying pain. It is our opinion that multiple crossover placebo N of 1 trials are inappropriate for controlled release morphine because of the frequency and severity of abstinence symptoms.

The planning and reporting of mixed methods studies on the built environment and health

“A Quasi Experimental study to compare the effectiveness of GCL and HWB application on Breast Engorgement in Postnatal Mothers in a selected Hospital of Dehradun, Uttarakhand”. Methodology: Quasi Experimental approach with Time Series Design was used as research design for the study. Sixty three postnatal mothers (32 in experimental group and 31 in control group) who fulfilled inclusion criteria were selected as sample consecutively and they were assigned randomly to experimental group and control group respectively. The data were collected by using Six point Engorgement scale and Numeric Pain scale. Intervention was given in the form of Green cabbage leave application in experimental group whereas, Hot water bag application in control group for 20 minutes in six interval of time. Results: Majority of Postnatal mothers (94%) in GCL group and (97%) in Hot Water Bag group were initiated breast feeding after 24 hour of delivery. Majority of the mothers (94 %) had undergone LSCS in GCLand (97%) in the HWB group. The homogeneity was checked in both the group by using chi square test, fisher’s exact test and ‘t’ test. It was found that except the educational status, the group were homogeneous in term of Age, Parity, Type of Delivery, Initiation of Breast Feeding, Frequency of Feeding, Duration of Breast Feeding, and Postnatal Day of engorgement. ANOVA was used for analysis. It was showed that from baseline to 20 minutes, mean engorgement and pain score in both the groups were same and then after six hours to 36 hours the mean and SD was decreased in both groups. Conclusion: Findings Concluded that GCL are more effective than HWB in reducing breast engorgement whereas in Pain, there was reduction in both the groups gradually.

Background: one of the common problems associated with breastfeeding and exclusive breastfeeding is breast engorgement until the incidence rate reaches 20%-70% in nursing mothers. Engorgement of the breasts can be prevented non-pharmacologically, namely by compressing cold cabbage leaves and the marmet technique. The study aimed to compare the effectiveness of cold cabbage leaf compresses and the Marmet technique in preventing postpartum breast engorgement in normal puerperal mothers. Methods: Types of pre-experimental research with One-shot case study design namely cabbage compress (duration 30 minutes) and marmet technique given 1 time. The total sample of 30 respondents, was divided by 15 respondents in each group and sampling by non-probability sampling type of consecutive sampling. The measuring instrument uses an observation sheet containing a six-point engorgement scale (SPES). Data was analyzed using the Wilcoxon and Mann-Whitney test (p&lt;0,05). Results: analysis of the effect of cold cabbage leaf compress management and marmet technique on the prevention of breast engorgement for normal puerperal mothers was obtained in cold cabbage leaf compresses p-value of 0.014 and in the marmet technique obtained p-value 0.317. The results of the analysis of the effectiveness of the two techniques were obtained with a p-value of 0.007 or &lt;0.05. Conclusion: Cold cabbage leaf compresses were significantly more effective in reducing breast engorgement compared to the Marmet technique in the Independent Practice of Midwives (PBM) Setia of Palu City. It is recommended to use both techniques in helping to prevent breast engorgement for normal puerperal mothers.