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Purpose: To evaluate the effect of nonpharmacological therapies on nutrition status, complications and quality of life in head and neck cancer patients and to provide a basis for clinical practice. Methods: This systematic review was reported in accordance with the Preferred Reporting Items for Systematic Review and Meta‐analysis statement. Ten databases were systematically searched for all available articles from construction to November 2023. Two researchers independently conducted literature screening, data extraction and quality evaluation. Cochrane Review Manager 5.3 was used for meta‐analysis. Results: Finally, 27 RCT studies including 2814 patients with head and neck cancer were included. Five categories of interventions were used: nutritional support, exercise, swallowing function training, psychological intervention and low‐level laser therapy. Nonpharmacological interventions can improve body weight loss in patients with HNC at the end of treatment (MD: 1.66 kg; 95% CI: 0.80 to 2.51), and subgroup analysis showed that nutritional support, psychological intervention and low‐level laser therapy were effective. Nonpharmacological interventions can also ameliorate decreases in BMI (MD: 0.71; 95% CI: 0.16 to 1.26) and reduce the incidence of malnutrition (RR: 0.76; 95% CI: 0.67 to 0.86), oral mucositis (RR: 0.54; 95% CI: 0.37 to 0.80) and gastrointestinal complications (RR: 0.61; 95% CI: 0.38 to 0.96) during radiotherapy; however, no significant differences were found in other complications and quality of life. Conclusion: Nonpharmacological interventions can improve the nutrition status of patients with head and neck cancer and reduce the incidence of severe oral mucositis and gastrointestinal complications during radiotherapy but have no significant impact on quality of life. [ABSTRACT FROM AUTHOR]

Background: Unnecessary childbirth interventions are still common in most hospitals in Jordan. Despite the recommendations from the WHO that unnecessary interventions during childbirth should be avoided, these interventions are still used. Non-pharmacological pain management interventions are considered a convenient alternative to unnecessary childbirth interventions because they can prevent unsafe side effects for mothers during childbirth. The study aims to determine the feasibility of non-pharmacological pain management interventions during childbirth and then to evaluate their influence on mothers' experience. Methods: Between May and June 2022, we implemented a quality improvement project with a bundle of non-pharmacologic comfort measures during childbirth. We started our project by (1) approaching all low-risk pregnant mothers who visited the hospital's antenatal clinic with a gestational age greater than 36 weeks. (2) Following the agreement, the researcher indicated that she would accompany the mother during the birthing process. (3) The researcher discussed different non-pharmacological pain management techniques and asked the mothers to choose how and when to utilize them. Non-pharmacological pain management techniques include breathing exercises, back massages, enabling mothers to move around, and providing modest amounts of water and soft food. (4) A few days after birth, the mother was interviewed one-to-one utilizing semi-structured audio-recorded interviews. The researcher interviewed eighteen postpartum mothers at a place of their choosing. Results: Three main themes emerged from the interview analysis. The following themes were selected from the participants' own words: "Positive, respectful, and satisfying childbirth experience"; "Maintain mother's sense of control and cope with childbirth pain"; and "Birth outcome". These themes are connected and impacted by one another. Discussion: Different research studies from diverse cultures recommend limiting the unnecessary use of interventions during childbirth and not interfering with childbirth unless medically necessary. Our participants expressed satisfaction with the use of culturally appropriate birth interventions during childbirth. These interventions were generally simple and safe, resulting in a satisfying birthing experience. Conclusion: The study findings contribute to achieving Sustainable Development Goal #3, "Good health and well-being" by reducing maternal and neonatal mortality, providing evidence of the effectiveness of non-pharmacological pain management, and avoiding unnecessary childbirth interventions. [ABSTRACT FROM AUTHOR]

Background Best practices for clinical trials stipulate that statistical analysis plans (SAPs) need to be finalized before initiation of any analysis. However, there is limited guidance about when changes to SAPs are acceptable and how these changes should be incorporated into the research plan with appropriate documentation. Methods We conducted a survey of 12 pragmatic clinical trials (PCTs) in the Pain Management Collaboratory that evaluated nonpharmacological interventions for pain to assess the following SAP information: (1) location of statistical analysis details, (2) types of statistical analyses planned, (3) sponsor requirements, (4) templates used for development, (5) publication plan, (6) changes since trial launch, (7) process of documenting changes, and (8) process of updating the trial registry. Results All 12 PCTs provided details of their SAPs for the primary outcomes in the institutional review board–approved trial protocol; 8 included plans for secondary outcomes, and 6 included plans for tertiary/exploratory outcomes. Most PCTs made SAP changes after trial initiation, many as a result of COVID-19–related issues. Eleven of the PCTs were actively recruiting participants. Changes were made to sample size, study design, study arms, and analytical methods, all before the data lock/unblinding. In all cases, justification for the changes was documented in the trial protocol or SAP, signed off by the trial biostatistician and principal investigator, and reviewed/approved by an institutional review board, data and safety monitoring board, or sponsor. Conclusions We recommend that SAP changes can be acceptable up to the time of data lock/unblinding. To maintain full transparency and necessary rigor, clear documentation of such changes should include details, rationale, date(s) such changes were implemented, and evidence of approval by relevant oversight bodies. [ABSTRACT FROM AUTHOR]

Background: Recent research has established an association between insomnia and an elevated risk of stroke. Given the severe global impact of stroke on public health, exploring nonpharmacological interventions, such as acupuncture, that can mitigate stroke risk among individuals with insomnia is crucial. Methods: In this retrospective cohort study, we used data from the Taiwan National Health Insurance Database (NHIRD) to examine the relationship between acupuncture and the risk of stroke among individuals who received a diagnosis of insomnia between 2000 and 2017. The study participants were divided into two cohorts: the acupuncture group that received acupuncture and a matched control group that did not. The primary outcome was the occurrence of stroke. Results: Of the 217,356 patients included in the study, 3668 individuals in the acupuncture group and 4913 in the control group experienced stroke. The incidence rate of stroke was lower in the acupuncture group (4.51 per 1000 person-years) than in the control group (6.86 per 1000 person-years). After adjustment for various potential confounders, patients who received acupuncture exhibited a notably reduced risk of stroke, with an adjusted hazard ratio of 0.66 (95 % confidence interval [CI]: 0.63, 0.69). Furthermore, a dose–response relationship was evident, in that individuals who received 6–11 acupuncture sessions experienced a 24 % reduction in stroke risk, whereas those who received 12–17 sessions, 18–29 sessions, and ≥30 sessions exhibited reductions of 31 %, 34 %, and 42 %, respectively. Conclusion: Acupuncture treatment was significantly associated with a reduced risk of stroke among patients with insomnia.

Abstract Background Unnecessary childbirth interventions are still common in most hospitals in Jordan. Despite the recommendations from the WHO that unnecessary interventions during childbirth should be avoided, these interventions are still used. Non-pharmacological pain management interventions are considered a convenient alternative to unnecessary childbirth interventions because they can prevent unsafe side effects for mothers during childbirth. The study aims to determine the feasibility of non-pharmacological pain management interventions during childbirth and then to evaluate their influence on mothers’ experience. Methods Between May and June 2022, we implemented a quality improvement project with a bundle of non-pharmacologic comfort measures during childbirth. We started our project by (1) approaching all low-risk pregnant mothers who visited the hospital’s antenatal clinic with a gestational age greater than 36 weeks. (2) Following the agreement, the researcher indicated that she would accompany the mother during the birthing process. (3) The researcher discussed different non-pharmacological pain management techniques and asked the mothers to choose how and when to utilize them. Non-pharmacological pain management techniques include breathing exercises, back massages, enabling mothers to move around, and providing modest amounts of water and soft food. (4) A few days after birth, the mother was interviewed one-to-one utilizing semi-structured audio-recorded interviews. The researcher interviewed eighteen postpartum mothers at a place of their choosing. Results Three main themes emerged from the interview analysis. The following themes were selected from the participants’ own words: “Positive, respectful, and satisfying childbirth experience”; “Maintain mother’s sense of control and cope with childbirth pain”; and “Birth outcome”. These themes are connected and impacted by one another. Discussion Different research studies from diverse cultures recommend limiting the unnecessary use of interventions during childbirth and not interfering with childbirth unless medically necessary. Our participants expressed satisfaction with the use of culturally appropriate birth interventions during childbirth. These interventions were generally simple and safe, resulting in a satisfying birthing experience. Conclusion The study findings contribute to achieving Sustainable Development Goal #3, “Good health and well-being” by reducing maternal and neonatal mortality, providing evidence of the effectiveness of non-pharmacological pain management, and avoiding unnecessary childbirth interventions.

Inequities with regard to brain health, economic costs, and the evidence base for dementia care continue. Achieving health equity in dementia care requires rigorous efforts that ensure disproportionately affected populations participate fully in-and benefit from-clinical research. Embedding-proven interventions under real-world conditions and within existing healthcare systems have the potential to examine the effectiveness of an intervention, improve dementia care, and leverage the use of existing resources. Developing embedded pragmatic controlled trials (ePCT) research designs for nonpharmacological dementia care interventions involves a plethora of a priori assumptions and decisions. Although frameworks exist to determine whether interventions are ready for ePCT, there is no heuristic to assess health equity-readiness. We discuss health equity considerations, case examples, and research strategies across ePCT study domains of evidence, risk, and alignment. Future discussions regarding health equity considerations across other domains are needed.

Shaherah Yousef Andargeery,1 Abdullah Ahmed Almalki,2,3 Nada Aljohani,4 Hanan Alyami,3,4 Abdulrhman Alhagbani3,5 1Nursing Management and Education Department, College of Nursing, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia; 2King Abdulaziz General Hospital, Makkah Healthcare Cluster, Makkah, Saudi Arabia; 3Saudi Patient Experience Club, Saudi Society for Health Administration, Riyadh, Saudi Arabia; 4Department of Medical and Surgical Nursing, College of Nursing, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia; 5Riyadh First Health Cluster, Riyadh, Saudi ArabiaCorrespondence: Shaherah Yousef Andargeery, Nursing Management and Education Department, College of Nursing, Princess Nourah bint Abdulrahman University, P.O. Box 84428, Riyadh, 11671, Saudi Arabia, Email syandargeery@pnu.edu.saBackground: Many patients experience stress and dissatisfaction when they are admitted to acute settings, where they receive short-term and active care for severe injuries, illnesses, or surgeries. Patient satisfaction is a key indicator of healthcare quality that affects patient outcomes, service delivery, and safety.Objective: This review aimed at systematically mapping and summarizing the evidence on non-pharmacological interventions that targeted patient satisfaction in inpatient acute settings.Methods: Three electronic databases were searched, including PubMed, EBSCO, and ScienceDirect. The inclusion criteria were: (1) studies of non-pharmacological interventions to improve patients’ satisfaction and targeting inpatients between the ages of 19 and 65 years old; (2) studies written in English and published in the last 10 years, starting from 2017. The search results were imported and screened for eligibility on Covidence. The data was then extracted, using a tool entered in Covidence’s Extraction 2.0. The extraction tool included domains on both intervention impact and delivery processes.Results: A total of 11 articles met the inclusion criteria. Randomized control trials represented the most among the group; seven studies were included given that the others were quasi-experimental studies. Those studies were conducted on the different types of services offered in acute care departments. These studies did not use a standardized questionnaire to evaluate their respective trial outcomes or to implement various adapted or adopted modules of intervention. Of note, the intervention was effective in enhancing patient satisfaction in only some of the studies.Conclusion: Different types of intervention modules have been effective in improving acute care patient satisfaction. However, further studies are needed to evaluate the effectiveness of an intervention among all patients in different acute care departments at the same time.Keywords: inpatient satisfaction, nonpharmacological interventions, systematic review, acute care, acute settings

Background: Despite advancements in cancer treatment, chemotherapy side effects significantly impact patients both physically and emotionally. While pharmacological treatments can mitigate these side effects, they may trigger additional side effects, exacerbating the overall discomfort experienced by patients; moreover, psychological factors influencing physical symptoms are beyond the reach of pharmacological interventions. Nonpharmacological interventions, however, offer the potential for complementary or alternative solutions. Objectives: This review aims to offer a comprehensive analysis of the literature on the effectiveness of nonpharmacological interventions in managing the physical side effects of chemotherapy. Methods: This review, based on a search of PubMed, PsycINFO, and Web of Science databases, identified 46 relevant studies. It categorizes interventions and evaluates their effectiveness in managing common chemotherapy side effects (fatigue, nausea, pain, diarrhea, and constipation). Results: Guided imagery, tailored exercises, and Qigong show promise in reducing fatigue, while interventions like yoga and cognitive-behavioral approaches address nausea and vomiting. Pain benefits result from guided imagery and educational interventions. Limited evidence exists for diarrhea and constipation interventions, necessitating further research. Conclusions: This review offers provisional conclusions, emphasizing the potential of integrating evidence-based nonpharmacological approaches alongside pharmacological interventions to enhance patient outcomes and reduce chemotherapy-induced side effects, considering factors such as accessibility, safety, customization, and adaptability in clinical settings. [ABSTRACT FROM AUTHOR]

Children of different age groups frequently undergo painful procedures involving needles, which can be a source of significant discomfort. Regrettably, this aspect of care often receives insufficient attention from healthcare professionals. The existing literature proposes several methodologies for managing procedural pain, with nonpharmacological techniques being particularly promising. These techniques should be adapted to the patient's age, but literature predominantly emphasizes their use with infants. Thus, it is necessary to evaluate their effectiveness in diverse age groups. Consequently, the purpose of this systematic review is to identify non-pharmacological interventions used to prevent needle-related procedural pain in children (age group 6–12 years). Primary studies in English language on non-pharmacological interventions in children aged 6–12 years undergoing needle-related procedures found on PubMed, CINAHL and Embase. A total of 18 studies were included. The results indicate the potential application of various non-pharmacological techniques, with distraction methods standing out. These techniques include activities like utilizing cards, watching cartoons, employing virtual reality and playing video games. Children's procedural pain represents a significant challenge in treatment plans. Literature offers several approaches, including nonpharmacologic methods, to control this problem. Prioritizing procedural pain management is critical both at clinical and organizational levels to improve the quality of pediatric care. These findings offer different options to support clinical practice, holding the potential to enhance the quality of patient care. • This study identifies different non-pharmacological options in managing needle-related procedural pain in children aged 6–12 years. • Distraction methods such as cards, cartoon-watching, Virtual Reality and video games are effective in children aged 6–12 years undergoing needle-related procedures which may be source of pain, stress and fear. • These findings may offer opportunities to enhance quality of pediatric care. [ABSTRACT FROM AUTHOR]

Cognitive decline refers to the gradual reduction in brain functions such as concentration, learning, attention, and memory (Hayden et al., 2011). This decline varies among individuals, with each person experiencing different degrees of decline at specific ages. Although there are various pharmacological treatments available for cognitive decline, they often come with numerous side effects, including diarrhea, weakness, dizziness, abdominal pain, nausea, anorexia, and bradycardia. Given these concerns, recent research has shifted focus to non-pharmacological strategies to delay cognitive decline. This review aims to highlight the evidence supporting the role of various physical and cognitive activities in mitigating cognitive decline among older adults. Both physical and cognitive approaches are directly linked to improved mental health in older adults, with more pronounced positive effects observed in middle-aged individuals and older adults without diagnosed cognitive decline. Studies indicate that lifestyle patterns and non-pharmacological strategies such as exercise, a Mediterranean diet, socialization, computer games, music therapy, and cognitive and behavioural therapies significantly enhance cognitive health in older adults. However, more longitudinal studies are needed to standardize the time, intensity, and duration of these non-pharmacological interventions. [ABSTRACT FROM AUTHOR]

Background and Aims: Childbirth is a multifaceted and distressing event that can profoundly affect mothers' psychological and physical well‐being. Noninvasive interventions like music therapy have been explored to improve labor outcomes by decreasing pain and anxiety levels, promoting relaxation, and enhancing maternal–fetal health. This study aimed to investigate the effect of Iranian traditional music on cervical dilation and labor progress in the active stage of term pregnancy. Methods: This study was a nonrandomized controlled trial that included pregnant women between 20 and 35, with a gravidity of two or three. Participants were assigned to either the intervention group, which received traditional Iranian music therapy during labor, or the control group, which received routine care without the music intervention. The primary outcome was the effect of music therapy on cervical dilation from 4 cm to full dilation (10 cm) during term pregnancy. The secondary outcomes included changes in fetal heart rate, maternal anxiety, and pain scores before and after the intervention. Statistical analyses were performed using appropriate methods, and the results were reported using descriptive and inferential statistics. Results: The mean age of the intervention group was 28.32 ± 6.13 years, and that of the control group was 28.31 ± 3.47 years (p = 0.890). The median duration of labor was not significantly different during the active stage, with 120 min in the intervention group and 137 min in the control group (p = 0.505). However, significant differences were observed in fetal heart rate, anxiety score, and pain score changes before and after the intervention between the two groups (p < 0.05). Conclusion: Using traditional Iranian music therapy as a noninvasive intervention during labor can potentially improve maternal and fetal outcomes by reducing anxiety and pain perception. Further research is needed to explore the potential benefits of traditional music therapy in clinical settings. [ABSTRACT FROM AUTHOR]

Background: Small infants experience a myriad of stimuli while in the Neonatal Intensive Care Unit (NICU), with many being painful or stressful experiences, although medically necessary. Purpose: To determine what is known about nonpharmacological developmental care interventions used in the NICU to mitigate procedural pain of infants born under 32 weeks gestation. Search/Strategy: Five electronic databases were searched: Medline, CINAHL, Scopus, Embase and the Cochrane Library. The inclusion criteria were as follows: experimental and nonexperimental studies from all publication years with infants born at less than 32 weeks gestational age; peer-reviewed research articles studying nonpharmacological interventions such as skin-to-skin care, facilitated tucking, nonnutritive sucking, hand hugs, and swaddling; and English language articles. Our search yielded 1435 articles. After the elimination of 736 duplicates, a further 570 were deemed irrelevant based on their abstract/titles. Then, 124 full-text articles were analyzed with our inclusion and exclusion criteria. Findings: Twenty-seven studies were reviewed. Sucrose, facilitated tucking, pacifier, skin-to-skin care, and human milk appeared to lessen pain experienced during heel sticks, suctioning, nasogastric tube insertions, and echocardiograms. All nonpharmacological interventions failed to prove efficacious to adequately manage pain during retinopathy of prematurity (ROP) examinations. Implications for Practice: Evidence review demonstrates that healthcare practitioners should use nonpharmacological measures to help prevent pain from day-to-day procedures in the NICU including heel sticks, nasogastric tube insertions, suctioning, echocardiograms, and subcutaneous injections. Implications for Research: Future research is necessary to better understand and measure how pain is manifested by very small premature infants. Specific research on mitigating the pain of examinations for retinopathy of prematurity is also needed. [ABSTRACT FROM AUTHOR]

The editorial discusses the impact of nonpharmacological interventions on glycemic control in diabetes management. Lifestyle changes, including nutrition therapy, physical activity, and psychosocial care, play a crucial role in achieving treatment goals and improving quality of life for individuals with diabetes. Studies on fruit consumption, carbohydrate counting, resistance training, and dog ownership provide insights into how these interventions can affect HbA1c levels and overall glycemic control in patients with Type 1 and Type 2 diabetes. The research emphasizes the importance of integrating nonpharmacological approaches with pharmacological treatments to optimize diabetes management. [Extracted from the article]

Barbara Badanta,1,&ast; Isabel Álvarez-Pérez,2 Patricia Bonilla Sierra,3 María González-Cano-Caballero,4,&ast; Giancarlo Lucchetti,5 Rocío de Diego-Cordero1,&ast; 1Department of Nursing; Faculty of Nursing, Physiotherapy and Podiatry, University of Seville, Seville, Spain; 2Faculty of Nursing, Physiotherapy and Podiatry. University of Seville, Seville, Spain; 3Department of Health Sciences, Universidad Técnica Particular de Loja (UTPL), Loja, Ecuador; 4Department of Nursing; Faculty of Health Sciences, University of Granada, Granada, Spain; 5Department of Medicine; School of Medicine, Universidade Federal de Juiz de Fora, Juiz de Fora, Brazil&ast;These authors contributed equally to this workCorrespondence: María González-Cano-Caballero, Department of Nursing, Faculty of Health Sciences, University of Granada, Av. de la Ilustración, 60, Granada, 18071, Spain, Email mariagcc@ugr.esAbstract: This study aims to investigate the current evidence for the use of complementary and alternative medicine (CAM) in fibromyalgia (FM). A systematic review was conducted searching for PubMed, Scopus, CINAHL, PsycInfo, and Web of Science databases. Randomized controlled trials published up to December 2023 in peer-reviewed journals were included. Methodological quality was assessed by the Quality Assessment of Controlled Intervention Studies tool. A total of 216 articles were identified and 15 constituted the final sample. The type of CAM most used was traditional Chinese medicine (60%), and the most common instrument used was the Fibromyalgia Impact Questionnaire (60%). Our review was grouped into four themes based on the origin of the therapies: 1) Traditional Chinese Medicine; 2) Japanese natural harmonization (eg, Reiki); 3) Ayurvedic Medicine; and 4) Other non-drug therapies. Our systematic review showed that there is a wide range of CAMs used to treat FM. Most of the clinical trials have shown significant results for the effectiveness of these interventions in both physical and mental health outcomes of FM as compared to control groups. However, the heterogeneity of the interventions and outcomes warrants further studies on this topic.Keywords: complementary therapies, fibromyalgia treatment, nonpharmacological interventions, traditional medicine

Aims and Objectives: To assess the effectiveness of different nonpharmacological treatments for severe radiation‐induced oral mucositis in patients with head and neck cancer. Background: Radiation‐induced oral mucositis is highly prevalent in patients with head and neck cancer. Current medications for radiation‐induced oral mucositis are limited in effectiveness and susceptible to side effects, and while there is an increasing adoption of nonpharmacological interventions, the optimal one remains unclear. Design: Systematic review and network meta‐analysis based on the PRISMA‐NMA guidelines. Methods: Six databases were searched. Two authors independently performed the literature screening, data extraction and methodological quality assessment of the included studies. Traditional pairwise meta‐analysis was performed by R Studio. A network meta‐analysis was then conducted to assess the effects of nonpharmacological interventions for severe radiation‐induced oral mucositis in patients with head and neck cancer. Results: Fifty‐two studies involving seven types of nonpharmacological interventions were enrolled. The network meta‐analysis indicated that natural plant‐based therapies might be the most effective, health education interventions might be the second most effective, and honey might be the third most effective interventions for reducing the incidence of severe radiation‐induced oral mucositis. For reducing the incidence of severe oral mucositis‐related pain, the pairwise meta‐analysis showed that only natural plant‐based therapies and health education interventions were effective. Conclusions: Nonpharmacological interventions are effective in the management of severe radiation‐induced oral mucositis among patients with head and neck cancer. Relevance to clinical practice: Nonpharmacological interventions are a category of safe and effective adjunctive therapies that should be encouraged in clinical practice. Trial registration details: CRD42023400745. [ABSTRACT FROM AUTHOR]

Abstract Background and Aims Childbirth is a multifaceted and distressing event that can profoundly affect mothers' psychological and physical well‐being. Noninvasive interventions like music therapy have been explored to improve labor outcomes by decreasing pain and anxiety levels, promoting relaxation, and enhancing maternal–fetal health. This study aimed to investigate the effect of Iranian traditional music on cervical dilation and labor progress in the active stage of term pregnancy. Methods This study was a nonrandomized controlled trial that included pregnant women between 20 and 35, with a gravidity of two or three. Participants were assigned to either the intervention group, which received traditional Iranian music therapy during labor, or the control group, which received routine care without the music intervention. The primary outcome was the effect of music therapy on cervical dilation from 4 cm to full dilation (10 cm) during term pregnancy. The secondary outcomes included changes in fetal heart rate, maternal anxiety, and pain scores before and after the intervention. Statistical analyses were performed using appropriate methods, and the results were reported using descriptive and inferential statistics. Results The mean age of the intervention group was 28.32 ± 6.13 years, and that of the control group was 28.31 ± 3.47 years (p = 0.890). The median duration of labor was not significantly different during the active stage, with 120 min in the intervention group and 137 min in the control group (p = 0.505). However, significant differences were observed in fetal heart rate, anxiety score, and pain score changes before and after the intervention between the two groups (p

With the increasing prevalence of tumors, effective symptom management has emerged as a cornerstone of patient care. While surgical interventions remain pivotal, non-surgical nursing methods have gained prominence in providing relief from pain, discomfort, and other tumor-related symptoms. This review delves into the various non-surgical approaches employed, emphasizing tumor sedation and analgesia. We discuss the array of non-pharmacological and pharmacological strategies, shedding light on their indications, contraindications, and potential side effects. Furthermore, the importance of addressing individual differences in pain perception and the ethical considerations in symptom management are highlighted. We conclude by providing insights into the recent innovations in the field, emphasizing the need for personalized and comprehensive care to enhance patients’ quality of life. Tumor sedation, Tumor analgesia, Non-surgical nursing care, Pain management, Non-pharmacological interventions, Palliative care, Recent innovations, Symptom management.

Abstract To maintain current cognitive function and access greater cognitive reserves, nonpharmacological interventions may be a viable alternative for older adults with or without cognitive impairment. This study aimed to compare different nonpharmacological interventions for enhancing global cognition, including mind–body exercise, physical exercise, non-invasive brain stimulation, cognitive training intervention (CTI), acutherapy (ACU), meditation, and music therapy, by applying a network meta-analysis (NMA). Sixty-one randomized controlled trials evaluating the efficacy of interventions on global cognition in older adults with or without mild cognitive decline were selected. An NMA was conducted to compare the efficacy of different nonpharmacological interventions. The NMA revealed that mind–body exercise (standardized mean difference, 1.384; 95% confidence interval, 0.777–1.992); ACU (1.283; 0.478–2.088); meditation (0.910; 0.097–1.724); non-invasive brain stimulation (1.242; 0.254–2.230); CTI (1.269; 0.736–1.802); and physical exercise (0.977; 0.212–1.742), showed positive effects compared to passive controls. There were no significant differences between the efficacies of other interventions. Nonpharmacological interventions may potentially enhance and maintain global cognition through various pathways, such as memorizing movements and enhancing brain plasticity by reducing stress in the older adult population. Additional studies are needed to clarify the impact of other variables, including intervention methods or psychological variables.

Abstract Trial‐based economic value of prevention programs for diabetes is inexplicit. We aimed to review the cost‐effectiveness of nonpharmacological interventions to prevent type‐2 diabetes mellitus (T2DM) for high‐risk people. Six electronic databases were searched up to March 2022. Studies assessing both the cost and health outcomes of nonpharmacological interventions for people at high‐risk of T2DM were included. The quality of the study was assessed by the Consolidated Health Economic Evaluation Reporting Standards 2022 checklist. The primary outcome for synthesis was incremental cost‐effectiveness ratios (ICER) for quality‐adjusted life years (QALYs), and costs were standardized in 2022 US dollars. Narrative synthesis was performed, considering different types and delivery methods of interventions. Sixteen studies included five based on the US diabetes prevention program (DPP), six on non‐DPP‐based lifestyle interventions, four on health education, and one on screening plus lifestyle intervention. Compared with usual care, lifestyle interventions showed higher potential of cost‐effectiveness than educational interventions. Among lifestyle interventions, DPP‐based programs were less cost‐effective (median of ICERs: $27,077/QALY) than non‐DPP‐based programs (median of ICERs: $1395/QALY) from healthcare perspectives, but with larger decreases in diabetes incidence. Besides, the cost‐effectiveness of interventions was more possibly realized through the combination of different delivery methods. Different interventions to prevent T2DM in high‐risk populations are both cost‐effective and feasible in various settings. Nevertheless, economic evidence from low‐ and middle‐income countries is still lacking, and interventions delivered by trained laypersons and combined with peer support sessions or mobile technologies could be potentially a cost‐effective solution in such settings with limited resources.

Background: The absence of a cure for dementia, combined with the increased longevity of the baby boom generation, is resulting in a dramatic increase in the number of people living with dementia. Aging-related changes coupled with dementia-related behavioral symptoms pose unique challenges for those living with dementia as well as those who provide care. There is evidence that improved sleep can improve health and well-being. Research also supports using auditory interventions as a form of nonpharmacological therapy. Objective: This study evaluated the effects of a customized auditory (sonic) treatment during sleep on the mood, behavior, quality of life, functional ability, and health condition of individuals living with the symptoms of dementia. Workforce outcomes were evaluated as a secondary outcome. Methods: A controlled before–after design with a mixed-method approach was used to evaluate the impact of the sonic sleep treatment during baseline, intervention, and discontinuation time frames. Results: Statistically significant improvements were observed in participants' cooperation with care (p =.0249) and daytime drowsiness (p =.0104). Other nonstatistically significant improvements included bed mobility, appetite, bathing self-performance, toilet use, incidence of falls, following requests and instructions, and nighttime insomnia. While workforce outcomes remained unchanged, staff were supportive of resuming the sonic sleep treatment after the discontinuation time frame. Conclusions: The sonic sleep treatment demonstrated improved outcomes for individuals living with dementia. This supports using an appropriate auditory stimulus as a fundamental component of care for individuals living in memory care settings. [ABSTRACT FROM AUTHOR]

Objective: It was aimed to determine the effect level of nonpharmacological methods applied by nurses to patients hospitalized in the intensive care unit on the duration of delirium. Materials and methods: For this study, relevant studies were accessed by searching in July–October 2022. After the necessary exclusions were made, 14 studies were included in the study. The total sample size of the studies was 1123. Results: According to the results, nonpharmacological interventions applied by nurses to intensive care patients were found to reduce the duration of delirium (SMD: − 0.625, 95% CI: − 1.1040–0.210; Z = − 2.950, p = 0.003, I2 = 93.119%). The country of the study (SMD: − 0.047, p = 0.001) and the types of nonpharmacological interventions used (SMD: − 0.062, p = 0.000) influenced the effect size of modulators on the duration of delirium in ICU patients. Conclusion: Nonpharmacological interventions applied by nurses, who have significant responsibilities in the protection and promotion of health, were found to reduce the duration of delirium in intensive care patients. This study shows that nurses, one of the main components of the multidisciplinary team in intensive care, are successful when they apply nonpharmacological interventions well. [ABSTRACT FROM AUTHOR]

IntroductionThe increasing number of people living with dementia and its burden on families and systems particularly in low- and middle-income countries require comprehensive and efficient post-diagnostic management. This study aimed to explore the acceptability and efficacy of a multi-professional case management and psychoeducation model (North Macedonia Interprofessional Dementia Care, or NOMAD) delivered by mobile teams for people with dementia and their caregivers in North Macedonia.MethodWe conducted a two-arm randomized controlled trial comparing the intervention with treatment as usual. Participants were recruited from 12 general practitioner (GP) offices in the Skopje region. The NOMAD intervention included the delivery of a personalized care plan over four home visits to dyads of people with dementia and their caregivers by a team including a dementia nurse and a social worker, in collaboration with GPs and dementia experts, and the introduction of a caregiver manual. We assessed caregivers' depressive symptoms, burden, and quality of life and the neuropsychiatric symptoms, daily living activities, and service utilization of people with dementia at baseline and follow-up; we also assessed the acceptability of the intervention by analyzing case notes and attendance rates.ResultsOne hundred and twenty dyads were recruited and randomized to either the control (n = 60) or the intervention group (n = 60). At follow-up, caregivers in the intervention group had, on average, scores that were 2.69 lower for depressive symptoms (95% CI [−4.75, −0.62], p = 0.012), and people with dementia had, on average, 11.32 fewer neuropsychiatric symptoms (95% CI [−19.74, −2.90], p = 0.009) and used, on average, 1.81 fewer healthcare services (95% CI [−2.61, −1.00], p < 0.001) compared to the control group. The completion of the home visits was 100%, but the intervention's acceptability was underpinned by relationship building, GP competencies, and resources to support families with dementia. There were no differences in the caregivers' quality of life and burden levels or daily living activities in people with dementia. NOMAD is the first case management, non-pharmacological, and multi-professional intervention tested in North Macedonia.DiscussionThe trial showed that it is effective in reducing caregivers' depressive symptoms and neuropsychiatric symptoms in people with dementia and the burden on health and social care services, and it is acceptable for families. Implementing NOMAD in practice will require building primary care capacity and recognizing dementia as a national priority.

BackgroundThis study addresses the pervasive issue of heightened preoperative anxiety in healthcare, particularly among pediatric patients. Recognizing the various sources of anxiety, we explored both pharmacological and nonpharmacological interventions. Focusing on distraction techniques, including active and passive forms, our meta-analysis aimed to provide comprehensive insights into their impact on preoperative anxiety in pediatric patients.MethodsFollowing the PRISMA and Cochrane guidelines, this meta-analysis and systematic review assessed the efficacy of pharmaceutical and distraction interventions in reducing pain and anxiety in pediatric surgery. This study was registered on PROSPERO (CRD42023449979).ResultsThis meta-analysis, comprising 45 studies, investigated pharmaceutical interventions and distraction tactics in pediatric surgery. Risk of bias assessment revealed undisclosed risks in performance and detection bias. Distraction interventions significantly reduced preoperative anxiety compared to control groups, with notable heterogeneity. Comparison with Midazolam favored distraction techniques. Subgroup analysis highlighted varied efficacies among distraction methods, with a notable reduction in anxiety levels. Sensitivity analysis indicated stable results. However, publication bias was observed, suggesting a potential reporting bias.ConclusionOur study confirms distraction techniques as safe and effective for reducing pediatric preoperative anxiety, offering a valuable alternative to pharmacological interventions.Systematic Review Registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?RecordID=449979, PROSPERO [CRD42023449979].

One of the most exhausting and common complications of cancer and its treatments is cancer-related fatigue. According to the results reported from various studies, non-pharmacological interventions are preferable to pharmaceutical treatments. The purpose of the present study was to investigate nonpharmacological approaches effective on cancer-related fatigue. Based on the results of various studies, there is much evidence of the positive effect of exercise and acupuncture on reducing cancerrelated fatigue during and after treatments. Existing studies on psycho-social support, sleep modification, nutrition, and complementary and alternative medicine methods, such as massage and touch, yoga, relaxation and meditation, and herbal medicines, suggest that these methods can reduce or eliminate related fatigue. In general, it seems that all the methods discussed in this study are noninvasive, low-risk, and relatively cheap methods that can be used alongside common treatments or even replace pharmaceutical methods. It is hoped that such studies will be used for evidence-based performance in reducing fatigue in cancer patients. [ABSTRACT FROM AUTHOR]

Aim: To review existing research on nonpharmacological tactile activity interventions for reducing behavioural and psychological symptoms of dementia in the acute hospital setting. Background: When people living with dementia are admitted to hospital, they often experience an exacerbation of behavioural and psychological symptoms of dementia. Pharmacological interventions are often used to manage behavioural and psychological symptoms of dementia despite the low success rate and the heightened risk of morbidity and mortality. Low‐cost alternatives that are implementable at the bedside are nonpharmacological interventions such as tactile activity interventions. Design: An integrative review of the literature. Methods: Four databases were searched using the PRISMA framework to guide the search and screening. Eligible studies were identified and the quality of each was evaluated using the Mixed Method Appraisal Tool. Thematic analysis was conducted to identify and analyse key themes across all articles. The PRISMA checklist was used to evaluate the current study. Results: Seven studies examined the use of tactile activity interventions to reduce the behavioural and psychological symptoms of dementia and the barriers and facilitators to implementation. Conclusion: There is limited evidence exploring tactile activity interventions for reducing behavioural and psychological symptoms of dementia in acute hospital settings. Individualised approaches in combination with staffing expertise appear central to implementation. Relevance to Clinical Practice: Acute hospital settings can result in increased behavioural and psychological symptoms of dementia which can be distressing for patients and family and challenging for nursing staff. Tactile activity interventions may offer a low resource bedside option to support people with dementia in acute health settings. Patient or Public Contribution: No direct patient or public contribution to the review. [ABSTRACT FROM AUTHOR]

What is Known on the Subject: Research has shown effectiveness of nonpharmacological interventions in improving or maintaining cognition, mood, functioning, self‐efficacy and quality of life for persons with mild‐to‐moderate dementia (PWDs).These interventions are critical during the earlier stages of dementia. However, Canadian and international literature report underutilization of and difficulty accessing the interventions. What this Paper Adds to Existing Knowledge: To our knowledge, this is the first review that explored factors influencing seniors' utilization of nonpharmacological interventions in the earlier stages of dementia. This review contributed to the discovery of unique factors such as PWDs' beliefs, fears, perceptions, and acceptability of nonpharmacological interventions and environmental influences on intervention provision.PWDs' intervention uptake may appear as a matter of personal choices related to individuals' knowledge, beliefs and perceptions. However, the analysis of the research evidence suggests that PWDs' choices are shaped by environmental factors such as formal and informal caregiver support, acceptability and accessibility of nonpharmacological interventions, dementia care workforce, community's attitudes towards dementia and funding. The complex interplay among factors highlights the importance of targeting health promotion strategies at both individuals and their environments. What are the Implications for Practice: The review findings feature opportunities for healthcare practitioners, including mental health nurses, in advocating for PWDs' evidence‐informed decision‐making and access to desired nonpharmacological treatments. Involvement of patients and families in care‐planning through ongoing assessment of health and learning needs, as well as enablers and barriers to using interventions, continuing information provision, and personalized referrals to appropriate services can promote PWDs' rights to healthcare. Introduction: Despite the significance of nonpharmacological interventions in optimal management of mild‐to‐moderate dementia, it remains unclear in the literature how persons with mild‐to‐moderate dementia (PWDs) view, understand and access nonpharmacological interventions. Aim: The purpose of this review was to explore the extent and nature of evidence concerning factors that influence the use of nonpharmacological interventions for community‐dwelling seniors with mild‐to‐moderate dementia. Method: An integrative review was undertaken following Toronto and Remington (A step‐by‐step guide to conducting an integrative review, 2020)'s instruction which expanded Torraco (Human Resource Development Review, 2016, 15, 404)'s and Whittemore and Knafl (Journal of Advanced Nursing, 2005, 52, 546)'s guidance. Results: The review of 16 studies suggests that PWDs' use of nonpharmacological interventions is shaped by a complex interplay of various personal, interpersonal, organizational, community and political influences. Discussion: The findings highlight the complex, interrelated relationships among multiple factors and subsequent limitations of behaviour‐oriented health promotion strategies. To assist PWDs in making healthier choices, health promotion strategies need to direct attention to both individuals' behaviours and environmental conditions impacting the behaviours. Implications for Practice: The findings of this review can inform multidisciplinary health practitioners' (including mental health nurses) practice with seniors living with mild‐to‐moderate dementia. We recommend actionable ways in which they can empower patients and their families in dementia management. [ABSTRACT FROM AUTHOR]

One of the most complex and challenging developments at the beginning of the third millennium is the alarming increase in demographic aging, mainly—but not exclusively—affecting developed countries. This reality results in one of the harsh medical, social, and economic consequences: the continuously increasing number of people with dementia, including Alzheimer's disease (AD), which accounts for up to 80% of all such types of pathology. Its large and progressive disabling potential, which eventually leads to death, therefore represents an important public health matter, especially because there is no known cure for this disease. Consequently, periodic reappraisals of different therapeutic possibilities are necessary. For this purpose, we conducted this systematic literature review investigating nonpharmacological interventions for AD, including their currently known cellular and molecular action bases. This endeavor was based on the PRISMA method, by which we selected 116 eligible articles published during the last year. Because of the unfortunate lack of effective treatments for AD, it is necessary to enhance efforts toward identifying and improving various therapeutic and rehabilitative approaches, as well as related prophylactic measures. [ABSTRACT FROM AUTHOR]

Parkinson's disease (PD) is a neurodegenerative illness characterized by the degeneration of dopaminergic neurons in the substantia nigra, resulting in motor symptoms and without debilitating motors. A hallmark of this condition is the accumulation of misfolded proteins, a phenomenon that drives disease progression. In this regard, heat shock proteins (HSPs) play a central role in the cellular response to stress, shielding cells from damage induced by protein aggregates and oxidative stress. As a result, researchers have become increasingly interested in modulating these proteins through pharmacological and non-pharmacological therapeutic interventions. This review aims to provide an overview of the preclinical experiments performed over the last decade in this research field. Specifically, it focuses on preclinical studies that center on the modulation of stress proteins for the treatment potential of PD. The findings display promise in targeting HSPs to ameliorate PD outcomes. Despite the complexity of HSPs and their co-chaperones, proteins such as HSP70, HSP27, HSP90, and glucose-regulated protein-78 (GRP78) may be efficacious in slowing or preventing disease progression. Nevertheless, clinical validation is essential to confirm the safety and effectiveness of these preclinical approaches. [ABSTRACT FROM AUTHOR]

Across Latin American and Caribbean countries (LACs), the fight against dementia faces pressing challenges, such as heterogeneity, diversity, political instability, and socioeconomic disparities. These can be addressed more effectively in a collaborative setting that fosters open exchange of knowledge. In this work, the Latin American and Caribbean Consortium on Dementia (LAC-CD) proposes an agenda for integration to deliver a Knowledge to Action Framework (KtAF). First, we summarize evidence-based strategies (epidemiology, genetics, biomarkers, clinical trials, nonpharmacological interventions, networking, and translational research) and align them to current global strategies to translate regional knowledge into transformative actions. Then we characterize key sources of complexity (genetic isolates, admixture in populations, environmental factors, and barriers to effective interventions), map them to the above challenges, and provide the basic mosaics of knowledge toward a KtAF. Finally, we describe strategies supporting the knowledge creation stage that underpins the translational impact of KtAF.

Background: Heart failure (HF) is the most common condition for rehospitalization among people aged ≥65 years in the United States, with 35,197,725 hospitalizations between 2014 and 2017. Hospitalized patients with HF have the highest 30-day readmission rate (25%). Overall, HF management, despite its progress, remains a challenge. Although several studies have evaluated interventions designed to reduce HF-related hospital readmissions, research comparing their effectiveness remains insufficient. Purpose: This systematic review and meta-analysis focused on studies that investigated the effectiveness of nonpharmacological interventions (NPIs) on reducing rehospitalization among patients with HF. Methods: This review conformed to the preferred reporting items for systematic reviews and meta-analyses guidelines, used four databases: Cumulative index to Nursing and Allied Health Literature, PubMed, Cochrane, and Web of Science. Studies were included in the review according to the following criteria: (a) included only randomized control trials (RCTs), (b) included participants with HF who were over 18 years of age, (c) peer-reviewed, (d) written in English, and (e) rehospitalizations occurring within 30-day, 90-day, and 1 year of discharge from the initial hospitalization. Results: Fourteen studies were included, with a total of 2,035 participants. Meta-analysis showed that rehospitalization was different between the intervention and usual care groups. The odds ratio was 0.54 (95% confidence interval [0.36, 0.82, p < 0.01]). Conclusions/Implications for Practice: NPIs designed to increase HF knowledge and self-management may effectively reduce rehospitalization among HF patients. NPIs can be delivered at the patient's home through visits, phone calls, or digital platforms and technologies. [ABSTRACT FROM AUTHOR]

Objective: The aim of the study was to investigate the prevalence, and determinants, of nonpharmacological pain management practices among nurses in multiple settings. Materials and Methods: A cross-sectional examination was conducted involving 324 nurses from 16 hospitals in Hai'l, Saudi Arabia. Participants completed a self-reported survey utilizing established tools to assess the frequency of nonpharmacological pain management interventions utilization and identify associated barriers. Data analysis was performed using SPSS version 29.0. Results: Nonpharmacological pain management practices were found to be utilized "sometimes," with a score of 2.89 ± 0.48. Commonly employed techniques included placing patients in comfortable positions and providing a tranquil environment. Gender was the sole demographic factor significantly affecting the use of these techniques (P < 0.001), with female nurses demonstrating higher utilization. Barriers to implementation varied based on the hours of recent pain management education (P = 0.004), with prevalent barriers including nurse shortages, multiple responsibilities, heavy workloads, and nurse fatigue. Conclusion: The study reveals moderate utilization of nonpharmacological pain management approaches, primarily focusing on patient positioning and creating a calm environment. Female nurses exhibited higher adoption rates of these techniques. Barriers to implementation, such as nurse shortages and heavy workloads, were influenced by recent pain management education. Consequently, enhancing education and fostering supportive work environments are crucial for surmounting these barriers and promoting pain management awareness among nurses. [ABSTRACT FROM AUTHOR]

Background: Delirium, which is frequently encountered in intensive care patients, can be prevented with multicomponent nursing interventions, and thus the negative consequences can be reduced. Aim: To examine the effect of using eye masks and earplugs in preventing delirium in intensive care units (ICUs). Study Design: A randomized, controlled, single‐blind intervention study. This study was conducted in the medical and surgical ICUs of a tertiary hospital, and nurses were given pre‐study training on delirium risks, diagnosis, prevention, and management. Data were collected using the patient information form, the Nursing Delirium Screening Scale, the Richard–Campbell Sleep Scale, and the daily follow‐up form. Various environmental modifications were made in the ICUs for all patients, and evidence‐based nonpharmacological nursing interventions were applied to the patients in both groups during the day and night shifts for 3 days. In addition, the patients in the intervention group were provided with eye masks and earplugs for three nights. Results: The study included a total of 60 patients (30 in the intervention group and 30 in the control group). There was a statistically significant difference in the development of delirium between the intervention and control groups (night of the 2nd day, p =.019; day of the 3rd day p <.001; night of the 3rd day p ≤.001). The average total sleep quality score of the intervention group was found to be significantly higher than the control group (p ≤.001 for three nights). Staying in the internal medicine ICU affected (odds ratio [OR], 11.84; 95% confidence interval [CI], 3.00–46.66; p =.017) more on the development of delirium than in coronary ICU, being in the age group of 65 and over, having a hearing impairment, coming to ICU from the operating room, and education level had an effect. Conclusions: The earplugs and eye masks used by the intensive care patients overnight were found to be effective in increasing sleep quality and preventing delirium. Relevance to Clinical Practice: The use of eye masks and earplugs is recommended for ICUs in preventing delirium. [ABSTRACT FROM AUTHOR]

• To face the pathology caused by the coronavirus, the researches focused on the use of pharmacological treatments (ie Remdesivir, hydroxychloroquine or Interferon) and the development of effective vaccines. • Not all studies have shown positive evidence for the use of some drugs as a treatment for coronavirus. • The diverse symptoms and high mortality rate have highlighted the use of non-pharmacological therapies, as alternatives or complementary to the drug approach. The aim of this study was to evaluate the use and effectiveness of non-pharmacological therapies as part of the treatment of COVID-19 and its complications, either combined or not with the usual treatment. A systematic review was conducted between August and October 2021 using PubMed, Scopus, CINAHL and Web of Science databases. From a total of 204 articles identified, 33 were included in the final sample (15 clinical trials and 18 quasi-experimental studies). The methodological evaluation was carried out using STROBE and CONSORT guidelines. There is a growing literature on the use of CAM for COVID-19. Most studies have shown positive findings, particularly for the use of TCM, other herbal therapies and acupuncture. Nevertheless, most studies were carried out in Asia and relied on quasi-experimental designs. The current evidence is available for physical outcomes (mortality rate, pneumonia resolution and other symptoms, negative PCR test, and hospitalization and ICU admissions) and for mental health outcomes. Despite a positive role of CAM on COVID-19 outcomes, the evidence is still mostly based on quasi-experimental studies. More robust clinical trials are needed in order to generate better evidence in this area. [ABSTRACT FROM AUTHOR]

Simple Summary: Symptoms such as light-headedness and fainting upon standing can have a large negative impact on the quality of life, especially for people with orthostatic hypotension (blood pressure drop upon or during standing). One treatment option suggested in the clinic is head-up tilted sleeping (HUTS), where the full body is inclined. In this paper we reviewed the available evidence for the use of HUTS. We identified 10 studies focussing on HUTS as a treatment to improve orthostatic tolerance. Unfortunately, the overall evidence was weak, mainly because of the low number of included participants. We also noticed that the studied angles differed as well as the type of measurements to evaluate HUTS. Despite this, the anecdotal evidence suggested that HUTS therapy could slightly improve low standing blood pressure and its associated symptoms. The effects were more marked if higher angles were applied. These results provide some, although weak, evidence favouring HUTS, but the clinical relevance and the tolerability need to be studied further in larger-scale trials. To systematically summarize the evidence of head-up tilt sleeping (HUTS) on orthostatic tolerance, we conducted a systematic, predefined search in PubMed, OVID Embase, Cochrane and Web of Science. We included studies assessing the effect of HUTS on orthostatic tolerance and other cardiovascular measures and rated the quality with the American Academy of Neurology risk of bias tool. We included 10 studies (n = 185) in four groups: orthostatic hypotension (OH; 6 studies, n = 103), vasovagal syncope (1 study, n = 12), nocturnal angina pectoris (1 study, n = 10) and healthy subjects (2 studies, n = 58). HUTS duration varied (1 day–4 months) with variable inclinations (5°–15°). In two of six OH studies, HUTS significantly improved standing systolic blood pressure. Orthostatic tolerance was consistently enhanced in OH studies with higher angles (≥12°), in 2 out of 3 with smaller angles (5°) but also in one studying horizontal sleeping. In vasovagal syncope, HUTS significantly augmented resilience to extreme orthostatic stress. One study was rated as a class II risk of bias, one of Class II/III and eight of Class IV. The evidence favouring HUTS to improve orthostatic tolerance is weak due to variable interventions, populations, small samples and a high risk of bias. Despite this, we found some physiological signs suggesting a beneficial effect. [ABSTRACT FROM AUTHOR]

Objective: The aim of the study was to investigate the prevalence, and determinants, of nonpharmacological pain management practices among nurses in multiple settings. Materials and Methods: A cross-sectional examination was conducted involving 324 nurses from 16 hospitals in Hai'l, Saudi Arabia. Participants completed a self-reported survey utilizing established tools to assess the frequency of nonpharmacological pain management interventions utilization and identify associated barriers. Data analysis was performed using SPSS version 29.0. Results: Nonpharmacological pain management practices were found to be utilized “sometimes,” with a score of 2.89 ± 0.48. Commonly employed techniques included placing patients in comfortable positions and providing a tranquil environment. Gender was the sole demographic factor significantly affecting the use of these techniques (P < 0.001), with female nurses demonstrating higher utilization. Barriers to implementation varied based on the hours of recent pain management education (P = 0.004), with prevalent barriers including nurse shortages, multiple responsibilities, heavy workloads, and nurse fatigue. Conclusion: The study reveals moderate utilization of nonpharmacological pain management approaches, primarily focusing on patient positioning and creating a calm environment. Female nurses exhibited higher adoption rates of these techniques. Barriers to implementation, such as nurse shortages and heavy workloads, were influenced by recent pain management education. Consequently, enhancing education and fostering supportive work environments are crucial for surmounting these barriers and promoting pain management awareness among nurses.

Disproportionate to the severity of Alzheimer’s disease (AD) and the huge number of patients, the exact treatment and prevention of AD is still being explored. With increasing ageing, the search for means to prevent and treat AD has become a high priority. In the search for AD, it has been suggested that exercise may be one of the more effective and less costly means of preventing and treating AD, and therefore a large part of current research is aimed at exploring the effectiveness of exercise in the prevention and treatment of AD. However, due to the complexity of the specific pathogenesis of AD, there are multiple hypotheses and potential mechanisms for exercise interventions in AD that need to be explored. This review therefore specifically summarises the hypotheses of the interaction between exercise and AD from a molecular perspective, based on the available evidence from animal models or human experiments, and explores them categorised according to the pathologies associated with AD: exercise can activate a number of signalling pathways inhibited by AD (e.g., Wnt and PI3K/Akt signalling pathways) and reactivate the effects of downstream factors regulated by these signalling pathways, thus acting to alleviate autophagic dysfunction, relieve neuroinflammation and mitigate Aβ deposition. In addition, this paper introduces a new approach to regulate the blood-brain barrier, i.e., to restore the stability of the blood-brain barrier, reduce abnormal phosphorylation of tau proteins and reduce neuronal apoptosis. In addition, this paper introduces a new concept.” Motor factors” or “Exerkines”, which act on AD through autocrine, paracrine or endocrine stimulation in response to movement. In this process, we believe there may be great potential for research in three areas: (1) the alleviation of AD through movement in the brain-gut axis (2) the prevention and treatment of AD by movement combined with polyphenols (3) the continued exploration of movement-mediated activation of the Wnt signalling pathway and AD. [ABSTRACT FROM AUTHOR]

Background: Attention deficit hyperactivity disorder is a common psychiatric disorder with a worldwide prevalence of about five percent among children and adolescents. This disorder affects most aspects of their lives e.g., academic performance and social relations, and their overall quality of life is reduced compared to healthy peers. The majority of children with ADHD are treated with medication that potentially has an insufficient effect and/or frequently occurring side effects. Objectives: To enable nurses and other health care professionals to guide children with ADHD and their families in their choices of treatment, based on the best available literature on the association between nonpharmacological interventions and quality of life. Data Sources: A literature search was performed in the databases CENTRAL, Embase, PubMed, CINAHL, and PsycINFO. Seven randomized controlled trials were included in this systematic review. They examined the use of polyunsaturated fatty acids, physical activity, psychoeducation, cognitive therapy, cognitive training, hippotherapy, and behavioral therapy. Conclusions: The study of behavioral therapy in the form of a sleep intervention detected an improvement in quality of life which was statistically significant compared to the control group. Implications for Practice: Children with ADHD and a sleep disorder may gain improvement in their quality of life from a sleep intervention. [ABSTRACT FROM AUTHOR]

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Background and Objectives Effectively adapting evidence-based interventions for nursing home (NH) implementation is a critical, yet underexamined, component of improving care quality. Montessori-based activity programming (MAP) is an evidence-based intervention that promotes person-centered care, engages persons living with dementia, and mitigates distress behaviors. Currently, there is sparse evidence of MAP in Department of Veterans Affairs NHs (i.e. community living centers [CLCs]). CLCs differ significantly from community NHs and require adaptations to support MAP use and sustainability. This study uses the Framework for Reporting Adaptations and Modifications-Enhanced (FRAME) to track changes made to MAP as an exemplar for clinicians and implementation scientists. This work fills a gap in adapting interventions through a detailed examination of the adaptation process in NHs. Research Design and Methods Qualitative and quantitative data were collected across 8 CLCs (e.g. advisory panel, staff interviews, training evaluations, field notes, and fidelity assessments). We used an iterative, rapid content analytic approach to triangulate findings and identify needed adaptations for the CLC setting. Results Thirty-six adaptations were made. Most adaptions occurred during the preimplementation phase, were reactive, focused on training/evaluation, and involved researchers, intervention developers, and practitioners. All were fidelity-consistent with MAP. The most common goal across adaptations was increased reach/engagement of the intervention. Discussion and Implications CLCs and community NHs can use findings to support intervention adaptation, and adapt and implement MAP to improve meaningful engagement for persons living with dementia and other residents. Future research should further evaluate and standardize FRAME for diverse users of complex interventions. [ABSTRACT FROM AUTHOR]

Background: Understanding the effectiveness of nonpharmacological interventions to improve cognitive function in older adults with MCI and identifying the best intervention may help inform ideas for future RCT studies and clinical decision-making. Aim: The main focus of this study was to assess the comparative effectiveness of nonpharmacological interventions on cognitive function in older adults with MCI and to rank the interventions. Methods: RCT studies until September 2022 were searched from six databases, including PubMed, the Cochrane Library, Embase, Web of Science, PsycINFO and CINAHL. The risk of bias in eligible trials was evaluated using the Cochrane Risk of Bias tool. Both pairwise and network meta-analyses were used, and pooled effect sizes were reported using SMD and the corresponding 95% confidence intervals. Results: A total of 28 RCT studies were included in this study, pooling 18 categories of nonpharmacological interventions. MBE (mind–body exercise) (SMD (standard mean difference): 0.24, 95% CI: 0.08–0.41, P = 0.004), DTE (dual-task exercise) (SMD: 0.61, 95% CI: 0.09–1.13, P = 0.02), PE (physical exercise) (SMD: 0.58, 95% CI: 0.04–1.12, P = 0.03) may be effective in improving cognitive function in older adults with MCI. Acupressure + CT (cognitive training) was the top-ranked intervention among all interventions. No greater benefits of MA (mindful awareness) on cognitive function were found. Conclusions: Overall, nonpharmacological interventions significantly improved cognitive function in older adults with MCI. Acupressure + CT(cognitive training) was the most effective intervention for managing cognitive impairment. Future studies with high quality and large sample size RCT studies are needed to confirm our results. [ABSTRACT FROM AUTHOR]

Background: Needle-related procedures are commonly performed in childhood and lead to considerable pain. Purpose: This randomized controlled study was conducted to compare the effects on venipuncture pain of the Buzzy, an informational animated video, multiple interventions, and standard care in children aged 6–12 years. Methods: One hundred eighty children were assigned to the groups using a computerized randomization program. Pain level was evaluated by the children, parents, and their nurses using the Wong–Baker Faces Pain Scale. The level of agreement among the nurse, parents, and children's pain reports was evaluated. Multivariable regression analysis was performed to identify the factors significantly associated with pain score. Results: The participants in the Buzzy, video watching, and multiple intervention groups reported lower mean pain scores (child: KW = 28.24, p <.001; parent: KW = 18.51, p <.001; nurse: KW = 44.4, p <.001) than their peers in the control group. Moreover, age was identified as a risk factor affecting pain level (OR = 1.375, 95% CI [1.086, 1.740]; p =.008). Conclusions: Buzzy and informational videos are potentially effective methods to facilitate venipuncture-related pain management in children. The use of pain management methods during venipuncture is recommended, especially in children younger than 10 years old. [ABSTRACT FROM AUTHOR]

Abstract Background Behavioral and psychological symptoms of dementia (BPSD) occur frequently in people with dementia and can contribute to an increased need for help and a reduced quality of life, but also predict early institutionalization. The Targeted Interdisciplinary Model for Evaluation and Treatment of Neuropsychiatric Symptoms (TIME) might be a useful personalized approach to BPSD in people with dementia. The main objective of this feasibility trial was to explore the trial design and methods along with the patients’ and the home care staff’s acceptance of the TIME intervention before developing a definitive trial. Additionally, we wanted to explore whether TIME could be appropriate for staff in home care services in their approach towards people with dementia with anxiety and depression. Methods This was a 18-month feasibility trial using a parallel cluster randomized controlled design. Nine municipalities from the eastern part of Norway (clusters) — 40 people with dementia and 37 of their next of kin— were randomized to the TIME intervention or to treatment as usual. In addition, qualitative data as field notes were collected and summarized. Results The staff in home care services experienced TIME as an appropriate method; in particular, the systematic approach to the patient’s BPSD was experienced as useful. However, the completion of the assessment phase was considered exhaustive and time-consuming, and some of the staff found it challenging to find time for the case conferences. Conclusions We consider that TIME, with some adjustments, could be useful for staff in home care services in cases where they face challenges in providing care and support to people with dementia. This feasibility trial indicates that we can move forward with a future definitive randomized controlled trial (RCT) to test the effect of TIME in people with dementia receiving home care services. Trial registration ClinicalTrial.gov identifier: SI0303150608.