Pelvic floor muscle training for urinary incontinence in older adults: a best practice implementation project.

OBJECTIVES: This project aimed to implement best practices for pelvic floor muscle training to manage urinary incontinence among older women in long-term care in Kerala, India. INTRODUCTION: Urinary incontinence is a prevalent and distressing condition that affects a significant proportion of older adults and is characterized by involuntary loss of urine, leading to social embarrassment, decreased quality of life, and increased health care costs. It is more prevalent in women and is associated with dementia, limited mobility, and other comorbidities in long-term care. Pelvic floor muscle training is a first-line treatment option for urinary incontinence in older adults, given its potential to improve quality of life and reduce health care costs. METHODS: This project was based on the JBI Evidence Implementation Framework. A baseline audit was conducted to evaluate current practice against best practices. After identifying barriers and implementing strategies, follow-up audits were conducted after 3 and 6 months. RESULTS: The baseline audit showed 0% compliance with all best practices. Barriers such as lack of knowledge and practice of pelvic floor exercises for urinary incontinence among participants and nurses; unknown cognitive status; and health emergencies were identified. Strategies including video-assisted training of pelvic floor muscle exercises, training calendars, and flip charts with instructions. The follow-up audits showed significant improvements in compliance. CONCLUSIONS: This project reduced urinary incontinence in the participants. Although two of the audit criteria did not reach 100% compliance by the end of 6 months, the stakeholders of the long-term care facility understood the importance of pelvic floor muscle training, which will be beneficial for future residents with urinary incontinence. SPANISH ABSTRACT: http://links.lww.com/IJEBH/A211.

Effectiveness of physical stimulation for reducing injection pain in adults receiving intramuscular injections: a systematic review and meta-analysis.

OBJECTIVE: The objective of this review was to synthesize the best available research evidence regarding the effectiveness of physical stimulation for reducing injection pain in adults receiving intramuscular injections. INTRODUCTION: Pain associated with intramuscular injections continues to be a challenge for nurses. Various physical stimulation methods to alleviate pain and improve satisfaction for patients receiving intramuscular injections have been reported; however, the evidence surrounding the effectiveness of these methods remains inconclusive. INCLUSION CRITERIA: This systematic review considered randomized and quasi-experimental studies that used any physical stimulation strategies (eg, skin tapping, manual pressure, massage, pinch, traction) for adults aged 18 years and over receiving intramuscular injections. Studies that evaluated pain using validated instruments were considered for inclusion. METHODS: A three-step search strategy was conducted. MEDLINE, Embase, CINAHL, the Cochrane Library (Cochrane CENTRAL), Google Scholar, Dissertation Abstracts International, ProQuest Dissertations and Theses, and MedNar were searched from inception until 2020. We restricted the inclusion of studies to trials published in English. Two independent reviewers conducted the critical appraisal of eligible studies using the JBI checklists for randomized controlled and quasi-experimental trials. Data were extracted using the JBI data extraction tool, and meta-analysis and subgroup analysis were undertaken, where appropriate. RESULTS: Twenty-five studies were included with a total sample size of 1956 patients. Pooled results demonstrated that pain was significantly less with the use of the Helfer skin tap technique compared to no intervention (two studies; RR 0.73; 95% CI 0.66, 0.81; P <0.00001) or standard intervention (three studies; SMD -2.25; 95% CI -3.65, -0.85; P =0.002). Intervention with acupressure using standard treatment as control showed significant reduction in pain intensity (MD -4.78; 95% CI -5.32, -4.24; P <0.00001). Similarly, pain was significantly lower with manual pressure (two studies; SMD -0.42; 95% CI -0.69, 0.15; P =0.002) when compared to standard treatment. Pain scores were significantly lower in patients who received pinch technique, ShotBlocker, massage, or combination intervention (skin traction, pressure, and rapid muscle release) compared with no intervention, standard treatment, or placebo control. CONCLUSIONS: The evidence from this review demonstrates that physical stimulation - particularly the Helfer skin tap technique, acupressure, manual pressure, pinch technique, ShotBlocker, massage, and combination - can significantly lower intramuscular injection pain; however, this is based on low or very low certainty of evidence. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO CRD42020168586.

Effectiveness of Platelet-Rich Fibrin with Decalcified Freeze-Dried Bone Allograft Compared to Decalcified Freeze-Dried Bone Allograft Alone in Mandibular Grade-II Furcation Defects: A Quasi-Experimental Study

ABSTRACT Objective: To assess the effectiveness of platelet-rich fibrin (PRF) with decalcified freeze-dried bone allograft (DFDBA) compared to DFDBA alone in mandibular grade-II furcation defects. Material and Methods: A quasi-experimental study was conducted on nine patients with chronic periodontitis, each having two almost identical mandibular grade II furcation defects. Test sites (left mandibular first molars) were treated with open flap debridement (OFD), DFDBA, and PRF, whereas control sites (right mandibular first molars) received OFD and DFDBA alone. Clinical parameters (plaque index (PI), gingival index (GI), vertical clinical attachment level (VCAL) and horizontal clinical attachment level (HCAL) into the furcation defect) and radiographic measurements (mean alveolar bone defect) were done at baseline and after six months postoperatively. Results: The gain in relative horizontal clinical attachment level (RHCAL) in the test sites was 2.94±0.52 mm compared to 1.33±0.35 mm in control sites (p=0.01). Improvement in mean alveolar bone defect (MABD) (was 1.21±0.5 mm2 at test sites compared to 1.15±0.7 mm2 at control sites) probing pocket depth (PPD), recession, relative vertical attachment level (RVCAL), and percentage of bone fill was found in the test sites compared to control, which statistically insignificant. Conclusion: The test sites had better outcomes than control sites, which was significant for the parameter RHCAL. Therefore, combining the biological benefits of autologous PRF with DFDBA is an efficient and economical treatment modality for the management of mandibular grade II furcation defects.

Effectiveness of physical stimulation on injection pain in adults receiving intramuscular injections: a systematic review protocol.

OBJECTIVE: The objective of this review is to evaluate the effectiveness of physical stimulation on injection pain in adults receiving intramuscular injections. INTRODUCTION: Intramuscular injections are the most commonly used modality for administration of pharmacological treatments. Despite this, pain from intramuscular injections is the most commonly reported side effect. Reducing patients' pain from intramuscular injections is important; however, the challenge is in selecting from the current methods available to alleviate pain, which are varied. The findings of this review may identify the most effective physical stimulation method to reduce the side effect of pain from an intramuscular injection. INCLUSION CRITERIA: This review will consider studies that include adults aged 18 years and over that use physical stimulation interventions during intramuscular injections. Any physical stimulation strategies used during intramuscular injections including devices, skin tapping, manual pressure, massage, pinch, and traction will be considered. Studies that evaluate pain using validated tools such as pain scales will be included. METHODS: The review will undertake to find both published and unpublished studies. The key information sources to be searched are MEDLINE, Embase, CINAHL, the Cochrane Library, Cochrane Central Register of Controlled Trials, Google Scholar, Dissertation Abstracts International, ProQuest Dissertations and Theses, and MedNar. Two independent reviewers will conduct a critical appraisal of eligible studies, assess the methodological quality, and extract the data. Studies will, where possible, be pooled in a statistical meta-analysis. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO CRD42020168586.

Empowerment of Anganwadi Workers in Oral Health Care: A Kerala Experience.

INTRODUCTION: Oral diseases are a serious public health problem, which affects the overall health of a person. The lack of available and affordable oral health services, especially in a developing country like India, not only results in aggravation of the disease, but also enhances the cost of treatment and care. Education and involvement of community workers like Anganwadi workers aid to remove stigma, discrimination and provide better atmosphere conducive for patients with various diseases. AIM: To assess the knowledge and practice of oral health care among the AWWs of the Pulikeezh block Panchayath before and after an oral health education training. MATERIALS AND METHODS: A self-administered questionnaire was distributed to anganwadi workers of the Pulikeezh block Panchayath, Thiruvalla, Kerala before and after an oral health education training within a period of 3 months. RESULT: The mean knowledge and practice scores in the pretest were found to be 9.6 + 2.2 and 5.0 + 1.0 respectively. The posttest conducted after a 3-month period showed an increase in the knowledge and practice score with a mean of 10.9 + 2.2 and 5.7 + 0.6 respectively. The increase in knowledge and practice was statistically significant (p < 0.0001). CONCLUSION: Empowered women are recognizably key agents in the change process who can play an effective role for health promotion. AWWs can function as oral health guides who can create awareness and help in prevention oral diseases. CLINICAL SIGNIFICANCE: As the oral health of an individual is set in the preschool period and more than 90% of dental diseases are preventable; preventive factors established around this age will determine the person's dental health for many years to come. The inclusion of oral health education in Anganwadi centers can be helpful in prevention of dental diseases. HOW TO CITE THIS ARTICLE: Cherian SA, Joseph E, et al. Empowerment of Anganwadi Workers in Oral Health Care: A Kerala Experience. Int J Clin Pediatr Dent 2019;12(4):268-272.

An in vitro investigation and comparison of the mechanical properties of human amnion and bovine collagen membrane

Introduction: The human amnion membrane is now increasingly used in Guided Tissue Regeneration(GTR). These placental allografts have excellent biologic properties. There is limited information regarding their mechanical properties as compared to other collagen membranes used in GTR. The aim of this study was to test and compare the mechanical properties of human amnion membrane with commercially available bovine collagen. Materials and methods: After measurement of average thickness, three strips of 5×1cm were cut from both amnion and bovine collagen membranes. Mechanical testing was done in a universal testing machine. Test speed was 1mm/min with a load cell of 100N. Tensile strength, Young's modulus and elongation at break were calculated. A suture retention test was also carried out using 3x1 cm size strips. Groups were compared through the Mann-Whitney U test. Results: Average thickness of amnion membrane was 0.46mm and thickness of bovine collagen membrane was 0.37mm.Tensile strength, Young's modulus and elongation at break of amnion membrane were 0.156MPa, 0.645MPa and 17mm; and that of bovine collagen membrane were 2.94MPa, 7.42MPa and 11.00mm, respectively (p = 0.05). Maximum load which can be applied during suturing for amnion membrane was 0.104N and for bovine collagen membrane was 2.07N (p = 0.037). Conclusion: There is no statistically significant difference in terms of tensile strength, Young's modulus and elongation at break between human amnion and bovine collagen membranes.(p=0.05)Membranes can only be considered different on the maximum load which can be applied during suturing.(p=0.037) (AU)

Prevalence, Characteristics, and Complications of Supernumerary Teeth in Nonsyndromic Pediatric Population of South India: A Clinical and Radiographic Study.

INTRODUCTION: Supernumerary teeth are the presence of more number of teeth over the normal dental formula and may occur in permanent as well as early mixed dentition. This study determined the prevalence, characteristics, and complications caused by supernumerary teeth in nonsyndromic South Indian pediatric population. MATERIALS AND METHODS: Characteristics of supernumerary teeth determined by clinical and radiographic examination were recorded. The age, sex, number of supernumerary teeth, eruption status, morphology, position, orientation, and complications (if any) associated with supernumerary teeth were recorded for each patient who had supernumerary teeth. The data collected were statistically analyzed. RESULTS: Supernumerary teeth were detected in 45 subjects (1.1%), of which 34 (75.6%) were male and 11 (24.4%) were female. There was no association between the number of supernumerary teeth and the gender of the patient. The total number of supernumerary teeth among the affected 45 patients was 54. The average number of supernumerary teeth per person was 1.2. The number of supernumerary teeth was one in 35 cases, two in 8 cases, and 3 in 1 case. Of the 45 patients, 8 patients with supernumerary teeth were in deciduous dentition stage, 29 patients were in mixed dentition stage, and 8 patients were in permanent dentition stage. Most supernumerary teeth presented in the anterior maxilla. Morphologically, conical-shaped supernumerary teeth were the most common finding. 68.5% of supernumerary teeth presented with straight orientation and inverted orientation was seen in 24.1%. Complications seen in patients with supernumerary teeth were delayed or noneruption of adjacent tooth malposition or rotation of adjacent teeth, diastema formation, and formation of dentigerous cyst. CONCLUSIONS: Supernumerary teeth have an incidence of 1.1% in South Indian population and can cause many complications that can harm the developing occlusion. Knowledge about supernumerary teeth may help the dentist in early diagnosis and early intervention.