Cooling spray or lidocaine spray and needle insertion pain in hemodialysis patients: an open-label cross-over randomized clinical trial.

BACKGROUND: The needle insertion pain to perform hemodialysis is the main challenge and a common problem that requires pain management techniques for patients' comfort. AIM: This study aimed to compare the effects of cooling and lidocaine sprays on needle insertion pain in hemodialysis patients. METHODS: In this randomized cross-over clinical trial study, the hemodialysis patients were selected through convenience sampling according to inclusion criteria and randomly assigned to three intervention groups using the block randomization method. Each patient received three interventions in a cross-over design: Cooling spray or 10% lidocaine spray or placebo spray. There was a 2-week wash-out time between each intervention. The pain score was measured four times for each patient by the Numerical Rating Scale. RESULTS: Forty-one hemodialysis patients were included. The results showed a significant interaction between time and group (p < 0.05), so only observations of time 1 with adjustment for baseline values were used to evaluate the effect of the intervention. Patients receiving cooling spray reported 2.29 less pain score on average compared to placebo (B=-2.29, 95% CI: -4.17 to -0.43; p < 0.05); Also, patients receiving cooling spray reported a 1.61 lower pain score than those receiving lidocaine spray, but this difference was not statistically significant (95% CI: -0.26 to 3.48; p > 0.05). CONCLUSION: The cooling spray was effective in reducing the needle insertion pain. Although it was impossible to compare the pain scores at different times and following different interventions, the present study results can help supplement the existing knowledge regarding cooling and lidocaine sprays.

Frequency of complications of falling from the walnut tree, as an occupational-seasonal injury.

BACKGROUND: Falling from a tree is one of the major causes of serious injuries in farmers but it can be prevented. Walnut is one of the most important agricultural products in Iran and falling from walnut trees is common during the season of harvest. The aim of this study was to determine the frequency of complications due to falling from walnut tree in patients referred to the emergency department of Imam Ali Hospital in Bojnurd City, Iran. METHODS: A descriptive cross sectional study was conducted on 127 patients with injuries due to falling from the walnut tree in Bojnurd City, Iran, in the walnut harvest season of August 2013 to November 2014. The tools used for data collection in this study included a demographic information form, checklists of information about the injury and the follow-up checklist of treatment. Data were analyzed using descriptive statistics by the SPSS software version 16. RESULTS: From a total of 127 injured patients, 120 cases (94.4%) were males with a mean age of 36.49 ± 15.65 years. Five patients died on the day of admission. Eighty two patients (64.56%) were admitted in hospital wards. The most common type of injuries were trunk injuries (26.19%), followed by spinal cord injuries (18.1%). Also, 7 patients suffered from complete spinal cord injury. CONCLUSIONS: Injuries caused by falling from walnut trees are seasonal and impose large financial burden on our health system. In most cases, young men suffer from varying degrees of disability and experience financial problems. It is very important to train farmers and workers, so as to prevent such injuries.