In Vitro Cellular Uptake and Insulin Secretion Studies on INS-1E Cells of Exendin-4 Loaded Self Nanoemulsifying Drug Delivery Systems.

Exendin-4 (ex-4) is a peptide molecule that regulates blood glucose levels without causing hypoglycemia by providing insulin secretion from beta cells in the pancreas. Self nanoemulsifying drug delivery systems (SNEDDS) attrack attention for oral administration of therapeutic peptide/proteins because they protect therapeutic peptide/proteins from the gastric environment, reduce changes due to food effects, are easy to prepare and scale-up. Ex-4 has no commercial form that can be administered orally. In this study the cytotoxicity, cellular uptake and insulin secretion of ex-4 and ex-4/chymostatin (chym) SNEDDS were investigated on INS-1E rat pancreatic beta cells. The effect of ex-4 and ex-4/chym SNEDDS on cell viability in INS-1E cells increased when the dilution ratio higher. Ex-4 and ex-4/chym SNEDDS increased insulin levels in 2.8 mM (low-dose) glucose-induced INS-1E cells 2.21 and 2.17-folds compared to control, respectively. Ex-4 and ex-4/chym SNEDDS increased insulin levels in 16.7 mM (high-dose) glucose-induced INS-1E cells compared to control, respectively. In cellular uptake studies, coumarin-6 solution penetrated the apical membrane of INS-1E cells and remained in the cytoplasm, while coumarin-6 loaded SNEDDS were visualized in the nuclei of the cell. These findings will likely be useful in the development of new formulations for the oral administration of peptides/proteins.

Pain Intensity After Cardiac Surgery and its Association With Kinesiophobia: A Descriptive Study.

PURPOSE: Severe pain and fear of pain may decrease physical activity and restrict movements after cardiac surgery. This study aimed to determine pain intensity after cardiac surgery and its association with kinesiophobia. DESIGN: This was a descriptive and correlational study. METHODS: The study was conducted with cardiac surgery patients (n = 170). The sample size was calculated by using the G*POWER 3.1 program. According to the power analysis, the sample size was calculated as 170, taking into account the dependent variable with the largest sample size (kinesiophobia) and 20% loss. The outcome measures were pain and kinesiophobia collected using the Visual Analog Scale and Tampa Kinesiophobia Scale. FINDINGS: Married patients were at the greatest risk for kinesiophobia, higher than that for single patients (ß = -3.765, ß = -3.609; P < .05). Obese patients were at the greatest risk for kinesiophobia higher when compared to patients of normal weight (ß = -2.907, P < .05). No statistically significant correlation was found between the pain intensity and kinesiophobia scores (P > 0.05). CONCLUSIONS: Kinesiophobia was higher in patients after cardiac surgery. Married and obese patients were predictors of kinesiophobia; however, pain was not associated with kinesiophobia.

An all-in-one nanoparticle for overcoming drug resistance: doxorubicin and elacridar co-loaded folate receptor targeted PLGA/MSN hybrid nanoparticles.

Overexpression of permeability-glycoprotein (P-gp) transporter leads to multidrug resistance (MDR) through cellular exclusion of chemotherapeutics. Co-administration of P-gp inhibitors and chemotherapeutics is a promising approach for improving the efficacy of therapy. Nevertheless, problems in pharmacokinetics, toxicity and solubility limit the application of P-gp inhibitors. Herein, we developed a novel all-in-one hybrid nanoparticle system to overcome MDR in doxorubicin (DOX)-resistant breast cancer. First, folic acid-modified DOX-loaded mesoporous silica nanoparticles (MSNs) were prepared and then loaded into PEGylated poly(lactic-co-glycolic acid) (PLGA) nanoparticles along with a P-gp inhibitor, elacridar. This hybrid nanoparticle system had high drug loading capacity, enabled both passive and active targeting of tumour tissues, and exhibited sequential and pH-triggered release of drugs. In vitro and in vivo studies in DOX-resistant breast cancer demonstrated the ability of the hybrid nanoparticles to reverse P-gp-mediated drug resistance. The nanoparticles were efficiently taken up by the breast cancer cells and delivered elacridar, in vitro. Biodistribution studies demonstrated substantial accumulation of the folate receptor-targeted PLGA/MSN hybrid nanoparticles in tumour-bearing mice. Moreover, deceleration of the tumour growth was remarkable in the animals administered with the DOX and elacridar co-loaded hybrid nanoparticles when compared to those treated with the marketed liposomal DOX (Caelyx®) or its combination with elacridar.

Insight into oral amphiphilic cyclodextrin nanoparticles for colorectal cancer: comprehensive mathematical model of drug release kinetic studies and antitumoral efficacy in 3D spheroid colon tumors.

Colorectal cancer (CRC) is the third most diagnosed cancer type globally and ranks second in cancer-related deaths. With the current treatment possibilities, a definitive, safe, and effective treatment approach for CRC has not been presented yet. However, new drug delivery systems show promise in this field. Amphiphilic cyclodextrin-based nanocarriers are innovative and interesting formulation approaches for targeting the colon through oral administration. In our previous studies, oral chemotherapy for colon tumors was aimed and promising results were obtained with formulation development studies, mucin interaction, mucus penetration, cytotoxicity, and permeability in 2D cell culture, and furthermore in vivo antitumoral and antimetastatic efficacy in early and late-stage colon cancer models and biodistribution after single dose oral administration. This study was carried out to further elucidate oral camptothecin (CPT)-loaded amphiphilic cyclodextrin nanoparticles for the local treatment of colorectal tumors in terms of their drug release behavior and efficacy in 3-dimensional tumor models to predict the in vivo efficacy of different nanocarriers. The main objective was to build a bridge between formulation development and in vitro phase and animal studies. In this context, CPT-loaded polycationic-ß-cyclodextrin nanoparticles caused reduced cell viability in CT26 and HT29 colon carcinoma spheroid tumors of mice and human origin, respectively. In addition, the release profile, which is one of the critical quality parameters in new drug delivery systems, was investigated mathematically by release kinetic modeling for the first time. The overall findings indicated that the strategy of orally targeting anticancer drugs such as CPT with positively charged poly-ß-CD-C6 nanoparticles to colon tumors for local and/or systemic efficacy is a promising approach.

A Randomized Controlled Trial on the Effect of Music Listening on Procedural Pain, Anxiety and Comfort Levels during Cystoscopy.

This study aimed to determine the effect of music listening on procedural pain intensity, anxiety, and comfort levels in patients during cystoscopy. This study was a prospective, randomized controlled trial. Study participants were randomly assigned to either a control or music group. The outcome measures were assessed using the Visual Analogue Scale, State Anxiety Scale, and General Comfort Questionnaire. A total of 36 patients in each group completed the study. The mean scores of pain in the music and control groups immediately after cystoscopy were 3.22 (SD, 1.72) and 5.22 (SD, 1.92), respectively. A statistically significant difference (between-group effect) was found, indicating that pain scores in the music group were significantly lower than those of the control group (group: F = 15.756, p < .001). However, no statistically significant difference was noted between the two groups regarding anxiety and comfort scores 20 min after cystoscopy (t1 = 1.156, p = .526; t1 = -0.586, p = .560, respectively). Music listening is a safe, economical, and effective method in pain management in patients undergoing cystoscopy.

Orally administered docetaxel-loaded chitosan-decorated cationic PLGA nanoparticles for intestinal tumors: formulation, comprehensive in vitro characterization, and release kinetics.

Intestinal cancers are the third most lethal cancers globally, beginning as polyps in the intestine and spreading with a severe metastatic tendency. Chemotherapeutic drugs used in the treatment of intestinal tumors are usually formulated for parenteral administration due to poor solubility and bioavailability problems. Pharmaceutically, clinical failure due to a drug's wide biodistribution and non-selective toxicity is one of the major challenges of chemotherapy. In addition, parenteral drug administration in chronic diseases that require long-term drug use, such as intestinal tumors, is challenging in terms of patient compliance and poses a burden in terms of health economy. Especially in the field of chemotherapy research, oral chemotherapy is a subject that has been intensively researched in recent years, and developments in this field will provide serious breakthroughs both scientifically and socially. Development of orally applicable nanodrug formulations that can act against diseases seen in the distant region of the gastrointestinal tract (GIT), such as intestinal tumor, brings with it a series of difficulties depending on the drug and/or GIT physiology. The aim of this study is to develop an oral nanoparticle drug delivery system loaded with docetaxel (DCX) as an anticancer drug, using poly(lactic-co-glycolic acid) (PLGA) as nanoparticle material, and modified with chitosan (CS) to gain mucoadhesive properties. In this context, an innovative nanoparticle formulation that can protect orally administered DCX from GIT conditions and deliver the drug to the intestinal tumoral region by accumulating in mucus has been designed. For this purpose, DCX-PLGA nanoparticles (NPs) and CS/DCX-PLGA NPs were prepared, and their in vitro characteristics were elucidated. Nanoparticles around 250-300 nm were obtained. DCX-PLGA NPs had positive surface charge with CS coating. The formulations have the potential to deliver the encapsulated drug to the bowel according to the in vitro release studies in three different simulated GIT fluids for approximately 72 h. Mucin interaction and penetration into the artificial mucus layer were also investigated in detail, and the mucoadhesive and mucus-penetration characteristics of the formulations were examined. Furthermore, in vitro release kinetic studies of the NPs were elucidated. DCX-PLGA NPs were found to be compatible with the Weibull model, and CS/DCX-PLGA NPs were found to be compatible with the Peppas-Sahlin model. Within the scope of in vitro cytotoxicity studies, the drug-loaded NPs showed significantly higher cytotoxicity than a DCX solution on the HT-29 colon cell line, and CS/DCX-PLGA showed the highest cytotoxicity (p < 0.05). According to the permeability studies on the Caco-2 cell line, the CS/DCX-PLGA formulation increased permeability by 383% compared to free DCX (p < 0.05). In the light of all results, CS/DCX-PLGA NPs can offer a promising and innovative approach as an oral anticancer drug-loaded nanoformulation for intestinal tumors.

A correlational study on pain and depression in geriatric patients scheduled for orthopaedic surgery.

AIM: Pain is prevalent in geriatric patients and is not only a signal of physical diseases but also a symptom of mental health problems. This study aimed to explore the relationship between pain and depression in geriatric patients scheduled for orthopaedic surgery. METHODS: The study used a correlational and cross-sectional design. The study sample consisted of geriatric patients (n = 200) scheduled for orthopaedic surgery in a research and training hospital in northern Turkey. Data were collected by the researchers using the Geriatric Pain Measure and Geriatric Depression Scale. In the data analysis, descriptive statistics, Pearson's correlation, and hierarchical regression analysis were used. RESULTS: The patients' mean age was 73.16 ± 8.27 years. It was found that 5.5% (n = 11) of the participants had mild pain, 45.5% (n = 91) had moderate pain, and 49% (n = 98) had severe pain. There was a positive and moderate significant relationship between the mean Geriatric Pain Measure and Geriatric Depression Scale scores (r = 0.479, P < 0.01). Age (ß = 0.133; P < 0.05) and education (ß = 2.484; P < 0.05) were statistically significantly associated with depression. There was a significant and positive relationship between depression and being dependent in activities of daily living (ß = 5.098; P < 0.05). CONCLUSION: This study demonstrated that geriatric patients who were older, illiterate, dependent in activities of daily living, and with higher levels of pain had higher depression. A multidisciplinary team approach including nurses should be utilised in pain management and it should not be ignored that severe pain may be associated with depression in geriatric patients.

Digital addiction, academic performance, and sleep disturbance among nursing students.

PURPOSE: This study aimed to examine the relationship between digital addiction, academic performance, and sleep disturbance among nursing students. DESIGN AND METHODS: The study was a correlational and cross-sectional design. Four hundred twenty-nine nursing students were enrolled in this study. FINDINGS: There was a positive significant relationship between the mean Sleep Disturbance (SD) T-scores and Digital Addiction Scale (DAS) scores (r = 0.203, p < 0.01). Furthermore, a positive correlation was found between the mean SD T-scores and DAS subscale scores (p < 0.01) PRACTICE IMPLICATIONS: This study demonstrated that digital addiction had an influence on sleep disturbance. It is recommended that nursing students be provided with training to inform them about negative effects of digital addiction.

Therapeutic efficacy and gastrointestinal biodistribution of polycationic nanoparticles for oral camptothecin delivery in early and late-stage colorectal tumor-bearing animal model.

Colorectal cancer (CRC) is the third most commonly diagnosed cancer in the world and is the second leading cause of cancer related deaths. New cases are increasingly diagnosed every day, but current therapeutic options are still insufficient for an effective treatment. In CRC treatment, there is a significant need for alternative treatment approaches that can both prevent relapse and provide strong antimetastatic effects as the intestines and colon are prone to metastasis to neighboring organs and tissues as well as the liver and the lung. In this study, optimized polycationic cyclodextrin (CD) nanoparticles for oral Camptothecin (CPT) delivery were comprehensively examined for in vivo performance in early and late stage tumor bearing mouse model in terms of antitumoral and antimetastatic efficacy of CPT bound to polycationic CD nanoparticles in comparison to free CPT. In addition, the gastrointestinal localization of a single administration of fluorescent dye loaded polycationic CD nanoparticles in the gastrointestinal tract at the end of 24 h after oral administration was also imaged and evaluated by in vivo imaging system against fluorescent dye intensity. Results showed that survival percentage was significantly improved in CRC-bearing mice compared to oral CPT solution, with significantly reduced colorectal tumor masses and number of liver metastatic foci (p < 0.05). It was also possible to differentiate between the effectiveness of nanoparticles in early or late stages of CRC. In vivo imaging studies have also confirmed that polycationic CD nanoparticles are able to deliver the therapeutic load up to the colon and tend to accumulate especially in tumor foci, indicating an effective local treatment strategy. In addition number of liver metastases were significantly decreased with the CPT-loaded polycationic CD nanoparticle formulation in both early and late stage tumor models. These findings indicated that CPT-loaded polycationic CD nanoparticles could be an efficient oral nanocarrier formulation for anticancer molecules that have limited application because of oral bioavailability and stability problems.

Oral self-nanoemulsifying formulation of GLP-1 agonist peptide exendin-4: development, characterization and permeability assesment on Caco-2 cell monolayer.

The objective of this study was to prepare a stable self-nanoemulsifying formulation of exendin-4, which is an antidiabetic peptide. As exendin-4 is commercially available only in subcutaneous form, several attempts have been made to discover an effective oral formulation. Self-nanoemulsifying drug delivery systems are known to be suitable carriers for the oral administration of peptide drugs. Various ratios of oil, surfactant, and co-surfactant mixtures were used to determine the area in the pseudoternary phase diagram for clear nanoemulsion. The Design of Experiment approach was used for the optimization of the formulation. Blank self-nanoemulsifying formulations containing ethyl oleate as oil phase, Cremophor EL®, and Labrasol® as surfactant, absolute ethanol, and propylene glycol as co-solvent in various proportions were approximately 18-50 nm, 0.08-0.204 and - 3 to - 23 mV in droplet size, polydispersity index, and zeta potential, respectively. When all formulations were compared by statistical analysis, five of them with smaller droplet sizes were selected for further studies. The physical stability test was performed for 1 month at 5 °C ± 3 °C and 25 °C ± 2 °C/60% RH ± 5% RH storage conditions. As a result of the characterization and physical stability test results, ethyl oleate: Cremophor EL®:absolute ethanol (30:52.5:17.5) formulation and four formulations containing ethyl oleate: Cremophor EL®:Labrasol®:propylene glycol:absolute ethanol at varying concentrations were considered for peptide encapsulation efficiency. Formulation having the highest encapsulation efficiency of exendin-4 containing ethyl oleate: Cremophor EL®:Labrasol®:propylene glycole:absolute ethanol (15:42.5:21.25:15.94:5.31) was selected for in vitro Caco-2 intestinal permeability study. The permeabiliy coefficient was increased by 1.5-folds by exendin-4-loaded self-nanoemulsifying formulation as compared to the exendin-4 solution. It can be concluded that intestinal permeability has been improved by self-nanoemulsifying formulation.

Cold Therapy and the Effect on Pain and Physiological Parameters in Patients Recovering from Spine Surgery: A Randomized Prospective Study.

BACKGROUND: This study aimed to determine the effect of cold therapy (CT) on pain and physiological parameters after spine surgery. MATERIALS AND METHODS: This study was a prospective, randomized controlled trial. Study participants were randomly assigned to either a control group or a CT group. The outcome measured was pain intensity rated by a numeric rating scale. Psychological outcome measures were considered secondary. RESULTS: Thirty-eight patients in each group completed the study. No statistically significant difference was found between the pain scores of patients in the CT and those in the control group during the 24-h period following surgery (group: F = 0.01, p = 0.922). However, it was found that the pain scores of patients in the CT group were significantly lower than those in the control group during the 48-h period (group: F = 10.59, p = 0.002). CONCLUSION: CT reduced pain scores during the 48-h period following spine surgery. Our findings support the use of CT as an adjuvant therapy in pain management.

Evaluation of the hypoglycemic effect of exendin-4's new oral self-nanoemulsifying system in rats.

The objective of this study is to develop a new self-nanoemulsifying system containing exendin-4 with or without enzyme inhibitor chymostatin and to evaluate the effects of oral administration of exendin-4 and exendin-4/chymostatin loaded self nanoemulsifying system on plasma exendin-4, plasma insulin, blood glucose levels and to compare with the oral and subcutaneous administration of exendin-4 in non-diabetic and streptozotocin-induced type 2 diabetic rats. Exendin-4 and exendin-4/chymostatin loaded self-nanoemulsifying system containing ethyl oleate as the oil phase, Cremophor EL®/Labrasol® as the surfactants and propylene glycol as the co-solvent were prepared. The mean droplet size, polydispersity index, zeta potential and viscosity of exendin-4 loaded self-nanoemulsifying system were found as 24.28 ± 0.43 nm, 0.17 ± 0.01, -1.28 ± 3.61 mV, 79.60 ± 3.30 m.Pas, respectively. The mean droplet size, polydispersity index, zeta potential and viscosity of exendin-4/chymostatin loaded self-nanoemulsifying system were found as 20.25 ± 0.35 nm, 0.11 ± 0.02, -1.85 ± 2.49 mV, 100.02 ± 7.65 m.Pas, respectively according to our previous study. In the present study, we focused on long-term physical stability studies, pharmacokinetic studies and pharmacodynamic studies of prepared self-nanoemulsifying systems. According to the long- term physical stability data, exendin-4 and exendin-4/chymostatin loaded self-nanoemulsifying systems were found stable both at 5°C ± 3°C and at 25°C ± 60% RH for 12 months. Exendin-4 and exendin-4/chymostatin loaded self-nanoemulsifying systems increased AUC and Cmax values in non-diabetic rats compared to the oral exendin-4 solution. In diabetic rats, exendin-4/chymostatin loaded self nanoemulsifying systems increased Cmax values compared to the exendin-4 solution. Exendin-4/chymostatin loaded self-nanoemulsifying system decreased inter-subject variability compared to commercial Byetta®. At 30th minute after administration of exendin-4 loaded self-nanoemulsifying system, exendin-4/chymostatin loaded self nanoemulsifying system and Byetta®, blood glucose levels decreased to 23%, 25%, 29%, respectively. It has been shown that pharmacodynamic response is close to Byetta® with exendin-4/chymostatin self-nanoemulsifying system oral administration. In conclusion, a self nanoemulsifying system was found to be a suitable carrier system, and the combination with enzyme inhibitor chymostatin is thought to be promising for oral delivery of exendin-4.

The effect of perceived stress on anxiety and sleep quality among healthcare professionals in intensive care units during the coronavirus pandemic.

The study aimed to explore the effect of perceived stress of healthcare workers on anxiety and sleep level in intensive care units during corona virus pandemic. The research was conducted in descriptive and cross-sectional types. The study was conducted between April 2020 and July 2020 at Atatürk University Research Hospital and Erzurum Regional Training and Research Hospital. In the research, it was aimed to reach all the healthcare professionals (260) working in intensive care units without selecting a sample. The data was collected by using the personal information form prepared by the researchers in line with the literature, Perceived Stress Scale, State-Trait Anxiety Inventory, and Visual Analog Sleep Scale. Of the 210 participants, 75.4% were female, and 88.1% were nurses. The mean age of the participants was 27.04 ± 5.71 years, and 51.9% of the participants were 20-25 years old. The mean perceived stress, state anxiety, trait anxiety, and visual analog sleep scores were moderate and found as 29.9 ± 6.83, 43.09 ± 5.55, 46.15 ± 5.3, and 503.79 ± 134.24, respectively. In conclusion, a general picture of the psychological state of healthcare professionals in Turkey during the COVID-19 pandemic has been presented.

Cyclodextrin nanoparticle bound oral camptothecin for colorectal cancer: Formulation development and optimization.

Chemotherapeutic drugs for colorectal cancer(CRC) which is currently the third most lethal cancer globally, are administered intravenously (iv) due to their low oral bioavailability resulting from their physicochemical properties. Non-selective biodistribution and difficulties of parenteral administration reduce treatment efficacy. The aim of this work is to develop cyclodextrin (CD) based cationic nanoparticles (NPs) for CRC treatment with model drug camptothecin (CPT) that can be administered orally, protecting CPT through gastrointestinal tract (GIT), accumulating at mucus layer and providing an effective local treatment for the tumor area. NPs using two different amphiphilic CDs were prepared and coated with polyethylenimine (PEI) or chitosan (CS) to obtain positively charged surface for all formulations. Pre-formulation studies resulted in optimal formulation, CPT loaded Poly-ß-CD-C6 NPs, with 135 nm diameter and zeta potential of + 40 mV. In vitro release study was designed to represent gastrointestinal pH and transit time revealing 52% of encapsulated CPT successfully delivered all the way to simulated colon. CPT bound to Poly-ß-CD-C6 NPs exhibited higher cytotoxicity on HT-29 cells compared to equivalent CPT in solution. Caco-2 cell permeability studies showed 276% increase in CPT permeability and significantly higher mucosal penetration in cationic CD nanoparticle form.

Development and characterization of exendin-4 loaded self-nanoemulsifying system and in vitro evaluation on Caco-2 cell line.

Aim: Aim of this study was to develop exendin-4 and exendin-4/chymostatin loaded self-nanoemulsifying drug delivery system (SNEDDS).Methods: Surfactants and co-surfactants were mixed, oil phase containing exendin-4 or exendin-4/chymostatin was added dropwise for SNEDDS. Short term physical stability test was performed prior to the release, lipolysis and permeability studies.Results: SNEDDS containing ethyl oleate: Cremophor EL®: Labrasol®: propylene glycole (15:42.5:21.25: 21.25) were selected for in vitro release and intestinal permeability studies for suitable parameters and physical stability test results. SNEDDS were obtained which yielded Grade B nanoemulsions having droplet size below 25 nm. In vitro release studies showed that 73.79% of the peptide was released for 2 h at pH 6.8. Both exendin-4 and exendin-4/chymostatin loaded SNEDDS were non-toxic to Caco-2 cells. Permeability coefficients of both exendin-4 loaded SNEDDS and exendin-4/chymostatin loaded SNEDDS were higher than exendin-4 solution.Conclusions: Intestinal permeability of exendin-4 has been improved by SNEDDS formulations.

Discharge Education Intervention to Reduce Anxiety and Depression in Cardiac Surgery Patients: A Randomized Controlled Study.

PURPOSE: This study aimed to determine possible effects of a discharge education intervention on anxiety and depression among cardiac surgery patients in a private hospital in the city of Ordu, Turkey. DESIGN: A randomized controlled trial. METHODS: Thirty-three patients were placed in standard care group and 33 into standard care plus discharge education group. Patients in the discharge education group were provided an individual training from the first day of the hospital admission until the day of the discharge. The standard care group received usual discharge instructions. FINDINGS: The Hospital Anxiety and Depression Scale-anxiety subscale scores were not significantly different between patients in the discharge and standard care groups (group: F = 1.58; P > .05). There was a significant difference for depression, indicating that the discharge education group had significantly lower depression than the standard care group (group: F = 19.23; P < .01). CONCLUSIONS: Our findings supported that the discharge education intervention reduced depression in cardiac surgery patients.

Relief of Procedural Pain in Critically Ill Patients by Music Therapy: A Randomized Controlled Trial.

BACKGROUND: This study aimed to determine the effectiveness of music listening for procedural pain relief using two different observational pain tools during endotracheal suctioning. MATERIALS AND METHODS: This study was a randomized controlled trial. The sample of the study included 98 patients with mechanical ventilation support who met the selection criteria. The patients were randomly assigned to control and music therapy groups. Patients in the control group were routinely suctioned as usual. Patients in the music group received music therapy 20 min before, during, and 20 min after endotracheal suctioning. The primary outcome was the pain relief during suctioning. RESULTS: Forty patients in each arm completed the study. Pain scores in the Critical Care Pain Observation Tool and Behavioral Pain Scale were lower in the music group than in the control group during endotracheal suctioning (group: F = 14.85, p = 0.000; F = 9.04, p = 0.000, respectively). It was also found to be a significant interaction effect between the groups and time (group × time: F = 17.35, p = 0.000; F = 18.00, p = 0.000, respectively). CONCLUSION: The Critical Care Pain Observation Tool and Behavioral Pain Scale in the current study generally demonstrated similar pain scores during the painful procedure. Our findings support that music therapy may act as a nonpharmacological therapy to relieve procedural pain in patients on mechanical ventilation.

The use of cold therapy, music therapy and lidocaine spray for reducing pain and anxiety following chest tube removal.

AIM: To determine the effect of cold therapy, music therapy and lidocaine spray on pain and anxiety following chest tube removal (CTR). METHODS: This study was a randomized clinical trial. The participants were randomly assigned either one of four groups: control group, cold therapy, music therapy, and lidocaine spray. The primary outcome of the study was to measure pain using Visual Analog Scale. Anxiety was used as secondary outcome. RESULTS: Thirty patients in each arm completed the study. There was no difference in pain scores between groups immediately after and 20 min after CTR (F = 2.06, p = 0.108). However, there was a significant difference between the anxiety scores of control and intervention groups 20 min after CTR (p < 0.05). CONCLUSIONS: Cold therapy reduced anxiety levels after the procedure. A multimodal approaches, such as the administration of pharmacologic agents in conjunction with non-pharmacological interventions including cold therapy may also be suggested.

The Use of the Buzzy, Jet Lidokaine, Bubble-blowing and Aromatherapy for Reducing Pediatric Pain, Stress and Fear Associated with Phlebotomy.

PURPOSE: This study aimed to investigate the effects of the Buzzy, Jet lidokaine, bubble-blowing and inhalation aromatherapy with lavender essence on pain, stress and fear in children undergoing phlebotomy. DESIGNS AND METHODS: This study was a prospective, randomized controlled trial. The sample was comprised of children aged 5 to 10 years requiring blood tests. Children were assigned to five subgroups through randomization performed using a computer program: the Buzzy group (n = 39), Jet lidokaine group (n = 39), bubble-blowing group (n = 39), inhalation aromatherapy with lavender essence group (n = 39) and control group (n = 39). The children's levels of pain were evaluated and reported by the parents, observers and the children, who self-reported using the Oucher Pain Scale. The children's fear levels were assessed using the Children's Fear Scale, and salivary cortisol analysis was conducted to evaluate stress levels. RESULTS: A significant difference was found between the intervention and control groups in terms of levels of pain during and after phlebotomy in favor of the Buzzy group (p < 0.05). There was a significant difference between the fear scores of the children in the intervention and control groups before phlebotomy (p < 0.05). This difference was found to be caused by the bubble-blowing method. There was a significant difference between intervention and control groups fear levels in favor of the Buzzy group during phlebotomy (p < 0.05). PRACTICE IMPLICATIONS: It is recommended that the Buzzy and bubble-blowing be used during phlebotomy in children to reduce the severity of their pain.