Nonpharmacological analgesic interventions among newborn infants in the University Hospital of the University of Sao Paulo: a best practice implementation project.

INTRODUCTION: Despite evidence from studies on nonpharmacological pain management among newborns, many health professionals still don't apply evidence from scientific knowledge in their clinical practice. OBJECTIVES: To promote evidence-based practice for nonpharmacological analgesic interventions among newborns in the Maternity Ward of the University Hospital of the University of Sao Paulo, improving pain management and promoting healthy newborn growth and development, and better use of resources. METHOD: The current evidence implementation project used the JBI Practical Application of Clinical Evidence System and Getting Research into Practice audit and feedback tool. The JBI Practical Application of Clinical Evidence System and Getting Research into Practice framework for promoting evidence-based healthcare involve three phases of activity: conducting a baseline audit, implementing strategies to address areas of noncompliance and conducting a follow-up audit to assess the outcomes of the interventions implemented to improve practice. Ten evidence-based criteria on nonpharmacological pain management among newborns were audited, by direct observation of the nursing staff activities involving single skin-breaking procedures in the newborn. RESULTS: The baseline audit indicated poor compliance with evidence in current practice in most of the evidence-based criteria audited. Discussion with the implementation team identified barriers to best practice, with interventions including a nursing protocol and educational program for all nursing staff on nonpharmacological analgesic approaches to reduce pain in the newborn (breastfeeding, skin-to-skin contact with the mother, nonnutritive sucking and glucose 25%), and a leaflet to inform the best available evidence on newborn pain management. In the follow-up audit, compliance increased in eight of nine audit criteria, with criterion 7 remaining at 100% compliance to best practice. CONCLUSION: The current best practice implementation project contributed to establishing evidence-based practice and enhancing neonatal pain management during skin-breaking painful procedures in the University Hospital. However, to achieve 100% compliance with all the evidence-based audit criteria, we will need to invest in continuing education and extend this implementation project to other related settings of the hospital. Moreover, it is necessary to perform follow-up cyclical audits to assess compliance and address barriers to best practice, enhancing the quality of nursing care, ensuring better results on pain management of the newborn and ongoing sustainability of this project.

On the effects of a workplace fitness program upon pain perception: a case study encompassing office workers in a Portuguese context.

INTRODUCTION Office workers share several behavioural patterns: they work seated without moving for long times, they use only a few specific muscles of their arms, wrists and hands, and they keep an overall poor body posture. These working patterns generate musculoskeletal disorders, and produce discomfort or pain. Implementation of a work fitness program is thus a low-cost strategy to reduce/prevent body pain derived from work. The aim of this study was to test the benefits of a workplace fitness program, specifically applied to an administrative department of a Portuguese enterprise. Recall that this type of primary prevention level of musculoskeletal disorders has been seldom applied in Portugal, so this research effort materialized an important contribution to overcome such a gap. METHODS The participants in this study were office workers (n = 29 in the study group, and n = 21 in the control group)-who consistently had reported pain mostly on their back side (neck, posterior back, and dorsal and lumbar zones), wrists and posterior legs. The workplace fitness program consisted of three sessions per week during an 8-month period, with 15 min per session; emphasis was on stretching exercises for the body regions most affected by workers' pain perception. Each participant was requested to point out the injured region, as well as the intensity of pain felt, by using a visual analogue scale. Statistical analyses of the perceived pain data from control and study groups resort to non-parametric hypothesis tests. RESULTS There was a strong evidence that the workplace fitness program applied was effective in reducing workers' pain perception for their posterior back, dorsal and lumbar zones, and for their right wrist (P < 0.05). CONCLUSIONS These results generated are rather promising, so they may efficiently serve as an example for other enterprises in that country-while raising awareness on the important issue of quality of life at the workplace.

Organochlorine and butyltin residues in deep-sea organisms collected from the western North Pacific, off-Tohoku, Japan.

Organochlorine (OCs) and butyltin (BTs) residues were determined in deep-sea organisms collected from the western North Pacific, off-Tohoku, Japan. Among OCs, concentrations of polychlorinated biphenyls (PCBs) and DDTs (DDTs and its metabolites) were the highest in deep-sea organisms (maximum concentrations of 6,700 and 13,000 ng/g lipid wt, respectively). Chlordane compounds (CHLs) were the next most abundant OCs, and hexachlorocyclohexanes (HCHs) and hexachlorobenzene (HCB) were the lowest. BTs were also detected at maximum concentrations of 570 ng/g wet wt. Concentrations of PCBs, CHLs and BTs in deep-sea organisms collected from the western North Pacific, off-Tohoku, were generally lower than those in deep-sea and shallow water organisms from Japanese coastal waters. On the other hand, considerable variations in the concentrations of OCs were found among deep-sea organisms analyzed. Several carnivorous fishes such as snubnosed eel, lanternshark and grenadiers accumulated some OCs such as PCBs, DDTs and CHLs at high concentrations of up to a few microg/g levels. In addition, the residue pattern of OCs and BTs in fishes showed a specific trend according to the sampling depth; higher concentrations of PCBs, DDTs and CHLs and lower concentrations of HCHs, HCB and BTs were found in fishes collected from greater depth (approximately 1,000 m) compared to those from shallower waters. This trend is consistent with the results of our earlier study on mesopelagic myctophid fishes. Results of this study suggest vertical transport of hydrophobic OCs such as PCBs, DDTs and CHLs and its accumulation in benthic deep-sea organisms.

Organochlorine and butyltin residues in walleye pollock (Theragra chalcogramma) from Bering Sea, Gulf of Alaska and Japan Sea.

Persistent organochlorine (OC) and toxic butyltin compounds (BTs) were determined in walleye pollock (Theragra chalcogramma) collected from Gulf of Alaska, Bering Sea and Japan Sea, during 1991 and 1992. Polychlorinated biphenyls (PCBs) and dichlorodiphenyltrichloroethane (DDTs) and its metabolites were the most abundant compounds ranging up to 3200 and 2500 ng/g on lipid weight, respectively, followed by chlordane compounds (CHLs), hexachlorocyclohexane isomers (HCHs) and hexachlorobenzene (HCB) in the liver of walleye pollock. Concentrations of HCHs and HCB in walleye pollock from these remote areas were higher than those in fishes from the western North Pacific and Japanese coastal waters, indicating atmospheric transport of these compounds to higher latitude regions such as Bering Sea and Gulf of Alaska and/or local input around northern Japan Sea. The concentrations of other OCs were generally comparable to those in fishes from North Pacific Ocean and Japanese waters but significantly lower than in cod-like fishes from North Atlantic and European countries. Among sampling locations, walleye pollock from Japan Sea showed higher concentrations of DDTs and HCHs compared to fishes from Bering Sea and Gulf of Alaska, suggesting greater input of these compounds around Japan Sea. Slower declining trend of DDTs and CHLs and an increasing pattern of PCBs concentrations were found in walleye pollock from Bering Sea during 1982-1992. This may imply a continuous input of these compounds by long-range transport and/or long-term persistency in these cold regions. Compared to the fishes from Japan Sea, walleye pollock from Bering Sea and Gulf of Alaska showed higher proportions of alpha-HCH and p,p'-DDE in the composition of HCH isomers and DDT compounds, respectively. This suggests selective transportability of these compounds during long-range transport to higher latitude remote areas. Concentrations of tributyltin (TBT) in the muscle of walleye pollock ranged from 1.1 to 5.5 ng/g on wet weight. Concentrations of TBT in deep-sea walleye pollock from Gulf of Alaska and Bering Sea were lower than those in Japan Sea.