Evidence Based Care
Volume:11 Issue: 4, Winter 2022

Childhood obesity is one of the most serious public health challenges in the 21st century. Since children's healthy habits are developed in the family, parents involvement in pediatric weight care strategies is among the most effective measures which can be implemented for the management of childhood obesity. In this regard, parents face many challenges that awareness of which is very important for managing and caring of childhood obesity. The present study aimed to explore the challenges experienced by parents in the care and management of childhood obesity. It merely focused on reporting the findings from interviews with participating parents regarding these experiences. This qualitative study was conducted through semi-structured interviews with 18 parents of obese children aged 6-12 years. A purposive sampling approach was used. The interviews were digitally recorded, transcribed verbatim, and analyzed through conventional content analysis based on Graneheim and Lundman method. Five categories emerged from the obtained data: Parental conflict, parents' indecisiveness and compassion, interference of others, child's stubbornness, and child's secretiveness.Implications for Practice: Given that the nurses are often charged with the responsibility of family counseling and helping them facing problems; therefore, an awareness of the difficulties presented to families can be of great help in planning and effective interventions.

The Emergency Severity Index (ESI) may not recognize high-risk patients with heart failure (HF) efficiently. This study aimed to compare the diagnostic validity and mistriage rates of the ESI plus the Capnometer (Capno) and ESI alone among dyspneic patients with HF. This quasi-experimental group (random assignment) study was conducted within April 2019-February 2020. Patients were randomly assigned to the ESI+Capno and ESI groups. Triage levels, resources used, disposition and door to an electrocardiogram, and physician visit were compared among patients admitted to the Cardiac Care Unit (CCU), the Cardiac Unit (CU), or discharged from the ED. Interobserver agreement (Kappa) was used to assess the reliability of the ESI. In this study, 65 HF patients were assigned to the ESI+Capno (n=36) and ESI (n=29) groups. The undertriage rates were 0% and 10% and the overtriage rates were 10% and 31% in the ESI+Capno and ESI groups, respectively. Sensitivity, specificity, and accuracy to recognize high-risk HF patients were 100%, 60%, and 90% for the ESI+Capno group and 62.5%, 42.86%, and 48.36% for the ESI group.Implications for Practice: The addition of Capno to the ESI increased the validity of triage decisions to recognize high-risk HF patients, compared to the ESI alone. It is recommended that decisions regarding triage HF patients be made after that an End-tidal Co2 is considered into the decision-making process.

Patients experience pain after intramuscular (IM) injection. Lidocaine and acupressure are two methods that can be used for the reduction of pain in patients.

The present study aimed to compare the effect of lidocaine spray and acupressure on the severity of pain induced by IM injection.

This randomized clinical trial was conducted on 254 participants who received IM injections in the Emergency Department of 22 Bahman Hospital in Neyshabur, Iran, in 2019. They were selected via convenience sampling and randomly assigned to three groups of lidocaine spray, acupressure, and control by permuted block randomization method. Data were collected using demographic characteristics form and visual analog scale (VAS). Data were analyzed in SPSS software (version 25).

The mean scores of pain intensity in the lidocaine spray (1.78) and acupressure (1.83) groups were lower, as compared to that in the control group (2.83). Nonetheless, the results of this study revealed that there was no significant difference between acupressure and lidocaine spray in the reduction of pain intensity (P=0.400). Moreover, demographic variables had no effect on the severity of pain induced by IM injection.
Implications for Practice: As evidenced by the obtained results, acupressure and lidocaine spray were not statistically effective in reducing the severity of pain induced by IM injection. The reduction in mean pain intensity in these methods was clinically significant, compared to that in the control group.

Anxiety is considered a common problem in women with breast cancer, and non-pharmacological interventions, such as reflexology, can contribute towards controlling. This study aimed to determine the effect of foot reflexology on anxiety in women with breast cancer. In this randomized-controlled clinical trial, 66 women with breast cancer referred to Ayatullah Khansari Hospital, Arak, Iran, were selected based on the inclusion criteria by convenience sampling method and randomly assigned into intervention and control groups using a randomized block allocation method. In the intervention group, reflexology was then conducted by a trained nurse in the oncology department in a two-point morning and afternoon session for 40 min on the thumb and solar plexus of the feet. However, the control group did not receive any intervention and the Spielberger State-Trait Anxiety Inventory was completed again by the patients. The mean anxiety scores before reflexology were 48.27±4.95 and 49.72±4.18 in the intervention and control groups, respectively (P=0.202). Furthermore, the mean anxiety scores in the intervention and control group after reflexology were obtained at 47.03±4.14 and 49.71±4.28, respectively.Implications for Practice: As reflexology did not affect the anxiety of women with breast cancer, this method can be combined with other non-pharmacological interventions to control anxiety in women with this complication; however, it should not be utilized alone in the clinic to manage anxiety. Further studies are recommended to be conducted with larger sample sizes and extended periods on anxiety and mental health disorders in these women.

Infantile colic is observed in healthy infants less than three months of age. Excessive crying in these infants leads to fatigue and maternal anxiety. The present study aimed to compare the effect of abdominal massage and Hugo point acupressure on the symptoms of infantile colic. In this clinical trial study, 144 infants were selected via convenience sampling and randomly assigned to three groups of abdominal massage, Hugo point acupressure, and control. The infants in two groups of abdominal massage and Hugo point acupressure received the interventions three times in the evening, while the control group only underwent the routine training. The duration of colicky crying and sleep duration per 24 hours was recorded for four weeks. At the end of four weeks, the Infant Colic Scale (ICS) was completed in three groups. Three groups were compared using the Wilcoxon test. The mean difference scores after the intervention in comparison with that before the intervention were obtained at -6.62±4.84, -3.55±3.12, and -3.92±4.02 in Hugo point acupressure, abdominal massage, and control groups, respectively. This difference was statistically significant (P<.05). The three groups of Hugo point acupressure, abdominal massage, and control significantly differ in terms of mean scores of sleep time in four weeks (P<001). There was a significant difference between the mean scores of crying duration in the second, third, and fourth weeks (P <0.001).Implications for Practice: Hugo point acupressure had a more significant effect on the alleviation of colic pain, as compared to abdominal massage and changing position. Furthermore, acupressure shortened the duration of crying and prolonged sleep. The development of acupressure training programs for mothers is recommended as a simple method for the treatment of infantile colic.

Gastrointestinal endoscopy is a useful diagnostic method in children. The level of anxiety in children is one of the important factors on the patient's acceptance of endoscopy. This study aimed to investigate the effect of a pre-endoscopy preparation program on children's anxiety and parental satisfaction. This clinical trial study investigated 76 children aged 6 to 18 years and their parents referred to the endoscopy unit of Besat Hospital, Hamadan, Iran, in 2019. The patients were randomly assigned into two equal groups. The experimental group was trained using pamphlets and face-to-face training before endoscopy, and then the two groups were compared in terms of children's anxiety and parental satisfaction. The data were collected using the Demographic Information Questionnaire, Spielberger State-Trait Anxiety Inventory, and Parental Satisfaction Questionnaire. Before the intervention, the mean±SD values of the state anxiety in the experimental and control groups were 48.92±2.81 and 49.18±2.86, respectively, and it was statistically lower in the experimental group (P=0.042). Moreover, after the intervention, the mean±SD values of the trait anxiety in the experimental and control groups were 48.47±31.10 and 49.86±2.87, and there was no statistically significant difference between the two groups (P=0.339). Parents' satisfaction in the experimental group was higher than that in the control group, which was statistically significant (P<0.001).Implications for Practice: The pre-endoscopy preparation program reduced the anxiety of the children. Findings can be utilized in planning to improve their parents' satisfaction.

The Improvement of quality of life (QOL) and its dynamics among patients with chronic heart failure (CHF) is an important task and one of the leading criteria for the therapy effectiveness among patients with CHF.

The present study aimed to compare the QOL in patients with heart failure with mid-range ejection fraction (HFmrEF) in different age groups, taking into account gender differences.

This cross-sectional study was conducted on 377 participants with CHF and a control group of 30 subjects matched in age without CHF in Belgorod, Russia, in 2020. The participants were selected by the purposive sampling method. All patients were assigned into three groups, including middle age, elderly age, and senile age. The participants completed the Minnesota Living with Heart Failure Questionnaire (MLHFQ), Zung Self-Rating Anxiety Scale, and Zung Self-Rating Depression Scale. The collected data were analyzed with nonparametric statistic methods.

It was revealed that the QOL was significantly lower in patients with HFmrEF of ischemic genesis than in the control group. The lowest QOL, according to the MLHFQ questionnaire, was revealed in old age. In the female population, the QOL was significantly lower than in men in the same age group. Moreover, the most pronounced manifestations of anxiety and depressive disorders were observed in middle-aged men and middle-aged women, respectively.
Implications for Practice: According to the findings of this study, it is suggested that physicians and therapists pay special attention to the QOL of the elderly and senile aged people with CHF.

Ventilator-associated pneumonia is a type of hospital-acquired pneumonia, and nurses have an essential role in its prevention.

This study aimed to determine the effect of text messaging via cell phone on nurses’ knowledge in intensive care units about ventilator-associated pneumonia.

This quasi-experimental study was performed in intensive care units of hospitals in North Khorasan Province, Iran. Nurses working in these wards were included in the study through the census sampling method. The research tool was a researcher-made questionnaire about ventilator-associated pneumonia whose qualitative face validity, quantitative content validity, and reliability were assessed. After a pre-test, text messages were sent 4 days a week, once a day for 10 weeks. The post-test was administered 1 and 3 months after that the last message was sent. To compare nurses’ knowledge before and after the intervention, repeated measures analysis of variance was used in SPSS software (version 20).

A total of 41 nurses were included whose mean scores of knowledge about ventilator-associated pneumonia were obtained at 9.65±1.89, 14.56±3.00, 14.63±2.7 at the baseline and 1 month and 3 months after sending text messages, respectively. It was revealed that the score before sending the messages was different from those 1 and 3 months after the intervention, which was statistically significant (P<0.05). Implications for Practice: It seems that the use of new educational methods, such as text messaging, can effectively improve nurses’ knowledge.