Evidence Based Care
Volume:5 Issue: 4, Winter 2016

Hyperbilirubinemia is a common physiological problem in approximately 80% of preterm infants during the first week after birth. Increase in bowel movements reduces enterohepatic circulation and increases bilirubin excretion. This study aimed to evaluate the effects of Field massage technique on bilirubin level and the number of defecations in preterm infants This clinical trial was performed on 80 preterm infants aged 30-36 weeks, who were hospitalized in neonatal intensive care units of Qaem, Imam Reza, and Ommolbanin hospitals of Mashhad, Iran, in 2011. The enrolled infants were randomized into intervention and control groups. The control group received the routine care, and the intervention group received a 15-minute massage twice a day (morning and evening), for five consecutive days. Field massage technique was applied by the researcher. The number of defecations and cutaneous bilirubin level were recorded on a daily basis until the sixth day after birth. Independent t-test and Mann-Whitney U test were performed to analyze the data, using SPSS version 14. The mean age of the intervention and control groups was 17.2±4.5 and 17.1±4.5 hours, respectively. The mean level of cutaneous bilirubin in the intervention and control groups on the first and sixth days were not significantly different (10.7±1.5, 10.8±1.4, 13.4±2.0, and 13.4±2.6, respectively; the first day: P=0.67, the sixth day: P=0.98). The number of defecations on the fourth (P=0.01), fifth (P<0.001), and sixth (P=0.005) days in the intervention group was significantly more than the control group. Implications for Practice: The five-day massage using the field technique could not reduce the level of bilirubin in preterm infants; however, it increased the number of defecations during the bilirubin peak days in preterm infants (fourth-sixth days), which can decrease bilirubin level in preterm infants.

The first three years of life have a pivotal role in growth and development of infants. Extra-uterine environment largely affects brain development of infants during the first year of life.However,no specific programs are available for brain development stimulation in foster homes. This study aimed to evaluate the effects of motor development stimulation package on anthropometric indices of infants staying in foster homes. This experimental study was conducted on 50 infants aged 1-12 months at Ali Asghar foster home of Mashhad, Iran in 2013. Infants were randomly divided into two groups of intervention (n=25) and control (n=25). Motor development stimulation packages were used for intervention group three times a week for eight consecutive weeks (24 sessions, two hours each). Anthropometric indices of infants were evaluated using standard instruments before and after intervention. Data analysis was performed in SPSS V.11.5 using independent T-test and Mann-Whitney U test. In this study, mean age of infants in intervention and control groups was 6.04±3.48 and 4.3±3.70 months, respectively. In total, 68% of infants were male, and 32% were female. After intervention, Mann-Whitney test results showed no statistically significant difference in height (P=0.47) and head circumference (P=0.11) of infants between the groups. However, independent T-test showed a statistically significant difference in body weight of infants (P=0.007) between the groups after intervention with the stimulation care package. Implications for Practice: According to the results of this study, use of evidence-based motor development stimulation package for eight weeks resulted in increased weight of infants, while it had no effect on height and head circumference. Therefore, it is recommended that complementary studies be conducted in this regard.

Venepuncture is a minimally invasive procedure, which is commonly performed in hospitals; if the pain is inadequately managed, it can cause negative feelings in children. Distraction can reduce pain through affecting the central nervous system and releasing neurotransmitters that inhibit pain. In this study, we aimed to compare the effects of play-dough and bubble making as distraction techniques on the intensity of venepuncture pain in children. In this randomized, controlled, clinical trial, 90 children aged three to six years old, were randomly allocated to the three groups of play dough, bubble making, and control (n=30 for each group). This study was performed in Qaem, Imam Reza, and Dr. Sheikh hospitals of Mashhad, Iran, in 2015. The interventions consisted of using play dough and bubble making, which were started five minutes before venepuncture. Following the intervention, pain assessment was performed using Wong-Baker Faces Pain Rating Scale. Chi-square, Fisher’s exact, and One-way ANOVA tests were performed to analyze the data, using SPSS version 16. The mean of pain intensity in the play dough, bubble making, and control groups was 5.1±1.8 6.2±1.4, and 8.2±1.5, respectively (out of ten). One-way ANOVA reflected a significant difference between the three groups (P<0.001). Tukey’s post-hoc test showed that there was a significant difference between the play dough and control groups (P<0.001), bubble making and control groups (P<0.001), and bubble making and play dough groups (P=0.009). Implications for Practice: Use ofplay dough could reduce the children's pain during venepuncture more effectively. Thus, use of such simple, inexpensive, and easy to access techniques might relieve pain in children.

Visitation of patients admitted at intensive care units (ICUs) is a controversial issue in the field of health care. It is commonly believed that the presence of family members might bring about physiological changes, such as tachycardia and hypertension, in ICU patients. This study aimed to evaluate the effects of scheduled visitation on the physiological indices of conscious patients at the ICU. This experimental study was conducted on 90 conscious patients admitted at the ICU of Ganjavian Hospital in Dezful, Iran in 2014. Patients were randomly divided into two groups of intervention and control. In the control group, patient visits were carried out in accordance with normal procedures of the ward. In the intervention group, patients were visited by relatives and family members for 30 minutes, preferably in evening shifts. Physiological indices of the patients were recorded before, during and after scheduled visitation. Data analysis was performed in SPSS V.18 using independent T-test and one-way ANOVA with repeated measures. In this study, mean age of patients in the intervention and control groups was 42.1±19.1 and 39.4±19.6 years, respectively. In the intervention group, systolic blood pressure had a more significant reduction at 10 and 30 minutes after visitation compared to the control group (independent T-test, P<0.05). However, no statistically significant difference was observed in other physiological indices of the study groups (independent T-test, P>0.05). Implications for Practice: According to the results of this study, scheduled visitation by family members caused no significant differences in the physiological indices of ICU patients. It is recommended that future studies be conducted as to confirm this finding and revise patient visitation policies in hospitals.

Headache is the most common complication caused by spinal anesthesia. Systematic educational programs about conservative treatments could be effective in the reduction of headache after spinal anesthesiz. This study aimed to evaluate the effects of training programs on the headache of patients after spinal anesthesia. This empirical study was conducted on 120 patients within the age range of 16-40 years who were candidates for general, orthopedic and urology surgeries in Dr. Shahidzadeh Hospital of Behbahan, Iran in 2015. Patients were randomly divided into two groups of intervention and control. Scheduled training was provided for the intervention group, and the control group received routine training. Intensity of headache was recorded using the visual analogue scale (VAS). Data analysis was performed in SPSS V.14 using Chi-square and independent T-test. In this study, Chi-square test showed a statistically significant difference between the groups in terms of incidence and time of occurrence of headaches. In total, eight patients (25.8%) in the intervention group and 23 patients (74.2%) in the control group had headaches (P=0.001). In the first 48 hours after anesthesia, all patients in the intervention group and 11 patients (47.8%) in the control group had headaches (P=0.03). Moreover, independent T-test revealed a significant difference between the mean of pain intensity in patients of the intervention (5.0±1.8) and control groups (7.1±2.1) (P=0.01). Implications for Practice: According to the results of this study, systematic education of patients could effectively reduce the occurrence and intensity of headaches after spinal anesthesia. Therefore, it is recommended that patient training be included in the preoperative preparation program in order to prevent headaches after surgery.