bluuebunny/crossref_metadata_2025 huggingface dataset:
Uncommon (Group 4.0) Primary Headaches
Authors: Ravishankar Krishnamurthy
Published: May 2021

Background:

Other primary headaches make up group 4.0 of the International Classification of Headache Disorders third edition (ICHD-3). This group includes a clinically varied group of headache entities whose pathophysiology is not well understood and whose treatments are based on open-label reports.

Objective:

To review and update the uncommon primary headaches included under group 4.0 in ICHD-3.

Methods:

We reviewed the headache disorders listed under group 4.0 of ICHD-3 for the clinical features, diagnostic criteria, and management, and described recent updates of these relatively rare disorders.

Results:

The entities included in this group have a characteristic presentation in practice. Some of them are activity-related and can be provoked by Valsalva maneuver (primary cough headache), some by prolonged exercise (primary exercise headache), and some by sexual excitation (primary headache associated with sexual activity); primary thunderclap headache has also been included here because all the above-listed entities can sometimes present in thunderclap fashion too. Two of the entities in this group 4.0 are linked to direct physical stimuli viz. cold stimulus headache and external pressure headache. Also included in this group are primary stabbing headaches and nummular headaches that are presumed to be due to the involvement of the terminal branches of the sensory nerves supplying the scalp and are, therefore, termed “epicranial headaches.” Hypnic headache syndrome and new daily persistent headache are included here as “miscellaneous headaches” because we still do not know enough about their causation.

Conclusion:

The headache disorders included under group 4.0 in ICHD-3 are uncommon, heterogeneous entities, which may pose diagnostic and management challenges to the physicians. The diagnosis may be missed owing to a lack of familiarity.
Occipital Neuralgia
Authors: Wamsley Christine E , Chung Michael , Amirlak Bardia
Published: May 2021

Background:

Occipital neuralgia (ON) is a primary headache disorder characterized by sharp, shooting, or electric shock-like pain in the distribution of the greater, lesser, or third occipital nerves.

Aim:

To review the existing literature on the management of ON and to describe our technique of an endoscopic-assisted approach to decompress the GON proximally in areas of fibrous and muscular compression, as well as distally by thorough decompression of the occipital artery from the nerve.

Methods:

Relevant literature on the medical and surgical management of ON was reviewed. Literature on the anatomical relationships of occipital nerves and their clinical relevance were also reviewed.

Results:

While initial treatment of ON is conservative, peripheral nerve blocks and many surgical management approaches are available for patients with pain refractory to the medical treatment. These include greater occipital nerve blocks, occipital nerve stimulation, Botulinum toxin injections locally, pulsed radiofrequency ablation, cryoneuroablation, C-2 ganglionectomy, and endoscopic-assisted ON decompression.

Conclusion:

Patients of ON refractory to medical management can be benefitted by surgical approaches and occipital nerve blocks. Endoscopic-assisted ON decompression provides one such approach for the patients with vascular, fibrous or muscular compressions of occipital nerves resulting in intractable ON.
Medication Overuse Headache
Authors: Kulkarni Girish B , Mathew Thomas , Mailankody Pooja
Published: May 2021

Background:

Medication overuse headache (MOH) is one of the highly disabling headache disorder and affects about 1% of the population of the world. It is associated with the development of headache for 15 days or more, with consumption of acute symptomatic medications for 10–15 days (depending on the class of drug, like, simple analgesics, triptans, and opioids) in a month, used for relief of headache for three or more months, in a known patient of primary headache disorder.

Objective:

The aim of this study was to review the topic of MOH and present the details of this disorder with an emphasis on recent updates in the field of pathophysiology and treatment.

Material and Methods:

Literature search was performed in the PubMed/MEDLINE and Cochrane database with appropriate keywords and relevant full-text articles were reviewed for writing this article.

Results:

Over the years, the concept of MOH has evolved, although the exact pathophysiology is still being explored. In a susceptible individual interplay of genetics, change in pain pathways, changes in areas of the brain associated with the perception of pain, and changes in the neurotransmitters have been implicated. It has to be differentiated from other secondary chronic daily headache disorders, by a careful history, targeted examination, details of intake of medications. Treatment predominantly involves patient education, removal of the offending agent, and initiation of prophylactic medications for primary headache disorder in the outpatient or inpatient services.

Conclusions:

MOH is a secondary headache disorder, which should be considered in any chronic headache patient. There are various pathophysiological mechanisms attributed to its development. Management includes educating the patients about the disorder, detoxification, and prophylactic therapy.
Paroxysmal Hemicrania
Authors: Paliwal Vimal Kumar , Uniyal Ravi
Published: May 2021

Paroxysmal Hemicrania (PH) is classified under trigeminal autonomic cephalalgia (TAC) as per the International Classification of Headache Disorders (ICHD). Since the first description by 0ttar Sjaastad and Inge Dale in 1974, PH has been reported by many authors. A greater understanding of PH phenotype and pathophysiology has resulted in the evolution of its diagnostic criteria, and management. We tabulated major case series of PH to describe the epidemiology, clinical features and recent updates of PH. PH is a rare headache characterized by daily, multiple paroxysms of unilateral, short-lasting (mean duration <20 minutes), side-locked headache in the distribution of ophthalmic division of trigeminal nerve with associated profound cranial autonomic symptoms. Recent ICHD classification added “restlessness” to the criteria for PH. Pain should completely respond to indomethacin to fulfil the diagnostic criteria of PH. PH should be differentiated from cluster headache, SUNCT/SUNA, and other short-lasting side-locked headaches. Trigeminal afferents possibly produce pain in PH and trigeminal-autonomic reflex explains the occurrence of autonomic features. Recently, a “permissive” central role of the hypothalamus is unveiled based on functional imaging studies. Other Cox-2 inhibitors, topiramate, calcium-channel blockers, epicranial nerve blocks have been shown to improve headache in some patients of PH who cannot tolerate indomethacin. Hypothalamic deep brain stimulation has been used in treatment-refractory cases.
Cluster Headache
Authors: Cheema Sanjay , Matharu Manjit
Published: May 2021

Background:

Cluster headache is a highly disabling primary headache disorder which is widely described as the most painful condition a human can experience.

Aim:

To provide an overview of the clinical characteristics, epidemiology, risk factors, differential diagnosis, pathophysiology and treatment options of cluster headache, with a focus on recent developments in the field.

Methods:

Structured review of the literature on cluster headache.

Results:

Cluster headache affects approximately one in 1000 of the population. It is characterised by attacks of severe unilateral head pain associated with ipsilateral cranial autonomic symptoms, and the tendency for attacks to occur with circadian and circannual periodicity. The pathophysiology of cluster headache and other primary headache disorders has recently become better understood and is thought to involve the hypothalamus and trigeminovascular system. There is good quality evidence for acute treatment of attacks with parenteral triptans and high flow oxygen; preventive treatment with verapamil; and transitional treatment with oral corticosteroids or greater occipital nerve injection. New pharmacological and neuromodulation therapies have recently been developed.

Conclusion:

Cluster headache causes distinctive symptoms, which once they are recognised can usually be managed with a variety of established treatments. Recent pathophysiological understanding has led to the development of newer pharmacological and neuromodulation therapies, which may soon become established in clinical practice.
Preventive Oral Treatment of Episodic Migraine
Authors: Ranganathan Lakshmi N , Ramamurthy Guhan , Kanthimathinathan Shunmugasundaram
Published: May 2021

Background:

Migraine is a common primary headache disorder and Episodic migraine is characterized by the occurrence of up to 14 headache days in a month. The preventive treatment of migraine is useful in patients with frequent migraine attacks, impaired activities of daily living, failure of acute pain management, disabling aura and limitations in the use of acute treatment. It is aimed at reducing headache frequency and intensity, improve response to acute treatment of migraine and improve the quality of life.

Aim:

To analyze the evidence for the efficacy and tolerability of preventive oral drugs used in the management of episodic migraine.

Methods:

A narrative review of the references were reviewed by searching the literature for the articles published in PubMed in English language using all the following MeSH keywords “preventive treatment”, “preventive oral treatment”, AND “episodic migraine”, “migraine”.

Results:

Out of articles identified in the search, 38 articles were reviewed for evidence and summarized. The various oral drugs used in the prevention of episodic migraine are antihypertensives (beta-blockers, calcium channel blockers and Angiotensin-converting enzyme inhibitors/Angiotensin receptor blockers), antidepressants (tricyclic antidepressants, selective serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors), antiepileptic drugs (valproic acid, topiramate, lamotrigine) and other miscellaneous agents. HURT questionnaire and HALT 30 index are useful in assessing response to treatment in the follow up of migraine patients.

Conclusion:

An appropriately chosen oral drug is useful in the preventive treatment of episodic migraine. In patients, who fail to respond to the preventive treatment, it is essential to review the diagnosis of migraine, titrate the dosage and duration of preventive treatment and ensure patient compliance. In those patients who fail to respond to monotherapy, polytherapy is a useful option to be considered.
Advances in the Understanding of Pathophysiology of TTH and its Management
Authors: Bhoi Sanjeev K , Jha Menka , Chowdhury Debashish
Published: May 2021

Background:

Tension-type headache (TTH) is the most common form of primary headache.

Objective:

The aim of this study was to document and summarize the advances in the understanding of TTH in terms of pathogenesis and management.

Material and Methods:

We reviewed the available literature on the pathogenesis and management of TTH by searches of PubMed between 1969 and October 2020, and references from relevant articles. The search terms “tension-type headache”, “episodic tension-type headache”, chronic tension-type headache, “pathophysiology”, and “treatment” were used.

Results:

TTH occurs in two forms: episodic TTH (ETTH) and chronic TTH (CTTH). Unlike chronic migraine, CTTH has been less thoroughly studied and is a more difficult headache to treat. Frequent ETTH and CTTH are associated with significant disability. The pathogenesis of TTH is multifactorial and varies between the subtypes. Peripheral mechanism (myofascial nociception) and environmental factors are possibly more important in ETTH, whereas genetic and central factors (sensitization and inadequate endogenous pain control) may play a significant role in the chronic variety. The treatment of TTH consists of pharmacologic and non-pharmacologic approaches. Simple analgesics like NSAIDs are the mainstays for acute management of ETTH. CTTH requires a multimodal approach. Preventive drugs like amitriptyline or mirtazapine and non-pharmacologic measures like relaxation and stress management techniques and physical therapies are often combined. Despite these measures, the outcome remains unsatisfactory in many patients.

Conclusion:

There is clearly an urgent need to understand the pathophysiology and improve the management of TTH patients, especially the chronic form.
Biomarkers in Migraine
Authors: Yan Brian M , Gibson Depoy E M , Ahmad Ayesha , Nahas Stephanie J
Published: May 2021

Background:

Disability from migraine has a profound impact on the world's economy. Research has been ongoing to identify biomarkers to aid in diagnosis and treatment.

Objective:

The aim of this study was to highlight the purported diagnostic and therapeutic migraine biomarkers and their role in precision medicine.

Methods:

A comprehensive literature search was conducted using PubMed, Google Scholar, and clinicaltrials.gov using keywords: “migraine” OR “headache” combined with “biomarkers” OR “marker.” Other keywords included “serum,” “cerebral spinal fluid,” “inflammatory,” and “neuroimaging.”

Results:

After a review of 88 papers, we find the literature supports numerous biomarkers in the diagnosis of migraine. Therapeutic biomarkers, while not as extensively published, highlight calcitonin gene-related peptide (CGRP) and pituitary adenylate cyclase-activating peptide-38 (PACAP-38) as biomarkers with the most substantiated clinical relevance. Genetic markers mainly focusing on gene mutations with resultant biochemical alterations continue to be studied and show promise.

Conclusion:

Although there are several proposed biomarkers for migraine, continued research is needed to substantiate their role in clinical practice.
Emerging Targets for Migraine Treatment
Authors: Moreno-Ajona David , Villar-Martínez María Dolores , Goadsby Peter James
Published: May 2021

Background:

While understanding the pathophysiology of migraine has led to CGRP-based treatments, other potential targets have also been implicated in migraine.

Objectives:

To catalog new promising targets for the treatment of migraine.

Methods:

We completed a literature review focusing on 5HT1F, PACAP, melatonin, and orexins.

Results:

The 5HT1F receptor agonist lasmiditan, following two positive randomized placebo-controlled trials, was FDA-approved for the acute treatment of migraine. PACAP-38 has shown analogous evidence to what was obtained for CGRP with its localization in key structures, provocation tests, and positive studies when antagonizing its receptor in animal models, although a PAC-1 receptor monoclonal antibody study was negative. Melatonin has undergone several randomized controlled trials showing a positive trend. Filorexant is the only dual orexin receptor antagonist, which was tested in humans with negative results.

Conclusions:

Further and ongoing studies will determine the utility of these new therapies with lasmiditan and melatonin having demonstrated efficacy for the treatment of migraine.
Ditans vs Gepants
Authors: Singh Alok , Gupta Dhyuti , Singh Abhishek
Published: May 2021

Background:

An acute attack of migraine, incapacitates the migraineurs, and is widely prevalent. And to warden off its symptoms, recently two groups of drugs have been approved and launched.

Objective:

The aim of this systematic review and indirect meta-analysis is to evaluate and summarize the effectiveness of these pharmacological interventions in managing the aforesaid disease.

Material and Methods:

An extensive literature search was done through Cochrane library, Pub Med, clincialtrials.gov, for a period of 5 years (2015–2020), using key words: lasmiditan; ubrogepant; rimegepant; and acute migraine. Randomized double-blind phase III clinical trials, published in English language, were included which explored the efficacy and safety of these drugs. The outcomes of this meta-analysis included proportion of patients' headache, most bothersome symptoms free, and no disability at all at 2 h post-dose, with sustained pain freedom 2-24 h, and experiencing any adverse event. An indirect network meta-analysis was also conducted to determine the comparative effectiveness of these drugs.

Results:

A total of seven RCTs involving 7266 patients were included. In general, the new drugs demonstrated better result in all the efficacy parameters. The adverse events were observed in treatment group compared to placebo. While in the indirect comparison, lasmiditan emerged to be superior in all the outcomes, except for sustained pain freedom 2-24 h (rimegepant was better). The adverse events were more with lasmiditan.

Conclusion:

All the newer drugs have shown significant improvement in the outcomes analyzed. Lasmiditan appears to be superior among the newer drugs in efficacy; however it has more adverse effects.
Role of Greater Occipital Nerve Block in Headache Disorders
Authors: Chowdhury Debashish , Datta Debabrata , Mundra Ankit
Published: May 2021

Background:

The proximity of sensory neurons in the upper cervical spinal cord to the trigeminal nucleus caudalis (TNC) neurons and the convergence of sensory input to TNC neurons from both cervical and trigeminal fibers underscore the rationale of using greater occipital nerve block (GON-block) for acute and preventive treatment in various headache disorders.

Objective:

The aim of this study was to critically review the existing literature regarding the safety and efficacy of GON-block in various headache disorders.

Methods:

We searched the eligible studies in English by searching in PubMed till December 31, 2020 for randomized controlled trials (RCTs), observational studies, open-label studies, case series, and case reports on the efficacy and the safety of GON-block for the treatment of headache disorders using the keywords “greater occipital nerve block”, “headache” and “treatment”. Studies using combination of GON-block and other peripheral nerve blocks (PNBs) and C2/C3 blocks were excluded.

Results:

Seventy-two eligible studies were reviewed. Based on RCTs and open-label studies, good evidence of the efficacy of GON-block was found for migraine, cluster headache (CH), post-dural puncture headache (PDPH), cervicogenic headache (CGH), and occipital neuralgia (ON). The analgesic effect of GON-block outlasted its anesthetic effect by days to weeks. Evidence for acute and short-term (transitional) treatment was more robust than for long-term prevention. GON-block was found to be safe and the treatment-emergent adverse effects (TEAEs) were generally mild and transient.

Conclusion:

GON-block is a useful modality of treatment in various headache disorders because of many attractive features such as its early effect in reducing the severity of pain, sustained effect following a single injection, easy technique, minimum invasiveness, minimum TEAE, no drug-to-drug interactions, and negligible cost.
Borderlands of Migraine and Epilepsy
Authors: Garg Divyani , Tripathi Manjari
Published: May 2021

Background:

The complex relationship between migraine and epilepsy has frequently been described to represent a clinical and electrographic “borderland.” These two conditions share clinical expressions such as paroxysmal and chronic nature, as well as semiology, particularly visual phenomenon.

Objective:

We aimed to review the current literature on the overlapping phenomena of migraine and epilepsy.

Materials and Methods:

We searched the PubMed for relevant literature and conducted a narrative review on migraine and epilepsy.

Results:

Migraine and epilepsy share a complex and pathophysiologically intriguing relationship. The International Classification of Headache Disorders, 3rd edition (ICHD-3) makes diagnostic provisions for migraine aura–triggered seizures (Subchapter 1.4.4) and headache attributed to epileptic seizure (Subchapter 7.6), the latter being further categorized as 7.6.1 Ictal epileptic headache, and 7.6.2 post-ictal headache. Neurological conditions such as certain channelopathies and epilepsy syndromes exhibit both conditions within their phenotypic spectrum, suggesting shared genetic and molecular underpinnings. Diagnostic confusion may arise, particularly between occipital epilepsy and the visual aura of migraine. Antiseizure medications may be effective for the treatment of migraines that occur in concert with epilepsy.

Conclusions:

Migraine and epilepsy share several clinical features and have intertwined genetic and molecular underpinnings, which may contribute to common pathogenesis. Electroencephalography may be useful as a diagnostic tool in selected cases.
Medical Management of Trigeminal Neuralgia
Authors: Khadilkar Satish V , Patil Varsha A
Published: May 2021

Background:

Trigeminal neuralgia (TN) is a painful condition, often leading to poor quality of life.

Objective:

The aim of this review was to discuss the various treatment modalities for the medical management of TN.

Materials and Methods:

We reviewed the available literature on TN in clinical databases including PubMed, Google Scholar, and the Cochrane Database of Systematic Reviews, with a specific focus on the pharmacological treatment and newer drugs under development for the treatment of TN.

Results:

Carbamazepine (CBZ) is the gold standard of treatment for TN. The first-line drugs for the treatment of TN are CBZ and oxcarbazepine (OXC). A proportion of cases (30%) are initially resistant to the first-line drugs. Alternative drugs need to be considered if the first-line drugs are not well tolerated or become ineffective with prolonged therapy. The second-line drugs comprise lamotrigine, baclofen, gabapentin, and pregabalin used as monotherapy or in combination with CBZ/OXC. Botulinum toxin A may be a promising presurgical option. Newer drug like vixotrigine has shown good results in phase two randomized control trials. About 50% of cases develop treatment resistance to oral drugs over the subsequent years of therapy and require surgical options.

Conclusion:

The first-line drugs for the treatment of TN (irrespective of the age group or type) are CBZ and OXC. Combination therapy with second-line or other drugs may become necessary with poor response to CBZ/OXC, or if adverse events occur. Patients should be offered surgical options if there is poor response or tolerance to the medical therapy.
Role of Monoclonal Antibodies against Calcitonin Gene-Related Peptide (CGRP) in Episodic Migraine Prevention
Authors: Nagaraj Karthik , Vandenbussche Nicolas , Goadsby Peter J
Published: May 2021

Background:

Medications targeting the calcitonin gene-related peptide (CGRP) pathway are exciting and novel therapeutic options in the treatment of migraine.

Objective:

In this article, we have reviewed the role of these CGRP monoclonal antibodies in patients with episodic migraine.

Materials and Methods:

We did an extensive literature search for all phase 2 and 3 studies involving CGRP monoclonal antibodies in episodic migraine.

Results:

Erenumab, fremanezumab, galcanezumab, and eptinezumab have all undergone phase 3 trials and have been found to be effective for episodic and chronic migraine. They have the advantage of being targeted therapies for migraine with very favorable adverse effect profiles comparable to placebo. Importantly, they are effective in subgroups of patients who have failed previous preventive therapies.

Conclusion:

Increasing use of these medications will certainly revolutionize the treatment and outlook for patients with migraine all over the world.
Noninvasive Neuromodulation in Headache
Authors: Lloyd Joseph , Biloshytska Maryna , Andreou Anna P , Lambru Giorgio
Published: May 2021

Background:

Migraine is a common disabling primary headache condition. Although strives have been made in treatment, there remains an unmet need for safe, effective acute, and preventative treatments. The promising concept of neuromodulation of relevant neuronal targets in a noninvasive fashion for the treatment of primary headache disorders has led to the trial of numerous devices over the years.

Objective:

We aimed to review the evidence on current neuromodulation treatments available for the management of primary headache disorders.

Methods:

Randomized controlled trial as well as open-label and real-world studies on central and peripheral cephalic and noncephalic neuromodulation modalities in primary headaches were critically reviewed.

Results:

The current evidence suggests a role of single-pulse transcranial magnetic stimulation, supraorbital nerve stimulation, and remote noncephalic electrical stimulation as migraine abortive treatments, with stronger evidence in episodic rather than in chronic migraine. Single-pulse transcranial magnetic stimulation and supraorbital nerve stimulation also hold promising evidence in episodic migraine prevention and initial positive evidence in chronic migraine prevention. More evidence should clarify the therapeutic role of the external vagus nerve stimulation and transcranial direct current stimulation in migraine. However, external vagus nerve stimulation may be effective in the acute treatment of episodic but not chronic cluster headache, in the prevention of hemicrania continua and paroxysmal hemicrania but not of short-lasting neuralgiform headache attacks. The difficulty in setting up sham-controlled studies has thus far prevented the publication of robust trials. This limitation along with the cost of these therapies has meant that their use is limited in most countries.

Conclusion:

Neuromodulation is a promising nonpharmacological treatment approach for primary headaches. More studies with appropriate blinding strategies and reduction of device cost may allow more widespread approval of these treatments and in turn increase clinician's experience in neuromodulation.
Surgical Options for Migraine
Authors: Totonchi Ali , Guyuron Bahman , Ansari Hossein
Published: May 2021

Objective:

The goal of this manuscript was to provide a comprehensive review of the surgical treatment for migraine headaches with a focus on trigger points and their clinical presentations, and to emphasize the importance of appropriate patient selection.

Background:

Migraine is a prevalent neurological disease with headache being a disabling component of it. Surgical treatment for migraine headache became available two decades ago, which is based on proper identification and the deactivation of the specific trigger sites in the head and neck area.

Design:

This manuscript reviews the discovery and evolution of migraine surgery with changes in patients' selection throughout the years.

Conclusion:

Patients with migraine headaches who do not respond or cannot tolerate the medical treatment might benefit from trigger site deactivation surgery. The success of the surgery is closely related to proper identification of trigger point (s) and close collaboration with a neurologist or a headache specialist. This collaboration would enhance patients' positive outcomes and help to rule out other causes of the headache.
The Relationship between Health Literacy Dimensions and Perceived Risk of Cardiovascular Disease in Middle-Aged Iranian Women
Authors: Enjezab Behnaz , Zarehosseinabadi Fatemeh , Tafti Arefeh Dehghani , Zarehosseinabadi Mina
Published: May 2021

Background:

The purpose of the study was to investigate the relationship between health literacy dimensions and the perceived risk of cardiovascular disease in middle-aged Iranian women.

Materials and Methods:

This is a descriptive-correlational study in which 280 women aged 40–60 years were investigated by random cluster sampling out of seven health centers in Yazd city in 2018. Data collection tools included predesigned demographic information from a standard Health Literacy for Iranian Adults (HELIA), and a standard perceived susceptibility and perceived risk components of the preventive behaviors of cardiovascular disease questionnaire. The data were analyzed using one-way ANOVA, independent t-test, Kruskal-Wallis, and Mann Whitney tests.

Results:

A significant relationship was identified between demographic information and health literacy (p < 0.001). The mean (SD) scores of the perceived risk of cardiovascular disease and health literacy appeared to be 30.71 (5.10) and 35.62 (15.32), respectively. The perceived risk of cardiovascular disease in the participants turned out to be significantly correlated with the accessibility dimension of health literacy (r = 0.31, p < 0.001), but it failed to have any significant relationship with demographic information, especially obesity.

Conclusions:

As there is a significant relationship between health literacy and perceived risk of cardiovascular disease, hence increasing the health literacy of middle-aged women, especially in persons with high body mass index through the media and health centers, considered as an important source of health information, can be an appropriate task to augment the perceived risk of cardiovascular diseases.
Experience of Workplace Incivility and Its Impact on Stress and Turnover Intention among the Nurses Working at a Hospital
Authors: Kanitha Devan , Naik Poonam R.
Published: May 2021

Background:

Incivility in the workplace drowns the mental health of the nurses and hampers the daily routine. The majority of the nurses working at hospitals were experiencing incivility. It affects the physical and psychological health of the nurses. Experience of workplace incivility and its impact on stress and turnover among nurses was discussed in this study.

Materials and Methods:

Cross-sectional survey approach was used to select 50 nurses by simple random sampling technique. Standard scales for incivility, stress, and pre-tested scale for the turnover intention was used to collect the data.

Result:

Nurses experience incivility in their workplace almost from all the sources. The majority (64%) of the staff nurses had a moderate level of stress and 30% had average intention to leave the present job. There was a positive relationship found between the experience of incivility and stress (r = 0.43, p < 0.002), stress, and turnover intention (r = 0.40, p < 0.004).

Conclusions:

Experience of incivility provokes stress among the nurses, and this may influence turnover intention.
Iranian Women's Self-concept after Hysterectomy
Authors: Goudarzi Fatemeh , Khadivzadeh Talat , Ebadi Abbas , Babazadeh Raheleh
Published: May 2021

Background:

The loss of female organs leads to profound changes in one's perception of oneself. There is limited information about the impact of hysterectomy on women's self-concept and culture. Therefore, this study was conducted with the aim to deepen our understanding of the self-concept of Iranian women after hysterectomy.

Materials and Methods:

This qualitative study was conducted using directed content analysis approach. The participants included 30 women with a history of hysterectomy who were selected through purposive sampling method. Data were collected from August 2018 to November 2019 using in-depth and semi-structured interviews based on the self-concept mode of the Roy Adaptation Model (RAM) in Mashhad, Iran. Data analysis was performed using the deductive approach of Elo and Kyngäs in MAXQDA software.

Results:

As a result of the analysis of the interviews, the main category of “incoherent cognition of self-concept” emerged, which included the two generic categories of “heterogeneous feelings toward and imaginations of the body” and “changed self-perception”, and five subcategories.

Conclusions:

Women's self-concept changed after hysterectomy in both its physical and psychological aspects. Therefore, counseling before and after hysterectomy is recommended to improve women's self-concept after hysterectomy.
Pediatric Ward Nurses’ Caring Self-Efficacy Scale
Authors: Bahrami Masoud , Alavi Azam , Zargham-Boroujeni Ali , Yousefy Alireza
Published: May 2021

Background:

No instrument specifically designed to investigate the caring self-efficacy of nurses in pediatric wards was found. The aim of the present study was therefore to develop a scale to evaluate pediatric wards nurse's caring self-efficacy.

Materials and Methods:

In this study, an exploratory, sequential, mixed method was used in 2015 in Iran. Data collected from 27 semi-structured interviews with nurses in pediatric wards were analyzed using conventional content analysis. The initial version of the scale was obtained with 65 items. Face validity was determined using impact score and content validity using the Content Validity Index (CVI) and Content Validity Ratio (CVR). The construct validity of the scale was investigated using exploratory factor analysis with 305 nurses in pediatric wards. The concurrent validity of the scale was acquired using the General Self-Efficacy Scale. Internal consistency and test–retest reliability were also examined.

Results:

The scale-CVI (S-CVI) (average) was 0.85. The 14 items with a CVR and CVI of less than 0.51 and 0.70, respectively, were deleted and the final 51-item scale was approved. All 51 items had good impact score (>1.50). In the final scale, four subscales were extracted using construct validity. The concurrent validity of the scale was also obtained (r = 0.77, p < 0.001). The total Cronbach's α correlation coefficient of the scale was 0.96 and test–retest reliability was 0.98.

Conclusions:

The Pediatric Ward Nurses' Caring Self-Efficacy (PWNCSE) scale developed in this study is a practical, reliable, and valid scale to evaluate pediatric ward nurses' caring self-efficacy.
Triage Training in Iran from 2010 to 2020
Authors: Javadi Naser , Rostamnia Leili , Raznahan Rasool , Ghanbari Vahid
Published: May 2021

Background:

Accurate decision-making in triage requires continuous education, so triage nurses should receive annual refresher courses. Identifying the most effective method can make the provision of practical education to triage staff in hospitals possible. This review was conducted with the aim to determine the effectiveness of triage education methods in Iran.

Materials and Methods:

In this systematic review on educational intervention studies, international and Iranian medical sciences databases were searched using a defined search strategy compatible with each database. PubMed, Scopus, Web of Science, Google Scholar, SID, Islamic Science Center (ISC), and IranDoc databases were searched for literature published from January 2010 to January 2020. The MeSH terms of “health care staff,” “triage,” “education,” and “Iran” in English and Persian were combined to develop a search strategy. Initially, 768 article titles were retrieved. Finally, 16 articles were selected for the review.

Results:

All conducted studies were quasi-experimental. Half of the studies had used a face-to-face approach for education (workshop, lecture, and simulation), and four studies had used lectures and pamphlets. All studies (except 1) reported that their educational intervention significantly improved nursing knowledge on triage.

Conclusions:

Almost all studies had reported the effectiveness of an educational intervention in improving nurses' triage knowledge. However, it seems that the non-face-to-face method is superior to the face-to-face method because of its learner-centeredness and cost-effectiveness. Moreover, providing educational content using a blended learning approach (simulation and games) can enhance the effectiveness of triage education.
Barriers to Occupational Therapy Fieldwork Education in Iran
Authors: Pashmdarfard Marzieh , Shafaroodi Narges , Mehraban Afsoon Hassani , Arabshahi Kamran Soltani , Parvizy Soroor
Published: May 2021

Background:

Clinical education is a vital factor in the process of learning in medical sciences universities. The aim of the present study was to explore the perspectives of fieldwork educators and students concerning barriers to occupational therapy fieldwork education in Iran.

Materials and Methods:

A qualitative research was conducted from May 2019 to April 2020 to address the study objectives. The data analysis was performed using conventional content analysis based on Graneheim and Lundman's approach. Purposive sampling was used to enroll 12 educators and 14 students of various backgrounds (physical disabilities-adult, physical disabilities-pediatrics, psychosocial-adult, and psychosocial-pediatrics) in the study.

Results:

The findings indicated that the main themes were related to fieldwork educators, fieldwork settings, educational planning, students, and educational regulation.

Conclusions:

It can be concluded that the perspectives of students and occupational therapy educators regarding the field of clinical education are not only important but also useful for the attainment of effective clinical education and the development of knowledge related to rehabilitation nursing education. Therefore, educational planners should develop effective programs based on these themes.
Reduction of the rate of hospitalization in patients with acute coronary syndrome
Authors: Dorri Safoura , Farahani Mansoureh Ashghali , Mohammadebrahimi Hossein , Shahraki Saied , Hakimi Hamideh
Published: May 2021

Background:

Readmission of patients with Acute Coronary Syndrome (ACS) causes many problems for them and their family. This study aimed to improve the quality of care provided to patients with ACS and discover solutions to reduce the rate of readmission among them.

Materials and Method:

This participatory action research study was done based on Streubert and Carpenter approach. This study included 45 participants (31 patients and 14 stakeholders) and carried out in a hospital affiliated to Isfahan University of Medical Sciences, Iran, from 2013 to 2014. Solutions with high and moderate feasibility, flexibility, and suitability were implemented in each cycle until reaching <15% readmission rate. Data were analyzed using SPSS (V.16) and running descriptive and inferential statistics.

Results:

In this study, several actions were performed in each cycle such as assigning a free and 24-h telephone line was patients to contact nurses and face-to-face patient's education. Second cycle actions included active participation of all nurses in the education of patients and involvement of families in patient care. By carrying out the first action cycle, the readmission rate reached 35%, which was not favorable. By completing the second action cycle, the readmission rate reached 12%, which was desirable and significantly lower than the first cycle.

Conclusion:

Discovering possible solutions with the participation of stakeholders in therapeutic settings that have feasibility, flexibility, and suitability can lead to improved care quality and reduced readmission rate in patients with ACS, especially if the families of the patients also participate in action cycles.
Developing and Psychometric Evaluation of a Reproductive Health Assessment Scale for Married Adolescent Women
Authors: Mardi Afrouz , Ebadi Abbas , Behboodi-Moghadam Zahra , Abazari Malek , Nezhad-Dadgar Nazila , Shadman Atefeh
Published: May 2021

Background:

Adolescent women's reproductive health is often neglected despite the high prevalence of early marriage. Since no appropriate scales were found to assess the health status of adolescent women, this study aimed to develop a reproductive health scale in married adolescent women in Iran and investigate its psychometric properties.

Materials and Methods:

An exploratory mixed-methods study was conducted in Ardabil healthcare centers (Ardabil City, Iran) between May 2017 and December 2018. In the qualitative phase, 14 semi-structured in-depth interviews were conducted with married adolescent women, and two focus group discussions were held with 12 key informants. In the quantitative phase, the initial scales were validated using face, content, and construct validities. In a cross-sectional study among 300 women, Exploratory Factor Analysis (EFA) was used to assess the construct validity. Internal consistency and test-retest methods were used to review. The initial scale was designed with 45 items, but only 30 items reached the construct validity stage. EFA revealed five factors that explained 50.96% of the variance. Cronbach's alpha coefficient of 0.75 estimates the reliability of the scale.

Results:

The qualitative study identified 76 items that reached 88 items through literature confirmed its reliability, and test-retest with a two-week interval confirmed its consistency (ICC = 0.99, p < 0.001). Finally, the scale was approved with 27 items and four domains: sexual, pregnancy and childbirth, psychosocial, and family planning.

Conclusions:

This valid and reliable scale with cultural sensitivity can be used to help health professionals to improve the reproductive health of married adolescent women.
Efficacy of Knee Arthroplasty on the Outcomes of Knee Osteoarthritis in Iranian Elderly Individuals
Authors: Hamedi Roya , Pourghane Parand , Mansour-Ghanaei Roya , Atrkar-Roushan Zahra
Published: May 2021

Background:

Knee osteoarthritis is a common musculoskeletal condition in elderly individuals. This survey was conducted with the aim to identify the problems of this group of patients for compilation of healthcare programs targeted at determining the outcome of osteoarthritis before and 3 months after knee arthroplasty.

Materials and Methods:

In the present cross-sectional study, 150 elderly individuals who had volunteered for knee arthroplasty were selected through nonrandomized sampling and were evaluated using the Knee Osteoarthritis Outcome Score (KOOS) questionnaire and a demographic characteristics form before and 3 months after the surgery via nonparametric statistical tests (Wilcoxon, Mann-Whitney U, and Kruskal-Wallis tests).

Results:

The mean (SD) age of the study subjects was 64.40 (7.20) years. A significant difference was observed between the mean scores of all subscales (pain with Z=10.62, knee pain/knee stiffness with Z=10.54, daily activity with Z=10.62, sport with Z=2.95, and quality of life with Z=10.48) before and after knee arthroplasty based on Wilcoxon test (<0.05). The results of the Mann-Whitney U test showed a significant statistical relationship between the difference in the mean score of daily activities and history of opium consumption (Z=1.90, p < 0.05) as well as that between knee pain/knee stiffness and gender (Z=2.57, p < 0.05) and educational level (Z=2.11, p < 0.05).

Conclusions:

Knee arthroplasty and history of opium consumption were correlated with improvement of patients' performance in their daily activities, and gender (women) and educational level (unread) were correlated with improvement of the score of the knee pain/knee stiffness subscale.
The effect of peer group education on anxiety, stress, and depression in older adults living in nursing homes
Authors: Mohammadbeigi Abolfazl , Khavasi Mohammad , Golitaleb Mohamad , Jodaki Kurosh
Published: May 2021

Background:

The effects of peer education have been addressed in different populations, but this method of education has not been applied in the elderly population of Iran, and its effect has not been studied. The present study investigated the effects of peer group education on anxiety, stress, and depression of the older adults living in nursing homes.

Materials and Methods:

This research is a quasi-experimental study with an intervention and control group and it was conducted on 70 elderly citizens living in Qom nursing homes in July 2017. For the intervention group, a relaxation and stress reduction program was trained through the peer group. The control group received routine care. Data were collected using a Demographic information questionnaire and Depression Anxiety Stress Scale-21 (DASS-21). Data were collected at the beginning, 10 and 30 days after the intervention. Data analysis was performed using SPSS 19, descriptive statistics, and repeated measure analysis of variance.

Results:

The results of the study showed no significant difference between any of the demographic variables at the beginning of the study (p > 0.05). The statistical test showed that the effects of time (p < 0.001) and group (p < 0.011) were significant on anxiety, stress, and depression.

Conclusions:

The results of this study showed that peer education could decrease anxiety, stress, and depression in the elderly. Therefore, this educational method can be used by nurses to promote various health education programs, e.g., to health promotion and prevent disease especially in the elderly community.
Remote Learning Under the COVID-19 Social Distancing: Reflections and a Netnography Study
Authors: Nasu Vitor Hideo
Published: May 2021

The purpose of this work is two-fold. First, it intends to discuss and reflect on the transition from face-to-face to remote learning in accounting education because of the COVID-19 pandemic. And second, it presents the results of a netnography study conducted at the beginning of the COVID-19 outbreak in Brazil (March and April of 2020). I also provide some personal experiences during these times. In section 2, I provide key technology resources I found helpful for accounting instructors and students. In section 3, I discuss the implications for instructors and students brought by the COVID-19. I especially appreciate the effors that both instructors and students are doing to keep their academic lives going, despite all the adversity. In section 4, I describe a netnography study in which I examined data from a graduate students’ Facebook community. And in section 5, I report closing thoughts.
Occupational Therapist Role in Post-Secondary Education Transition Program: Emphasis on Self-Advocacy Skills
Authors:   , Vorhees Nikki
Published: May 2021

It is becoming increasingly important for individuals to obtain post-secondary education in order to gain employment (Alverson et al., 2019; Chandroo et al., 2018). This increased importance to attend post-secondary education makes it imperative for students who are graduating from high school to be fully prepared for the transition to post-secondary education (Rothman et al., 2008). The transition from high school to post-secondary education is difficult for any individual. However, it is even more difficult for students with learning differences, as they tend to have problems in the areas of social skills, communication, problem solving, self-advocacy, and executive functioning (Alverson et al., 2019). These are critical skills required for successful post-secondary transition planning. This indicates a necessary role for OTs to contribute to students’ transition planning as OTs are fully equipped to support the development of skills such as self-advocacy and self-determination (Angell et al., 2019; Spencer et al., 2017). However, currently, there is a limited number of OTs working in transition planning for postsecondary education (Dirette, 2019). The purpose of this capstone project is to develop an occupational therapy-based transition program from high school to post-secondary education. The program will focus on social, self-advocacy, and self-determination skills to help the students transition from high school to post-secondary education as smoothly as possible.