Does a New Modification of the Two-Step Injection Technique for Inferior Alveolar Nerve Block Reduce Pain Compared to the Conventional Technique? A Randomized Clinical Trial

Background. The ability to control pain is an essential part of dental procedures and the need for optimal pain control and reduction of discomfort is the primary concern of every dentist. This study aims to compare the pain and vital signs during inferior alveolar nerve block between conventional and a new modification of the two-step injection techniques. Methods. In this institutional single-blind randomized clinical trial, attendees of dental school at Mazandaran University of Medical Sciences from February to May 2022 were included. Inclusion criteria were 20-60 years old and healthy (ASA1) individuals who were willing to participate in this study. Individuals who were taking medications affecting their understanding of pain and patients with active infections at the injection site were excluded. These individuals were divided into two groups. First, superficial anesthesia was performed and afterward, conventional and two-step injection techniques were performed. For the two-step injection method, 6 mm of the needle was injected into the mucosa and one-third of the local anesthetic solution was released from the computer-controlled injection toolkit. Afterward, a 25 mm 30-gauge needle was reinserted into the previous hole delivering the remaining local anesthetic. The pain during injection was measured by a patient-reported numerical rating scale (NRS). Moreover, vital signs were monitored immediately before and after the injection. Kolmogorov-Smirnov test, Mann-Whitney U test, independent T-test, and Fisher's exact χ2 test were performed for statistical analysis (α = 0.05). Results. This study involved 32 adults aged between 20 and 50 years old with 1: 1 female/male sex distribution. The pain score was significantly higher in the conventional injection technique compared to the two-step injection technique in all sex and age groups. There were no significant differences in vital signs between the conventional and two-step injection techniques. There was no significant difference in the mean pain scores of females and males, regardless of their injection techniques. Conclusion. Utilizing the two-step injection technique in patients for inferior alveolar block reduces pain during injection without altering patients' vital signs significantly. This trial is registered with IRCT20220106053646N1

Mortality risk factors in patients with gastric cancer using Bayesian and ordinary Lasso logistic models: A study in the Southeast of Iran

Aim: The aim of this study was to apply two types of statistical models to determine the factors that influence the mortality rate in patients with gastric cancer. Background: In Iran, gastric cancer ranks the first and second most prevalent among men and women, respectively. It is the first cause of death in Iran in both gendersival. Methods: In this retrospective study, data were obtained from 339 (216 male) patients diagnosed with gastric cancer in the city of Kerman (South-East of Iran) during 2001-2015. In this study, ordinary and Bayesian Lasso (least absolute shrinkage and selection operator) logistic regression models, with goodness-of-fit indices, were compared and the models' risk factors were also determined. Results: The mean age of the participants was 62.84-14.53 years, and 12.4 of them were younger than 45 years. Also, the mortality rate was 57.7. Gender, morphology of the tumor, and time of diagnosis were found to be significant factors in the mortality of the patients in both models. This study found that the Bayesian Lasso model had better fitness. Conclusion: The high mortality rate of gastric cancer and its high prevalence at age below 45 years are alarming. Thus, great attention should be paid to prevention, early diagnosis, especially in females, and adenocarcinoma to improve the survival of patients with gastric cancer. ©2020 RIGLD, Research Institute for Gastroenterology and Liver Diseases

The effect of auricular acupressure on short-term postoperative pain intensity after cesarean section: a three-arm randomized controlled trial

Introduction: Pain control after a cesarean section remains a challenge for healthcare professionals. Both pharmacological and non-pharmacological treatment methods can be used to reduce this pain. The present study evaluated the effect of auricular acupressure (applied using the finger) combined with routine care on the short-term pain severity compared to sham acupressure or routine care alone. Methods: A randomized controlled clinical trial with three parallel groups was conducted between April and May 2021. Participants were pregnant women aged 18–35 years, of gestational age 37–40 weeks who underwent cesarean section according to the anesthesia protocol provided in Imam Ali Hospital, Amol, Mazandaran, Iran. Using the balanced blocks randomization method, participants were randomly allocated into three study groups. Participants (N = 180) were randomly assigned to either routine care with auricular acupressure (n = 60), routine care with sham control (n = 61), or routine care only (n = 59). The intervention (auricular acupressure) was performed by a trained nurse three times (three, five, and seven hours after surgery) on ear acupoints including Shen Men, Point Zero, Pelvic, abdomen, Endocrine, and Uterus points, in both ears. The primary outcome was pain severity assessed using the Visual Analog Scale (VAS) at eight time points (i.e., before the intervention, and then 15, 30, and 60 min after the intervention, and 3, 6, 12, and 24 h after the intervention). Patients and outcome assessors were blinded. Results: The pain intensity in the three groups was not significantly different until 6 h after the intervention. The level of pain in the intervention group receiving auricular acupressure was significantly lower than the sham group at 6 h (MD: -1.06 [95% CI: -1.83; -0.30]), 12 h (MD: -1.24 [95% CI: -1.96; -0.52]), and 24 h (MD: -1.21 [95% CI: -1.96; -0.47]) after the intervention. Also, the pain intensity in the intervention group was significantly lower than the control group at 6 h (MD: -0.80 [95% CI: -1.53; -0.08]), 12 h (MD: -0.98 [95% CI: -1.67; -0.30]) and 24 h (MD: -1.00 [95% CI: -1.70; -0.29]) after the intervention. Moreover, no adverse outcomes were observed related to auricular acupressure. Conclusion: Auricular acupressure might be an effective adjuvant complementary treatment for post-operative cesarean pain in controlling pain and reducing the need for analgesics with no adverse effect

Mental Health and Resilience in Emergency Medical Services Practitioners During the COVID-19 Pandemic

Background: The prevalence of the Coronavirus disease 2019 (COVID-19) pandemic, as one of the biggest global health threats, has had psychological impacts on healthcare workers (HCWs) and all aspects of their mental health, particularly resilience. Objectives: This study aimed to investigate the relationship between mental health and resilience in prehospital emergency medical services (EMS) practitioners. Methods: This descriptive/analytical cross-sectional study was conducted in 2020 using a web-based questionnaire, wherein the data were collected from a total number of 115 EMS practitioners working in 115 EMS stations in Golestan province, northern Iran, selected using convenience sampling. The data collection tools were also the General Health Questionnaire-28 (score range: 0-84) and the Connor-Davidson Resilience Scale (score range: 0-100). The relationship between both questionnaires was then examined by structural equation modeling via maximum likelihood estimation. In addition, multiple linear regression (MLR) was applied to reflect on the factors affecting the resilience mean score. Results: The mental health and resilience mean scores in the EMS practitioners were 25.73 ± 8.90 and 72.25 ± 12.63, respectively. Furthermore, 43.5 and 49.6 of the subjects had good and mild mental health conditions, respectively. The correlation coefficient between both questionnaires (-0.51) revealed that mental health deterioration diminished resilience in the EMS practitioners. Additionally, the type of employment and mental health mean score had a significant effect on the resilience mean value (R2 in MLR = 0.54). Conclusions: The study results demonstrated that more than half of the EMS practitioners had moderate mental health status, and their resilience mean score was high. Therefore, it is suggested to evaluate the prevalence of other common types of mental problems, such as anxiety, depression, and sleep disorders, in HCWs during the COVID-19 pandemic at the national level in future studies. © 2022, Author(s)

Job satisfaction and the role of self‐esteem and self‐efficacy: A cross‐sectional study among Iranian nurses

Abstract Aim This study aims to investigate the relationship between nurses' self‐efficacy and self‐esteem, and their job satisfaction. Design A cross‐sectional study was conducted. Methods Employing a random sampling method that included 234 nurses from three hospitals in Iran enrolled. This study utilized the General Self‐Efficacy Questionnaire, Coppersmith Self‐Esteem Inventory, and Minnesota Job Satisfaction Questionnaire. Descriptive analysis, independent t‐tests, Pearson correlation analyses, and linear regression were employed for data analysis. Results The mean self‐efficacy score for nurses was 26.73 ± 5.62 (out of 40), while self‐esteem and job satisfaction scored 37.13 ± 6.87 (out of 50) and 68.27 ± 12.65 (out of 100), respectively. Significant correlations were found between self‐efficacy, self‐esteem, and job satisfaction. Moreover, self‐esteem and the age group >40 years were identified as important predictors of nurses' job satisfaction. This study highlights the influential role of self‐esteem in determining nurses' job satisfaction