BACKGROUND
Many women would like to avoid pharmacological or invasive methods of pain management in labour and this may contribute towards the popularity of complementary methods of pain management. This review examined evidence supporting the use of acupuncture and acupressure for pain management in labour.


OBJECTIVES
To examine the effects of acupuncture and acupressure for pain management in labour.


SEARCH STRATEGY
We searched the Cochrane Pregnancy and Childbirth Group's Trials Register and The Cochrane Complementary Medicine Field's Trials Register (October 2010), the Cochrane Central Register of Controlled Trials (The Cochrane Library 2010, Issue 4), MEDLINE (1966 to October 2010), and CINAHL (1980 to October 2010).


SELECTION CRITERIA
Published and unpublished randomised controlled trials comparing acupuncture and acupressure with placebo, no treatment or other non-pharmacological forms of pain management in labour. We included all women whether primiparous or multiparous, and in spontaneous or induced labour.


DATA COLLECTION AND ANALYSIS
We performed meta-analysis using risk ratios (RR) for dichotomous outcomes and mean differences (MD) for continuous outcomes. The outcome measures included pain intensity, satisfaction with pain relief, use of pharmacological pain relief, relaxation, caesarean section rate, augmentation with oxytocin, length of labour and anxiety.


MAIN RESULTS
We included 13 trials with data reporting on 1986 women. Nine trials reported on acupuncture and four trials reported on acupressure. Less intense pain was found from acupuncture compared with no intervention (standardised mean difference (SMD) -1.00, 95% confidence interval (CI) -1.33 to -0.67, one trial, 163 women). One trial increased satisfaction with pain relief compared with placebo control (RR 2.38, 95% CI 1.78 to 3.19, 150 women). Reduced use of pharmacological analgesia was found in one trial of acupuncture compared with placebo (RR 0.72, 95% CI 0.58 to 0.88, 136 women), and compared with standard care, however, there was significant heterogeneity (RR 0.68, 95% CI 0.56 to 0.83, three trials, 704 women). Fewer instrumental deliveries from acupuncture were found compared with standard care (RR 0.67, 95% CI 0.46, 0.98, three trials, 704 women); however, there was significant heterogeneity. Pain intensity was reduced in the acupressure group compared with a placebo control (SMD -0.55, 95% CI -0.92 to -0.19, one trial, 120 women), and a combined control (SMD -0.42, 95% CI -0.65 to -0.18, two trials, 322 women). No trial was assessed as being at a low risk of bias for all of the quality domains.


AUTHORS' CONCLUSIONS
Acupuncture and acupressure may have a role with reducing pain, increasing satisfaction with pain management and reduced use of pharmacological management. However, there is a need for further research.

Cochrane Database of Systematic Reviews (Reviews) || Acupuncture or acupressure for pain management in labour

Resumo Objetivo Identificar na literatura nacional e internacional, estudos sobre a eficacia de metodos nao farmacologicos na reducao da dor do parto. Metodos Revisao integrativa realizada nas bases de dados MEDLINE/PUBMED, SCOPUS, CINAHL, LILACS e BDENF, com recorte temporal entre os anos de 2013 a 2018, em portugues, ingles e espanhol. Utilizado a metodologia PICo para construir a pergunta de pesquisa e selecionar descritores controlados e nao controlados, que foram combinados com os operadores booleanos “AND”, “OR” e “NOT”. Resultados Foram selecionados 19 artigos. Dentre os metodos nao farmacologicos encontrados, destacam-se: a acupuntura e suas principais variacoes (acupressao e auriculoterapia) (29,17%), hidroterapia (25%), exercicios perineais com a bola suica (16,67%), terapias termicas (8,33%) e os demais metodos (20,83%). Conclusao A acupuntura e a acupressao agem tanto sobre aspectos fisiologicos da dor como sobre sua subjetividade. O banho quente de aspersao, a musicoterapia, a aromaterapia e as tecnicas de respiracao promovem o relaxamento e a diminuicao dos niveis de ansiedade. As terapias termicas contribuem para a analgesia local de regioes afetadas pela dor. Os exercicios na bola suica sao importantes para reduzir a dor e adotar a posicao vertical, importante na progressao do trabalho de parto.

pdf/evidencias-cientificas-sobre-metodos-nao-farmacologicos-para-2x7if4d0q3.pdf

Evidências científicas sobre métodos não farmacológicos para alívio a dor do parto

Breathing is a vital rhythmic motor behavior with a surprisingly broad influence on the brain and body. The apparent simplicity of breathing belies a complex neural control system, the breathing central pattern generator (bCPG), that exhibits diverse operational modes to regulate gas exchange and coordinate breathing with an array of behaviors. In this review, we focus on selected advances in our understanding of the bCPG. At the core of the bCPG is the preBötzinger complex (preBötC), which drives inspiratory rhythm via an unexpectedly sophisticated emergent mechanism. Synchronization dynamics underlying preBötC rhythmogenesis imbue the system with robustness and lability. These dynamics are modulated by inputs from throughout the brain and generate rhythmic, patterned activity that is widely distributed. The connectivity and an emerging literature support a link between breathing, emotion, and cognition that is becoming experimentally tractable. These advances bring great potential for elucidating function and dysfunction in breathing and other mammalian neural circuits. Expected final online publication date for the Annual Review of Neuroscience, Volume 45 is July 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.

https://www.annualreviews.org/doi/pdf/10.1146/annurev-neuro-090121-014424

Breathing Rhythm and Pattern and Their Influence on Emotion.

Objective: To identify non-pharmacological therapies applied during pregnancy and labor. Method: Integrative review conducted in the databases: PubMed, ScieLO and PEDro, searching for articles from 2008 in English, Spanish and Portuguese. The descriptors used were: pregnancy, childbirth, physiotherapy, alternative and complementary medicine, alternative therapy, non-pharmacological therapy, biomechanical therapy. Results: Forty-one articles were analyzed and subdivided into ten categories of nonpharmacological therapies: massage, perineal massage, hot bath, supportive care, childbirth preparation group, breathing techniques, pelvic floor exercises, transcutaneous electrostimulation, Swiss ball and spontaneous pushing. Six articles (60%) showed a positive outcome for reduction of pain in labor and all of them had a positive outcome for different variables of labor, such as reduction of time, anxiety and pelvic floor laceration rates. Conclusion: The use of non-pharmacological therapies was efficient to reduce the effects of labor and childbirth, such as pain, duration of labor, anxiety, laceration and episiotomy.

/pdf/non-pharmacological-therapies-applied-in-pregnancy-and-labor-kpxphxm9g7.pdf

Non-pharmacological therapies applied in pregnancy and labor: an integrative review

Background: Migraine is an intractable headache disorder, manifesting as periodic attacks It is highly burdensome for patients and society Acupuncture treatment can be beneficial as a supplementary and preventive therapy for migraine Objectives: This systematic review and meta-analysis aimed to investigate the efficacy and safety of acupuncture for migraine, and to examine transcranial doppler changes after acupuncture Methods: Reports, conference, and academic papers published before March 15, 2019 in databases including PubMed, Cochrane library, Embase, China National Knowledge Infrastructure, WANFANG Database, Chinese journal of Science and Technology, and China Biomedical were searched Randomized controlled trials (RCTs) involving acupuncture, sham acupuncture, and medication in migraine were included The Cochrane Collaboration software, RevMan 53, was used for data processing and migration risk analysis Results: Twenty-eight RCTs were included 15 RCTs included medication only, 10 RCTs included sham acupuncture only, and 3 RCTs included both The study included 2874 patients, split into 3 groups: acupuncture treatment group (n = 1396), medication control group (n = 865), and sham acupuncture control group (n = 613) The results showed that treatment was more effective in the acupuncture group than in the sham acupuncture group (MD = 188, 95% CI [161, 220], P < 000001) and medication group (MD = 116, 95% CI [112, 121], P < 000001) Improvement in visual analog scale (VAS) score was greater in the acupuncture group than in the sham acupuncture group (MD = -100, 95% CI [-127,-046], P < 000001; MD = -059, 95% CI [-081,-038], P < 000001), and their adverse reaction rate was lower than that of the medication group (RR = 016, 95% CI [005, 052], P = 0002) The improvement of intracranial blood flow velocity by acupuncture is better than that by medication, but the heterogeneity makes the result unreliable Conclusions: Acupuncture reduced the frequency of migraine attacks, lowered VAS scores, and increased therapeutic efficiency compared with sham acupuncture Compared with medication, acupuncture showed higher effectiveness with less adverse reactions and improved intracranial blood circulation However, owing to inter-study heterogeneity, a prospective, multicenter RCT with a large sample is required to verify these results

/pdf/a-systematic-review-and-meta-analysis-of-the-therapeutic-2a5gimbqj9.pdf

A Systematic Review and Meta-analysis of the Therapeutic Effect of Acupuncture on Migraine

This study investigated the effect of acupuncture, hypnotherapy, and pharmacotherapy in migraine treatments among 90 patients They were divided into 3 groups of 30 persons each Group 1, Group 2, and Group 3 were treated with acupuncture, hypnotherapy, and pharmacotherapy, respectively Changes in the visual analog scale (VAS) and Migraine Disability Assessment (MIDAS) scores from baseline were monitored Reductions in the percentages of the VAS and MIDAS scores at the end of the third month were significantly higher in the acupuncture and hypnotherapy groups than those of the pharmacotherapy group (p < 01) Acupuncture and hypnotherapy can be developed as treatment options alone as an equivalent to conventional treatment

A Comparison of the Efficacy of Acupuncture and Hypnotherapy in Patients With Migraine.

Amac: Ozellikle dogumdan sonraki ilk aylarda gebelik ve depresyon arasindaki iliski iyi bilinmektedir. Gebelikle ilgili depresyon hem anne, hem de bebek sagligini tehlikeye atabilir. Bu arastirmada sosyal destegin dogum sonrasi donemdeki annelerde depresyona olan etkisini arastirmayi amacladik. Yontemler: Erzurum sehir merkezinde 110 anneyi iceren kesitsel bir arastirma yurutuldu. Veriler Edinburg Postpartum Depresyon skalasi (EPDS) ve Cok Boyutlu Algilanmis Depresyon Skalasi (MSPSS) ile toplandi. Bulgular: Katilimcilarin ortalama yasi 28,8±5,9 yil idi. Katilimcilarin cogunlugu ev hanimi idi ‎‎(%75,5; n=83). Katilimcilarin  %26,4’unun (n=29) depresyon oykusu vardi. EPDS’ye gore annelerin %47,3’u (n=52) kesme duzeyinin uzerinde puana sahipti. Ortalama ‎EPDS ve MSPSS puanlari sirasiyla 12,0±4,7 ve 58,3±13,0 idi. EPDS ve MSPSS puanlari arasinda anlamli bir korelasyon saptandi (r=-0.42; p<0.001)‎. Sonuc: Sosyal destek ve dogum sonrasi depresyon siki bir sekilde iliskilidir. Depresyonun anne, bebek ve aile uzerindeki olumsuz etkilerini onlemek icin ozellikle yuksek risk altindaki bolgelerde birinci basamak saglik hizmeti sunuculariyla baglantili olarak dogum sonrasi depresyonun erken taninmasi icin etkili tarama yontemleri kullanilmalidir.

http://jsurgmed.com/tr/download/article-file/507346

The effects of perceived social support on postpartum depression

OBJECTIVE Studying medicine is hard and it takes longer time compared to other majors. In addition, medical students find medical education boring. It is now necessary to turn medical education into an enjoyable and interesting way. The aim of this study is to evaluate the impact of an educational program related to how to learn taking medical history and how an effective patient-doctor interview should be. The program is structured in various scenarios, on the students learning skills, by the "role playing" method. MATERIALS AND METHODS A scenario prepared by the lecturer was employed in this study. While one of the students acted in a doctor role, the other one played in the role of patient's relative. The lecturer always played in the role of patient. After performing the role playing, students' written and oral feedbacks were gathered. Data were analysed by using SPSS 20.0 program. RESULTS A total of 470 feedbacks (51.3% were given by the female students) were taken from the students. Thirty-three volunteer students, nineteen of them were male, took part in the role playing. In the patient-doctor interview, the field that students were best were greeting the patients and dealing only with patients during the examination. The mean scores were 3.81±0.95 and 3.79±0.94 respectively. The ability to "summarize" and to "address the patient with his/her name" had the lowest scores; the mean scores of the students in these areas were 2.94±1.11 and 2.70±1.31, respectively. CONCLUSION Medical education is a long and tough process. Therefore, it should be interesting, attention getting and cheerful. Role playing can be effective in meeting that need.

Third Year Medical School Students' Experiences of Revealing Patients' Stories through Role Playing.

Noro Linguistik Programlama (NLP) beyin-sinir dilinin yeniden programlanmasidir. NLP basarili davranislar elde etmek icin dilin etkili kullanimina yardimci olur ve belirledigimiz hedeflere ulasabilmemiz icin sinir sistemimizi organize etmenin program ve tekniklerini bize sunar. NLP, koklerini psikoterapiden aldigi icin dogal olarak bu alanda ozellikle iddialidir. Ote yandan, insanin psikolojisinin kisinin bedeni uzerindeki etkileri ve iyilesme surecinin modellenebilirligi nedenleriyle NLP, diger terapi dallarinda da guclu bir arac olarak kullanilmaktadir. Bu yazida gunumuzde uygulanan sekliyle NLP‟nin dogasi hakkinda bilgi verilmesi ve aile hekimligi pratigindeki kullanim alanlarindan bahsedilmesi amaclanmistir

/pdf/noro-linguistik-programlama-ve-aile-hekimliginde-kullanimi-ebwxsq335n.pdf

Nöro Linguistik Programlama ve Aile Hekimliğinde Kullanımı

Giris ve amac Turkiye’de alti yillik tip egitiminin ardindan ‘tip doktoru’ unvanini alan hekimler uzmanlasmak icin 1987 yilindan beri yilda iki kez yapilan Tipta Uzmanlik Sinavinda (TUS) basarili olmak zorundadir. Saglikta donusum projesi, 5947 sayili tam gun yasasi ve hatali tibbi uygulama davalarinin ve cezalarin artmasi gibi cesitli faktorlerin etkisiyle hekimlerin TUS tercihleri degismeye baslamistir. Bu arastirmada 2007-2013 yillari arasindaki TUS kadro ve puanlarinin incelenmesi ve yillara ve alanlara gore degisimlerin analiz edilmesi amaclanmistir. Gerec ve yontem 2007 Nisan -2013 Nisan arasinda duzenlenen 13 adet TUS ile ilgili veriler Olcme, Secme ve Yerlestirme Merkezi web sitesinden ( http://www.osym.gov.tr/ ) indirildi ve incelendi. Arastirmanin ana sonuc olcutunu taban puanlar olusturdu. Analizlerde SPSS 18.0 paket istatistik programi kullanildi. Bulgular Yillar icerisinde Tibbi biyokimya ve Tibbi Mikrobiyoloji puanlarinda yukselme olurken Kadin Hastaliklari ve Dogum, Genel Cerrahi ve Cocuk Sagligi ve Hastaliklari branslarinin taban puanlarinda belirgin dususlerin oldugu dikkat cekiciydi. Saglik Bakanligi’na ait kurumlarin ortalama taban puanlari 62,3±2,6; universitelerin ortalama taban puanlari ise 61,8±2,0 olarak saptandi. Kurumlar arasinda taban puan ortalamalari acisindan istatistiksel olarak anlamli bir fark saptanmadi (t=1,18; p=0,241). 2009 sonrasinda cerrahi branslara gore dahili branslarda daha az olmakla birlikte yatakli hizmeti olan branslarin puanlarinda tedrici bir dusus gozlenirken yatakli hizmeti olmayan branslarin puanlarinda yillar icerisinde bir artis oldugu dikkati cekti. Brans gruplari arasindaki puan farki 2007 yilinda istatistiksel olarak anlamli iken (F=4,691; p=0,02) diger yillarda anlamsiz bulundu (p>0,05). Sonuc Yillar icerisinde TUS’da brans tercihindeki trend degismektedir. Gelecekte branslar arasinda olusabilecek dengesizlikten kaynaklanacak saglik hizmeti sunumunda aksakliklar olabileceginden TUS kontenjanlarinin ve tercihlerin belirlenmesinin bu trend bilgileri isiginda yapilmasi uygun olacaktir.

/pdf/2007-2013-arasi-tipta-uzmanlik-sinavlari-bir-trend-analizi-57u47ldhwe.pdf

2007-2013 arası Tıpta Uzmanlık Sınavları: Bir Trend Analizi

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