Objective To evaluate the effectiveness of cryotherapy in managing the pain at the puncture site of Arterio-Venous Fistula (AVF) among children undergoing maintenance hemodialysis (HD). Methods A one-group pre-post quasi-experiment was performed in two HD centers affiliated with Cairo University. The experiment involved 40 children with AVF undergoing HD. Before puncturing, cryotherapy was applied using 2 cm–3 cm pieces of frozen distilled water in a plastic bag. Pain was assessed subjectively and objectively in two dialysis sessions before and after cryotherapy. A part from a physiological assessment of vital signs, pain was assessed using the Wong–Baker Faces Pain and the Observed Pain Behavior rating scales. All research ethics were applied. Results HD had a median duration of four years, while cryotherapy had a median application time of 8.8 min. The Wong–Baker Faces Pain score and almost all observed pain behaviors significantly decreased after cryotherapy. Significant improvements were observed in respiratory rate before and after needle puncture and in oxygen saturation after needle puncture. A lower skin dryness was observed after cryotherapy (12.5%) than before cryotherapy (52.5%; p < 0.001). Conclusions Cryotherapy can effectively reduce the venipuncture pain among children with AVF undergoing maintenance HD. However, the confounding effects of distraction and the non-randomized design used must be both considered when interpreting the findings. This study recommends the use of cryotherapy in managing needle puncture pain. Further research must adopt a randomized trial design with a placebo to support further the benefits of this procedure.

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Leadership behavior affects nurses' performance and satisfaction especially in high stressful environment such as the pediatric hospitals. Aim: The study aimed to assess the leadership behaviors as perceived by pediatric nurses and its effect on their satisfaction and performance.

Nursing educators should recognize the need to develop innovative teaching strategies that would enhance student learning. Aim: The study aimed to evaluate the effect of applying a self-instruction package on cognitive performance among pediatric nursing students in Egyptian and Saudi settings. Methods: This quasi-experimental study was carried out at the Faculty of Nursing, Cairo-University, Egypt and the College of Nursing, Hail University, Kingdom of Saudi Arabia (KSA) on a sample of convenience of 100 Egyptian and 90 Saudi nursing students. A self-instruction unit addressing lower respiratory infections, especially pneumonia was prepared and applied. The effectiveness was measured through pre-post-testing. Results: The results showed that the students in both samples had high levels of success in the posttests reaching in total 99.0% in the Egyptian sample and 100.0% in the Saudi sample. The lowest level of success in both samples were in the "compare" level of knowledge, 91.0% and 94.4% in the Egyptian and Saudi samples, respectively. As for the rates by question type, it reached 100.0% for "MCQ" and "list" types in both samples. Saudi students had significantly higher scores in the "know" level of knowledge (p=0.04), and in the "list" (p=0.02) and "compare/match" (p=0.004) types of questions, but with no statistically significant difference in total score (p=0.20). In multivariate analysis, the module was the main statistically significant independent positive predictor of the knowledge score improvement at all levels of knowledge. The Egyptian nationality was a positive predictor for the "know" and "analyze" levels. Meanwhile, the female gender was a positive predictor of the "apply" level of knowledge. Additionally, the Egyptian nationality was a positive predictor for the "MCQ" and "list" types. Conclusion: the self-instruction package is effective in improving the cognitive performance of nursing students in Egypt and Saudi Arabia in all cognitive levels and used various types of questions. The study recommends the use of the package in nursing schools, and development of similar ones in different topics.

Although advances in neonatology led to considerable decreases in preterm infants