Baseline Discomfort Research Articles

Randomized control trial to investigate compliance with, and impacts of, cow comfort recommendations on smallholder dairy farms in Kenya

Smallholder dairy farmers (SDF) in developing countries often have limited understanding on the importance of cow comfort. We conducted a randomized controlled trial with 124 cows on 114 Kenyan SDF to determine the status of cow comfort, to assess compliance to farm-specific cow comfort recommendations, and to evaluate the impacts of the farm-specific interventions on cow comfort. On the first farm visit, stall dimensions and characteristics (e.g. stall base hardness and hygiene) were measured and categorized as adequate, marginal or inadequate/absent based on cow size. Where measurements were not adequate, farm-specific cow comfort recommendations were provided in written and oral form to the randomly allocated intervention group of farms (n = 74). On the second farm visit two months later, the same measurements were taken, and percent compliance to the recommendations was evaluated. A discomfort index was arithmetically calculated based on the stall base hardness (scale was 1–3 for soft to hard) and hygiene (scale was 1–5 for clean to dirty). Multivariable linear regression models were used to determine specific associations with the discomfort index. On the first visit, the mean stall base hardness and stall hygiene scores were 1.7 and 2.3, respectively, for a mean discomfort index of 4.0. Intervention farmers were given 3.9 comfort recommendations, on average, and complied with 2.1 recommendations, significantly improving the discomfort index at visit two to 3.3. The overall compliance to the recommendations was 49.0%. In a final model, the interaction between intervention group and visit number was significantly associated with discomfort index, indicating that after adjusting for baseline discomfort indices, the intervention led to better cow comfort. Specifically, bedding type and neck rail positioning were significantly associated with discomfort index. We concluded that farmers can substantially improve cow comfort on SDF by providing recommendations to them. Farm advisors should include cow comfort recommendations to SDF.

Examining the effectiveness of a lower back exoskeleton in reducing discomfort and workload in vascular surgery

Musculoskeletal disorders and intraoperative pain are prevalent among vascular surgeons which can negatively affect their surgical performance and quality of life. The effectiveness of a lower back support exoskeleton to reduce discomfort of the back, subjective fatigue, and the workload associated with performing vascular surgery was evaluated, as well as the participants’ intraoperative upper body postures. Three vascular surgeons were asked to rate their discomfort and fatigue before, during and after performing surgery, and their subjective workload post-operatively. Inertial measurement units (IMUs) were used to measure their intraoperative body postures. No significant differences were found between exoskeleton and baseline discomfort, fatigue, workload, or intraoperative postures. This indicates that although the exoskeleton did not restrict the vascular surgeons’ postures, this exoskeleton was ineffective at reducing their discomfort or workload. Future studies with exoskeletons specifically designed for healthcare applications may show more efficacy in reducing the ergonomic risks to surgeons.

Can the Borg CR-10 scale for neck and low back discomfort predict future neck and low back pain among high-risk office workers?

PurposePerceived discomfort could indicate an early sign of pain, for example, as a result of a biomechanical load on the musculoskeletal system. Assessing discomfort can, therefore, help to identify workers at increased risk of musculoskeletal disorders for targeted intervention development. We aimed: (1) to identify the optimal cut-off value of neck and low back discomfort among office workers and (2) to evaluate its predictive validity with future neck and low back pain, respectively.MethodsAt baseline healthy participants (n = 100) completed questionnaires, including the Borg CR-10 discomfort scale (on a 0–10 scale), and were followed for six months, during which musculoskeletal pain was assessed monthly. Logistic regression analyses were performed to assess the associations of baseline discomfort with the onset of future neck or low back pain. Sensitivity, specificity, and the area under the receiver operating characteristics curve were estimated to identify the optimal discomfort cut-off value predicting future pain.ResultsBorg CR-10 scores ≥ 3.5 for perceived neck and low back discomfort had acceptable sensitivity and specificity to predict future neck and low back pain, respectively. Perceived discomfort at baseline as a dichotomous measure (using the ≥ 3.5 cut-off) was a statistically significant predictor of future neck pain (OR = 10.33) and low back pain (OR = 11.81).ConclusionWe identified the optimal cut-off value of the Borg CR-10 discomfort scale to identify office workers at increased risk of developing neck and low back pain. These findings might benefit ergonomists, primary health care providers, and occupational health researchers in developing targeted interventions.

Pain Recognition With Electrocardiographic Features in Postoperative Patients: Method Validation Study.

BackgroundThere is a strong demand for an accurate and objective means of assessing acute pain among hospitalized patients to help clinicians provide pain medications at a proper dosage and in a timely manner. Heart rate variability (HRV) comprises changes in the time intervals between consecutive heartbeats, which can be measured through acquisition and interpretation of electrocardiography (ECG) captured from bedside monitors or wearable devices. As increased sympathetic activity affects the HRV, an index of autonomic regulation of heart rate, ultra–short-term HRV analysis can provide a reliable source of information for acute pain monitoring. In this study, widely used HRV time and frequency domain measurements are used in acute pain assessments among postoperative patients. The existing approaches have only focused on stimulated pain in healthy subjects, whereas, to the best of our knowledge, there is no work in the literature building models using real pain data and on postoperative patients.ObjectiveThe objective of our study was to develop and evaluate an automatic and adaptable pain assessment algorithm based on ECG features for assessing acute pain in postoperative patients likely experiencing mild to moderate pain.MethodsThe study used a prospective observational design. The sample consisted of 25 patient participants aged 18 to 65 years. In part 1 of the study, a transcutaneous electrical nerve stimulation unit was employed to obtain baseline discomfort thresholds for the patients. In part 2, a multichannel biosignal acquisition device was used as patients were engaging in non-noxious activities. At all times, pain intensity was measured using patient self-reports based on the Numerical Rating Scale. A weak supervision framework was inherited for rapid training data creation. The collected labels were then transformed from 11 intensity levels to 5 intensity levels. Prediction models were developed using 5 different machine learning methods. Mean prediction accuracy was calculated using leave-one-out cross-validation. We compared the performance of these models with the results from a previously published research study.ResultsFive different machine learning algorithms were applied to perform a binary classification of baseline (BL) versus 4 distinct pain levels (PL1 through PL4). The highest validation accuracy using 3 time domain HRV features from a BioVid research paper for baseline versus any other pain level was achieved by support vector machine (SVM) with 62.72% (BL vs PL4) to 84.14% (BL vs PL2). Similar results were achieved for the top 8 features based on the Gini index using the SVM method, with an accuracy ranging from 63.86% (BL vs PL4) to 84.79% (BL vs PL2).ConclusionsWe propose a novel pain assessment method for postoperative patients using ECG signal. Weak supervision applied for labeling and feature extraction improves the robustness of the approach. Our results show the viability of using a machine learning algorithm to accurately and objectively assess acute pain among hospitalized patients.International Registered Report Identifier (IRRID)RR2-10.2196/17783

Efficacy of Sedation by Midazolam in Association With Meperidine or Fentanyl and Role of Patient Distress During Elective Colonoscopy.

Meperidine and fentanyl are opioids currently used in addition to midazolam for sedation and analgesia during colonoscopy in Italy. The aim of the study was to assess the impact of patients' psychological state before elective colonoscopy on the efficacy of the sedation regimens. Eighty outpatients who underwent an elective colonoscopy were included in our study. The Hospital Anxiety and Depression Scale questionnaire was self-administered to evaluate basal anxiety and depression state. The rate of baseline discomfort was evaluated by a standard 100-mm visual analog scale. Sedation was obtained alternatively with a midazolam-meperidine or midazolam-fentanyl combination. There were no statistically significant differences between the fentanyl and meperidine groups on body mass index, age, and gender composition. Patients in the meperidine group reported less pain during colonoscopy than patients in the fentanyl group. There were statistically significant positive correlations in the meperidine group with the distress, anxiety, and depression. Our study has pointed out greater effectiveness of the midazolam plus meperidine regimen, equal recovery times, and no significant differences in the duration of the endoscopic examinations. The evaluation of patients' psychological status seems to predict the efficacy of sedation when the nociceptive component of pain is well controlled.

The urge to blink in Tourette syndrome

Functional neuroimaging studies have attempted to explore brain activity that occurs with tic occurrence in subjects with Tourette syndrome (TS). However, they are limited by the difficulty of disambiguating brain activity required to perform a tic, or activity caused by the tic, from brain activity that generates a tic. Inhibiting ticcing following the urge to tic is important to patients' experience of tics and we hypothesize that inhibition of a compelling motor response to a natural urge will differ in TS subjects compared to controls. This study examines the urge to blink, which shares many similarities to premonitory urges to tic. Previous neuroimaging studies with the same hypothesis have used a one-size-fits-all approach to extract brain signal putatively linked to the urge to blink. We aimed to create a subject-specific and blink-timing-specific pathophysiological model, derived from out-of-scanner blink suppression trials, to eventually better interpret blink suppression fMRI data. Eye closure and continuously self-reported discomfort were reported during five blink suppression trials in 30 adult volunteers, 15 with a chronic tic disorder. For each subject, data from four of the trials were used with an empirical mathematical model to predict discomfort from eye closure observed during the remaining trial. The blink timing model of discomfort during blink suppression predicted observed discomfort much better than previously applied models. Combining this approach with observed eye closure during fMRI blink suppression trials should therefore extract brain signal more tightly linked to the urge to blink. The simple mean of time-discomfort curves from each subject's other trials also outperformed older models. The TS group blinked more than twice as often during the blink suppression block, and reported higher baseline discomfort, smaller excursion from baseline to peak discomfort during the blink suppression block, and slower return of discomfort to baseline during the recovery block.

A Prospective, Randomized, Controlled Trial Assessing Diazepam to Reduce Perception and Recall of Pain During Transrectal Ultrasonography-Guided Biopsy of the Prostate

The effect of oral anxiolytics in diminishing patient discomfort and pain perception has been demonstrated in GI endoscopy, percutaneous coronary interventions, and various procedures in the emergency department setting, but has not been prospectively studied in the setting of prostate biopsy. The purpose of this study was to investigate the effect of diazepam on pain perception during and after prostate biopsy. Sixty patients undergoing prostate biopsy at a single academic institution were enrolled into a prospective, randomized, placebo-controlled study. A questionnaire was administered prebiopsy to determine baseline discomfort and pain history. A visual analog pain scale was used to determine pain associated with each step of the transrectal Ultrasonography-guided prostate biopsy and was administered 20 minutes after biopsy and 1 week later. Responses were compared between groups using the Mann-Whitney U test, Fisher exact test, and Wilcoxon signed rank test as appropriate. A total of 60 patients (29 diazepam, 31 placebo) completed pre- and postbiopsy surveys for analysis. The number of cores sampled during biopsy was controlled during analysis and was found to have no correlation with total pain measured. There were no differences between diazepam and placebo groups in age, prebiopsy survey results, immediate and 1 week postbiopsy survey results. There was no difference in the patients' willingness to undergo a repeated procedure in the control and treatment groups. Complications of taking diazepam prebiopsy included drowsiness, chills, and ankle injury. Diazepam does not improve patient pain perception immediately after or at 1-week recall after prostate biopsy. Omitting diazepam simplifies the biopsy regimen and allows the patient to drive himself home. Based on these results, routine use of diazepam in prostate biopsy is not recommended.

The Moderating Effect of the Severity of Baseline Musculoskeletal Discomfort on the Effect of an Alternative Keyboard: A 5-Month Randomized Clinical Trial

Objective: To determine if baseline discomfort severity would moderate differences in 5-month follow-up discomfort in those using a fixed split-angle (FSA) keyboard compared to those using a standard (ST) keyboard. Procedure: Computer operators with keyboard related musculoskeletal discomfort were randomly assigned to use an FSA keyboard or a ST keyboard in their workplace for 5 months. They reported weekly levels of discomfort using the Weekly Discomfort Survey. Result: The interaction between baseline severity and keyboard was significant. This significant interaction suggests that those who had moderate/severe baseline discomfort who used the FSA keyboard improved significantly more than: 1) those who had moderate/severe baseline discomfort who used the ST keyboard; or 2) those who had none/mild baseline discomfort and used either keyboard.

Prognostic factors for the effects of two interventions for work-related neck–shoulder complaints: Myofeedback training and ergonomic counselling

Aim To explore prognostic factors for the effects of two interventions (myofeedback training in combination with ergonomic counselling (Mfb/EC) and ergonomic counselling alone (EC)) on discomfort and disability in work-related neck–shoulder complaints. Methods Thirty-six females completed the interventions. Discomfort and disability were assessed at baseline, immediately after the intervention, and at 3-month follow-up. Potential sociodemographic and psychological prognostic factors were assessed using questionnaires. Data were analysed using multiple regression and general linear modelling. Results Changes in discomfort were best predicted by baseline discomfort levels. Changes in disability were predicted by baseline disability levels, patient profile, and coping strategy ‘ignoring sensations’. A significant difference between the Mfb/EC and EC group was found for coping strategy ‘ignoring sensations’, which appeared to be a predictor for changes in disability at 3-month follow-up in the Mfb/EC group only. Conclusions Subjects with high levels of initial discomfort and disability and specific psychological patient profiles benefit most from interventions. Myofeedback training contributes a specific quality to those who ignore pain sensations.

Predictors of Upper Extremity Discomfort: A Longitudinal Study of Industrial and Clerical Workers

Upper extremity discomfort associated with work activity is common with a prevalence of over 50% in many settings. This study followed a cohort of 501 active workers for an average of 5.4 years. Cases were defined as workers who were asymptomatic or had a low discomfort score of 1 or 2 at baseline testing and went on to report a discomfort score of 4 or above on a 10-point visual analog scale. This change is considered clinically significant. Controls had a low baseline discomfort score and continued to have a low discomfort rating throughout the study. The risk factors found to have the highest predictive value for identifying a person who is likely to develop a significant upper extremity discomfort rating included age over 40, a BMI over 28, a complaint of baseline discomfort, the severity of the baseline discomfort rating and a job that had a high hand activity level (based upon hand repetition and force). The risk profile identified both ergonomic and personal health factors as risks and both factors may be amenable to prevention strategies.

The analgesic efficacy of topical capsaicin is enhanced by glyceryl trinitrate in painful osteoarthritis: a randomized, double blind, placebo controlled study

The aim of this study was to assess if the pain of osteoarthritis is reduced by topical capsaicin and to determine whether addition of glyceryl trinitrate has an effect on analgesic efficacy and tolerability of capsaicin. A randomized, double blind, placebo controlled study was carried out on 200 adult patients attending a Pain Clinic with osteoarthritis pain. Patients applied one of four creams topically over the affected joint over a 6 week period. Creams contained either placebo (vehicle), 0.025% capsaicin, 1.33% glyceryl trinitrate or 0.025% capsaicin + 1.33% glyceryl trinitrate. Analgesic efficacy, tolerability of cream and analgesic consumption were assessed. One hundred and sixty-seven of 200 patients completed the study. Baseline visual analogue scores (0–10 scale) for pain were 6.40. There was a significant reduction in pain scores in the glyceryl trinitrate group (mean decrease 0.59, p< 0.05, 95% confidence limits 0.04–1.14), 0.025% capsaicin group (mean decrease 0.5, p< 0.05, 95% confidence limits 0.05–1.05) and the glyceryl trinitrate capsaicin group (mean decrease 1.1, p<0.05, 95% confidence limits 0.22–1.98). Baseline discomfort of application scores were similar for all but the capsaicin groups (they were significantly higher (by 2.1 units, p< 0.001)). The odds ratio in favour of continuing treatment was 2.1 (95% confidence limits 1.0–4.4) for glyceryl trinitrate and 2.4 (95% confidence limits 1.2–5.1) for capsaicin and 5.0 (95% confidence limits 3.8–6.4) for capsaicin GTN combination. The study showed that topical capsaicin and glyceryl trinitrate have an analgesic effect in painful osteoarthritis. When used together this effect is increased with the combination being more tolerable than capsaicin alone. Analgesic consumption is decreased by capsaicin, glyceryl trinitrate and to a greater extent by both combined.

Pain in knee arthrography: comparison of air vs. CO2 and reaspiration vs. no reaspiration

A prospective study of 255 patients undergoing double-contrast arthrography of the knee was performed to evaluate postexamination knee pain after two procedural modifications: (1) intraarticular carbon dioxide versus room air and (2) postprocedural joint reaspiration versus no reaspiration. A moderate or severe increase in pain during the 24 hr after the examination was experienced by 20% of patients. Carbon dioxide resulted in slightly greater patient pain immediately after the procedure than did room air. However, there was no difference in morbidity in these two groups at 24 hr. Aspiration of the knee joint had no immediate or delayed effect on patient pain. Older patients, women, and patients with abnormal arthrograms, reported more baseline discomfort but, allowing for this, they tolerated the procedure as well as younger patients, men, and patients with normal arthrograms. It is recommended that double contrast arthrography of the knee be performed using intraarticular air without reaspiration of the joint.