Comfort Behaviour Research Articles

Are changes in behavior of fast-growing broilers with slight gait impairment (GS0-2) related to pain?

Impaired walking ability in terms of slight or definite defects is more common in broiler production than lameness that obviously hinders movement, but it has received limited scientific attention. This study aimed to compare behavior of conventional broilers with impaired walking ability (assessed as gait score (GS) 2) with those walking normally (GS0) and those with only a slight gait defect (GS1). Behavior in the home environment was registered, and an analgesic intervention to quantify changes in time budgets indicating pain relief was applied. The study included 192 Ross 308 broilers. On day 27 of age, the birds were distributed as evenly as possible into birds of GS0 and GS2 of each sex based on obtained gait score. Following this, each experimental bird was housed with 3 companion birds. On days 30 and 32 of age, the behavior in the home pens was recorded. All experimental birds were injected with the NSAID carprofen on one of the 2 d and saline on the other. The statistical analyses used the GS scored on the day of recording as explanatory factor. Compared to GS0 birds, GS2 birds tended to be more inactive (mean (CI): 4,193 (3,971–4416) vs. 4,005 (3,753–4,257) s; P = 0.074), spent more time sitting while feeding (306 (266–353) vs. 213 (180–251) s; P = 0.026), were less likely to perch (probability: 0.78 (0.69–0.85) vs. 0.91 (0.85–0.95); P = 0.012), and spent less time performing comfort behavior (749 (689–814) s vs. 875 (792–967) s; P = 0.043). Compared to GS1 birds, GS2 birds spent more time inactive (GS1: 4,022 (3,818–4225) s; P = 0.027), less time foraging (289 (253–329) vs. 347 (309–388) s; P = 0.047), and were less likely to perch (GS1: 0.90 (0.86–0.93); P = 0.001). For some of these behavioral variables, administration of carprofen led to behavioral changes across the GSs, which may suggest that the behavioral expression of the broilers was limited by pain. These findings are of relevance to animal welfare, but the underlying causes are still not fully clarified.

Impacts of Probiotic feeding on Behavior and Welfare related parameters of Heat Stressed Broilers

This study was performed to detect the efficacy of probiotic (PROBAC plus) as anti-stress on behavior and welfare of heat-stressed broilers (32-35oc) from age 22d to 42d. One-hundred twenty chick were divided into 4 groups. The first group was control (basal diet), second was broilers reared at high temperature (basal diet), third was broilers reared at high temperature (basal diet + Probiotic) and fourth was probiotic group (basal diet + probiotic). Behavioral patterns of broilers were recorded from week 4 till the end of the experiment. At last day of experiment, 10 birds from each group were slaughtered to collect blood samples. Blood films were stained for measuring heterophils / lymphocytes (H / L) ratio. Serum cortisol was measured. The results showed that feeding, comfort behaviors, and movement activities of heat-stressed broilers were decreased while the drinking frequency was increased. Heat-stressed birds showed higher H / L ratio and cortisol concentration. Addition of probiotic either to diets of birds reared with or without stress improved some behaviors of birds and decreased H / L ratio and cortisol hormone. These results suggest that feeding of probiotic can be a useful tool to counteract the adverse effects of heat stress in broiler industry.

Эффективность использования компьютерных технологий для дистанционной работы педагога-психолога

Researched is the problem of the use of computer technologies in the activities of a teacher-psychologist in remote interaction with students with the aim of formation of effective learning process. The relevance of the issue lies in the complexity of the current social, economic and geopolitical situation, which ambiguously affects the educational process and the work of teachers in the current conditions. By creating specialized constructs using computer technologies, a teacher-psychologist can work much more widely and with the greatest coverage with those subjects of the educational process who are interested in this or for whom psychological support is an important element of normal life, stabilizing their psychological state and comfortable behavior in society. The research is aimed at studying the experience of teachers-psychologists in regional universities who present specialized computer programs for remote testing of students and teachers (students and faculty), as well as evaluating these constructs and developing recommendations for diversifying solutions in adapting such tests to real University practice in order to increase their effectiveness. In conclusion, we developed a construct for evaluating the effectiveness of remote work of a teacher-psychologist in higher education when analyzing psychological problems of university audience.

The Effect of the Type of Non-Caged Housing System, Genotype and Age on the Behaviour of Laying Hens.

Simple SummaryFor several years, a constant decreasing trend has been observed in the number of hens housed in the cage system in favour of non-caged systems, i.e., deep-litter, free-range and organic systems. This study investigated the welfare of laying hens in different non-caged housing systems, namely a deep-litter barn system, a free-range system and an organic system. The study was conducted on hens of a native breed Green-legged Partridge (Z-11) and Hy-Line Brown hybrids. Dustbathing, scratching, wing-leg stretching, wing flapping and preening were recorded as comfort behaviours. Pecking, fighting, threatening and chasing were recorded as agonistic behaviours. The native breed of hen chose to use the outdoor area more often than the commercial breed of hen, which may be a result of better adaptation to the local environmental conditions. The type of non-caged egg production system influenced the percentage of hens displaying comfort and agonistic behaviours in these laying hens. A greater proportion of comfort behaviours were observed in the free-range system and organic system compared with the deep-litter system, which may indicate a higher level of behavioural welfare of laying hens in these systems.This study investigated the welfare of laying hens in different non-caged housing systems, namely a deep-litter barn system (BS), a free-range system (FRS) and an organic system (OS). The study was conducted on 270 hens of a native breed Green-legged Partridge (Z-11) and 270 Hy-Line Brown hybrids. Visual scans were performed to record behaviour of hens. Hens were housed in groups of 30 and observed over the course of one day at 20, 36 and 56 weeks of age. Dustbathing, scratching, wing stretching, wing flapping and preening were recorded as comfort behaviours. Pecking, fighting, threatening and chasing were recorded as agonistic behaviours. The percentage of run use was higher in native hens than in commercial hens (p < 0.05). The proportion of hens exhibiting comfort behaviours housed in the FRS and OS was similar but over twice as high as in the BS (p < 0.05). In the FRS and OS, the percentage of hens displaying comfort behaviours increased with age (p < 0.05). In all the production systems, the percentage of birds displaying comfort behaviours was higher in native breed hens than in commercial breeds (p < 0.05). In the BS, the higher proportion of hens displaying an agonistic behaviour was seen more in commercial breed than in the native breed hens (p < 0.05). The percentage of birds displaying an agonistic behaviour declined with hen age, both in commercial and native breed hens.

Grado de disconfort del paciente crítico pediátrico y correlación con variables sociodemográficas y clínicas, analgosedación y síndrome de abstinencia. Estudio multicéntrico COSAIP (Fase 2)

IntroductionThere are clinical and sociodemographic factors that have an impact on the comfort of the critically ill paediatric patient. The main aim of this study was to determine the level of discomfort of paediatric patients admitted to different national hospitals, and to analyse its correlation with sociodemographic and clinical variables, analgosedation, and withdrawal syndrome. MethodsAn observational, analytical, cross-sectional, and multicentre study was conducted in five Spanish hospitals. The level of analgosedation was assessed once per shift over a 24h period, using a BIS sensor, and pain with scales adapted to paediatric age population. The intensity of withdrawal syndrome was determined using the Withdrawal Assessment Tool (WAT-1) scale once per shift for 3 days. Discomfort level was simultaneous assessed using COMFORT Behaviour Scale-Spanish version (CBS-S). ResultsA total of 261 critically ill paediatric patients with median age of 1.61 years (IQR=0.35-6.55) were included. An overall discomfort score of 10.79±3.7 was observed during morning compared to 10.31±3.3 observed during the night. When comparing analgosedation and non-analgosedation groups, statistically differences were found in both shifts (χ2: 45.48; P=.001). At the same time, an association was observed (P<.001) between low discomfort scores and development of withdrawal syndrome development assessed with WAT-1. ConclusionsAs there is a percentage of the studied population with discomfort, specific protocols need to be developed, guided by valuated and clinically tested tools, like the COMFORT Behaviour Scale-Spanish version.

Automated measurement of broiler stretching behaviors under four stocking densities via faster region-based convolutional neural network

Stretching behavior is one of the broiler comfort behaviors that could be used for animal welfare assessment. However, there is currently no methodology for automatic monitoring of stretching behavior under representative production practices. The objectives of this study were to (1) develop a faster region-based convolutional neural network (faster R-CNN) stretching behavior detector for broiler stretching behavior detection, (2) evaluate broiler stretching behaviors under stocking densities (SDs) of 27 (27SD), 29 (29SD), 33 (33SD), and 39 kg/m2 (39SD) and at weeks 4 and 5 of bird ages, and (3) examine the temporal and spatial distribution of broiler stretching behaviors. The results show that the precision, recall, specificity, and accuracy were over 86% on broiler stretching detection across all SDs and bird ages using the faster R-CNN stretching behavior detector. Broilers spent 230–533 sec stretching every day and showed more stretching behaviors under the 29SD, 33SD, and 39SD in week 4 and under the 29SD and 33SD in week 5, as compared to other SDs. They performed less stretching in a couple of hours after light ON and before light OFF but preferred to stretch in areas with less traffic and disturbance, that is, along the fences and away from the inspection aisle. It is concluded that the stretching behavior detector had acceptable performance in detecting broiler stretching, thus being a useful tool for broiler stretching detection. Broiler stretching behavior is affected by SD and bird age and shows temporal and spatial variations.

In-situ phosphine oxide physical networks: A facile strategy to achieve durable flame retardant and antimicrobial treatments of cellulose

• Cotton cellulose was modified via in situ phosphine oxide macromolecules. • Phosphorus monomer was crosslinked with amine via Michael addition reaction. • Excellent flame retardancy and durability to 50 laundry cycles was achieved. • Hydrophilicity and comfort properties of the treated fabrics were enhanced. • Antimicrobial property was achieved via in situ silver nano particle treatment. A facile methodology to durably modify cellulose fibers by forming in-situ phosphine oxide macromolecular physical networks is developed in this work. Such networks were formed by treating the cellulose fibers with a mixture of Michael adducts [trivinyl phosphine oxide (TVPO) and cyclic amines (piperazine and 2,4,6-tri(piperazine-1-yl)-1,3,5-triazine)] followed by a click crosslinking reaction initiated by dry heat, microwave, or steaming process. The in-situ phosphine oxide network is integrated within the cellulose fibers to produce a durable treatment against laundering. NMR and SEM analysis of the treated fibers verified the in-situ formation of phosphine oxide macromolecules in the bulk of cellulose fiber. The treatment was homogenous and achieved an outstanding phosphorus (P) retention (>95%) after even 50 laundry cycles. The treated cotton exhibited excellent fire retardant properties with a limiting oxygen index value >27% and passed the Swiss vertical flammability test at 2 wt% P. Analysis of evolved gasses during thermal decomposition of treated cellulose supported both the condensed and gas phases mechanism. The flame retardant treatment was further adapted to include antimicrobial properties by in-situ formation of silver nanoparticles within the cellulose fibers using a single-step process to demonstrate the versatility of this novel treatment methodology. The treated fabric exhibited excellent antimicrobial as well as flame retardant properties and was also durable to 50 laundry cycles. Contact angle measurements and moisture management test confirmed the excellent comfort behavior of the treated cellulose fabric.

Massage for Combat Injuries in Veteran with Undisclosed PTSD: a Retrospective Case Report

Introduction: Massage has shown promise in reducing symptoms related to dissociation and anxiety that can exacerbate chronic pain and suffering. The combat wounded, veteran population is increasing and requires a multidisciplinary approach for comprehensive treatment. This case study examines massage therapy use to improve veteran combat injury rehabilitation and recovery experience through purposive, retrospective, and comprehensive SOAP note review. Methods: A 31-year-old White male received seven, 60-min, full body massages for combat related shoulder injury complications incurred approximately six years before presentation. The right shoulder sustained a broken humeral head and complete dislocation during a defensive maneuver in a life-threatening attack. This case study utilized data from three different assessments: goniometric measurements for shoulder range of motion, observation and documentation for environmental comfort behaviors, and client self-report for treatment goal attainment. Six weekly, full body, 60-min massages were completed sequentially. A follow-up 60-min treatment was completed at Week 8. Treatment to the injured area included focused trigger point therapy, myofascial release, and proprioceptive neuromuscular facilitation to the neck, shoulder, and chest. Results: Total percent change for active flexion, extension, abduction, adduction, internal rotation, and external rotation were 12.5, 150, 40, 167, 14.3, and 0%, respectively. Total percent change for passive flexion, extension, abduction, adduction, internal rotation, and external rotation were 63.6, 350, 66.7, 450, 133, and 77.8%, respectively. Environmental comfort behaviors were reduced. Client treatment goals were attained. Conclusions: Massage therapy provided meaningful benefit to a combat injury for a veteran with PTSD.

Intensive Care Unit Safety Management Procedures in Computed Tomography Examination of Tracheal Intubation Patients

Objective: To explore the application effect and nursing strategy of comprehensive safety management process in CT examination of ICU patients with tracheal incubation and general tuberculosis. Methods: A total of 52 patients with tracheal incubation and general pulmonary tuberculosis who underwent CT examination in our hospital were selected as the research objects, and they were divided into control group and observation group according to the random number table method, with 26 cases in each group. The control group adopted the traditional nursing mode, and the observation group applied the integrated safety management process based on the control group. The general conditions, nursing satisfaction, comfort, compliance behavior, and anxiety scores of the two groups during the CT examination were compared. Results: The change rate of CT vital signs in the observation group (19.23%) was significantly lower than that in the control group (46.15%), and the scan completion rate (100.00%) was significantly higher than that in the control group (84.62%). The satisfaction score and comfort score of the observation group after inspection were significantly higher than those of the control group, and the differences were statistically significant (P &lt; 0.05). There was no significant difference in the anxiety scores between the two groups of patients before the examination (P &gt; 0.05); the anxiety scores of the two groups after the examination were significantly lower than those before the examination; the anxiety score of the observation group after the examination was significantly lower than that of the control group. There was statistical significance (P &lt; 0.05). The Grade 1 coordination rate in the observation group (69.23%) was significantly higher than that in the control group (57.65%), and the difference was statistically significant (P &lt; 0.05). Conclusions: The combined application of comprehensive safety management procedures in CT examination of ICU tracheal intubation patients can effectively improve the patient's nursing satisfaction, comfort, safety and compliance behavior, and improve patient anxiety, which is worthy of clinical promotion and application.

Transcultural adaptation and characteristics of the Spanish version of the COMFORT Behavior Scale in pediatric critical care patients.

To determine the measurement properties of the Spanish version of the COMFORT Behavior Scale developed by van Dijk et al. (2000) in pediatric critical care patients. Prospective observational and psychometric study. Level III Intensive Care Area at a university's children hospital. A total of 311 children with median age of 5.07 years (IQR = 0.9-11.7). None. To determine the measurement properties the Spanish version of the COMFORT Behavior Scale was simultaneous administered by 2nurses to 311 patients admitted to an eighteen-bed critical care unit of a third level pediatric hospital. The Spanish version of the COMFORT Behavior Scale obtained a Cronbach alpha coefficient of 0.715 and it is a tool made up of 3factors with 2items: 1) alertness and physical movement; 2) calmness/agitation and respiratory response/crying, and 3) muscle tone and facial tension. The COMFORT B was adapted to Spanish and it has shown to be a valid an reliable tool to assess comfort in a group of children admitted to an Spanish Intensive Care Unit.

Behavioural patterns of free roaming wild boar in a spatiotemporal context.

Although the almost worldwide distributed wild boar Sus scrofa is a well-studied species, little is known about the behaviour of autochthonous, free living wild boar in a spatiotemporal context which can help to better understand wild boar in conflict terms with humans and to find solutions. The use of camera traps is a favourable and non-invasive method to study them. To observe natural behaviour, 60 camera traps were placed for three months in a state forest of 17.8 km2 in the region of the Luneburg Heath in northern Germany. In this area wild boar, roe deer, red deer, wolves and humans are common. The cameras recorded 20 s length video clips when animals passed the detection zone and could be triggered again immediately afterwards. In total 38 distinct behavioural elements were observed, which were assigned to one of seven behavioural categories. The occurrence of the behavioural categories per day was evaluated to compare their frequencies and see which are more essential than others. Generalised Additive Models were used to analyse the occurrence of each behaviour in relation to habitat and activity time. The results show that essential behavioural categories like foraging behaviour, locomotion and vigilance behaviour occurred more frequently than behaviour that “just” served for the well-being of wild boar. These three behavioural categories could be observed together mostly in the night in broad-leaved forests with a herb layer of 50–100%, comfort behaviour occurred mostly at the ponds in coniferous forest. It is also observable that the behavioural categories foraging and comfort behaviour alternated several times during the night which offers the hypothesis that foraging is mostly followed by comfort behaviour. These findings pave the way towards implementing effective control strategies in the wild and animal welfare in captivity.

Effects of Phenolic-Rich Onion (Allium cepa L.) Extract on the Growth Performance, Behavior, Intestinal Histology, Amino Acid Digestibility, Antioxidant Activity, and the Immune Status of Broiler Chickens.

The effect of phenolic-rich onion extract (PROE), as a feed additive, was evaluated on the growth, carcass traits, behavior, welfare, intestinal histology, amino acid ileal digestibility “AID%,” and the immune status of broiler chicks for 35 days. A total number of 400, 1-day-old broiler chicks (45.38 g ± 1.35) were allocated to four different treatments with 10 replicates each (100 chicks/treatment) consisting of: T1, basal diet without additives (control treatment) (PROE0); T2, basal diet + phenolic-rich onion extract (1 g/kg diet) (PROE1); T3, basal diet + phenolic-rich onion extract (2 g/kg diet) (PROE2); and T4, basal diet + phenolic-rich onion extract (3 g/kg diet) (PROE3). An increase in the final body weight “FBW,” bodyweight gain “BWG,” and feed consumption was observed (P < 0.05) at different PROE levels. Also, the thymus and bursa percentages were increased in the PROE2 and PROE3 treatments (P < 0.05). The chicks fed on PROE supplemented diets had increased frequency of feeding and drinking and showed comfortable behavior (P < 0.05) with lesser aggression (P < 0.05). Additionally, an increase was observed in the antioxidant enzyme activity, phagocytic %, phagocytic index, and serum lysozyme activity in PROE supplemented treatments, with the best outcome reported in the PROE3 treatment (P < 0.01). IgM was increased in the birds fed with PROE2 and PROE3 diets (P < 0.01). PROE supplementation increased the AID% of lysine and methionine (P <0.01), PROE3 treatment increased the AID% of threonine (P < 0.05), and PROE2 and PROE3 treatments increased the AID% of leucine and isoleucine (P < 0.05). Besides, PROE2, and PROE3 treatments increased the villus height and width, mucosal thickness, and goblet cell count from the duodena, jejuna, and ilea (P < 0.05) compared to control treatment. Based on these results, we concluded that the dietary addition of phenolic-rich onion extracts can improve the growth rate of broiler chicken by improving the AID% of amino acids and intestinal histology. Also, it can improve the welfare, antioxidant enzymes activity, and immune status of the birds. Phenolic-rich onion extracts can be used as a natural growth promoter in the poultry feed for good health and improved performance.

Transcultural adaptation and characteristics of the Spanish version of the COMFORT Behavior Scale in pediatric critical care patients

ObjectivesTo determine the measurement properties of the Spanish version of the COMFORT Behavior Scale developed by van Dijk et al (2000) in paediatric critical care patients. DesignProspective observational and psychometric study. SettingLevel III Intensive Care Area at a university’s children hospital. PatientsA total of 311 children with median age of 5.07 years (IQR = 0.9-11.7). InterventionsNone. Principal variables and resultsTo determine the measurement properties the Spanish version of the COMFORT Behavior Scale was simultaneous administered by two nurses to 311 patients admitted to an eighteen-bed critical care unit of a third level paediatric hospital. The Spanish version of the COMFORT Behavior Scale obtained a Cronbach alpha coefficient of 0.715 and it is a tool made up of three factors with two items in each domain: i) alertness and physical movement; ii) calmness/agitation and respiratory response/crying, and iii) muscle tone and facial tension. ConclusionsThe COMFORT B was adapted to Spanish and it has shown to be a valid an reliable tool to assess comfort in a group of children admitted to an Spanish Intensive Care Unit.

The effect of Aromatherapy on Pain, Itching, State Anxiety Levels and Respiratory Distress in Children with Burns: A Systematic Review

Background: Search of the literature reveals that there is no published systematic review on the effect of aromatherapy therapy on the pediatric and adolescent burns. For this reason, we conducted a systematic review to inspect the effects of massage therapy on reducing pain, itching, and anxiety levels in children with burns. Materials and Methods: In this systematic review, English databases such as Medline, Scopus, Web of Science, EMBASE and Cochrane Library, no time limitation were conducted from inception until February 2019. Results: Three studies evaluated the effect of aromatherapy in pediatric burn patients Results: In the first study, massage therapy with Johnson's Baby Bedtime Oil decreased significantly all the pain, itching, and anxiety level of adolescents in a burn unit (p < 0.001). In the second study, 284 children were massaged with aromatherapy in a burns ward, no significant difference were observed in terms of comfort behavior scores (p=0.18), or heart rates (p=0.18) among the groups’ oil. The third study was conducted on 71 pediatric burn patients, aromatherapy significantly decreased the pain, itching, and anxiety level (p <0.001). Heart rate showed a significant decrease from 118 to 109 and respiratory rate decreased significantly from 34 to 30, p Conclusion: Inhalation with essential oils can improve the pain, itching, state anxiety, respiration, the child's falling asleep, and the calmness in the pediatric burn patients. This method of treatment can be beneficial and the findings of these studies should be interpreted with caution due to the high heterogeneity between the studies, the small number of studies and small sample sizes.

Validity and Reliability of the Comfort Behavior Scale in Children Undergoing Wound Dressing Replacement in Vietnam

This study translated and culturally adapted the Comfort Behavior Scale (Comfort-B) into Vietnamese using a standard protocol guided by the World Health Organization. The Comfort-B was translated into Vietnamese and then English back-translated by independent translators. These versions were reviewed and assessed by a Vietnamese expert’s panel and an English expert’s panel. Thirty-four nurses of the Nhi Dong 1 Hospital were invited to use the Vietnamese Comfort-B to assess pain while watching five videos recorded before, during and after wound dressing replacement. The eight characteristics of the Vietnamese Comfort-B were assessed by 34 nurses. Fifteen nurses agreed to do the second assessment two weeks from the first assessment. The content validity index was used to assess the relevance and clarity of all items and the whole scale. Agreements between raters were explored using Kappa statistics. Intraclass correlation coefficients (ICC) were used to assess intra-rater and inter-rater reliability. Multi-level linear regression was used to assess changes in the Vietnamese Comfort-B before, during and after wound dressing replacement between two assessments. The Vietnamese Comfort-B was accredited by the Vietnamese expert’s panel. The English-back translated version was approved by the English expert’s panel. The nurses agreed that the Vietnamese Comfort-B can be used in clinical practice and research. Kappas of all items were ≥0.96 indicating excellent agreement between raters. Alpha coefficients of two assessments were ≥0.97 indicating excellent internal consistency. All ICCs ≥ 0.79 indicated good intra-rater and inter-rater reliability. The study suggested that the Vietnamese Comfort-B can be used for future studies assessing children’s pain in the local hospital context.

Thermophysiological comfort properties of woven fabrics produced from hybrid yarns containing copper wires

The aim of this study was to determine the thermophysiological comfort behavior of fabrics based on copper wire that can be used for electro-textile applications. For this purpose, hybrid folding yarns were produced by twisting cotton/polyester yarn with copper wire. These electrically conductive hybrid yarns were then used to produce upholstery fabrics with different weave types as plain, 2/1 twill and sateen weave in three different density levels as tight, medium and loose. Thermophysiological comfort properties such as air permeability, thermal and water vapor properties of the hybrid fabrics were measured. In addition, the heat transfer properties of the fabrics were investigated with thermal camera videos, and porosity values were determined from microscope images. In this way, the main thermophysiological comfort properties of the basic electro-textile structures were revealed. According to the results obtained, it was found that the use of conductive wire in the fabric structure did not negatively affect the thermophysiological comfort properties of the fabrics, and fabric density was a determining parameter in relation to the thermophysiological comfort properties of the fabrics. The obtained results of this study may be used to improve the design of electro-textile structures taking into account the thermophysiological comfort.

Assessment of Procedural Distress in Sedated/Intubated Children Under 3 Years Old Using the Newborn Infant Parasympathetic Evaluation: A Diagnostic Accuracy Pilot Study.

Newborn infant parasympathetic evaluation index is based on heart rate variability and is related to the autonomic response to pain or stress. The Comfort Behavior Scale is used to assess distress intensity in sedated intubated children. The objective of this study was to assess the validity and performance of newborn infant parasympathetic evaluation as a distress indicator during procedural distress. Monocentric, prospective, noninterventional pilot study of diagnostic accuracy between October 1, 2017, and April 30, 2019. PICU in a tertiary care university hospital. Sedated intubated children under 3 years old. We continuously obtained mean newborn infant parasympathetic evaluation and instantaneous newborn infant parasympathetic evaluation scores and compared them to Comfort Behavior scores obtained before (T1 period), during (T2 period), and after (T3 period) care procedures. We obtained 54 measurements from 32 patients. The median age was 4 months (23 d to 31 mo). Between T1 and T2, there was a significant decrease in the instantaneous newborn infant parasympathetic evaluation and mean newborn infant parasympathetic evaluation scores (64 ± 2 to 42 ± 1 [p 0.0001] and 64 ± 1 to 59 ± 1 [p = 0.007], respectively) and a significant increase in the Comfort Behavior scores (from 12 ± 0 to 16 ± 1; p 0.0001). Comfort Behavior scores and instantaneous newborn infant parasympathetic evaluation and mean newborn infant parasympathetic evaluation scores were significantly inversely correlated (r = -0.44, p 0.0001 and r = -0.19, p = 0.01, respectively). With a instantaneous newborn infant parasympathetic evaluation score threshold of 53, the sensitivity, specificity, positive predictive, and negative predictive values to predict a Comfort Behavior Scale up to 17 were 80.0%, 73.5%, 43.8%, and 93.5%, respectively. Instantaneous newborn infant parasympathetic evaluation is valid for assessing distress in sedated/intubated children in the PICU. Further studies are needed to confirm these results and for newborn infant parasympathetic evaluation-based comparisons of sedation-analgesia protocols.

The Effect of Warm Compression Applied before Heel Lance on Pain Level, Comfort Level and Procedure Time in Healthy Term Newborns: A Randomized Clinical Trial

Background & aim: Warm compression is an effective method preferred in relieving pain. It enables procedures to be completed in a shorter time, and with less pain due to increasing blood flow in the area. This study aimed to investigate the effects of warm compress applied before heel lance on the procedure time, level of pain, and comfort level of healthy term newborns. Methods: This randomized controlled clinical was conducted on 80 neonates who were randomly divided into experimental and control groups. The data were collected using demographic questionnaire, observation checklist for procedure, Neonatal Infant Pain Scale (NIPS), and The Comfort Behaviour Scale (TCBS). The experimental group was subjected to local dry mild-warm compression to the heel before the heel lance procedure. The control group received routine heel lance procedure. Body temperature, peak heart rate, and oxygen saturation levels before, during, and after the procedure were recorded in both groups. Data were analyzed in SPSS software (version 16) using the Chi-square test and Mann-Whitney U test. Results: The results of the study showed shorter procedure time in the experimental group compared to the control group (P<0.05). Moreover, the mean NIPS and TCBS total scores were lower in the experimental group compared to control group, and this was found to be statistically significant (P<0.05). Conclusion: It was found that warm compression applied before heel lance decrease the length of the procedure and is effective in decreasing pain and providing comfort in newborns.

Discomfort of the critically ill paediatric patient and correlated variables

IntroductionThe care of critically ill children is usually invasive and aggressive, requiring numerous traumatic procedures that may cause fear, pain, and discomfort. ObjectivesThe aim of this study was to analyse the level of discomfort of patients admitted to the paediatric intensive care unit of a specialist children's hospital and to determine the sociodemographic and clinical variables that influence the degree of discomfort experienced by critically ill paediatric patients. MethodsWe performed a descriptive observational cross-sectional study that included a total of 311 children with a median age of 5.07 y (interquartile range = 0.9–11.7). A team of 10 paediatric critical care nurses assessed the degree of discomfort once for each shift (morning, afternoon, and night) on 2 successive days using the COMFORT Behavior Scale—Spanish version. ResultsIn total, 49.8% (n = 155) of the patients were free of discomfort (score ≤10 points) vs. 50.2% (n = 156) who experienced discomfort. There was a significant negative correlation between discomfort and the length of stay in days (Rho = 0.16; p = 0.02), that is, the longer the stay, the less discomfort the patient felt. The correlation between age and degree of discomfort was found to be both positive and significant (Rho = 0.230, p < 0.001); the greater the age, the greater the discomfort. In comparison of all children who received analgosedation (n = 205), with discomfort levels of 10.77 ± 2.94, with those who did not receive analgosedation (n = 106), with discomfort levels of 11.96 ± 2.80, we did find a statistically significant difference (χ2 = −4.05; p < 0.001). ConclusionsHalf of the patients admitted to the paediatric intensive care unit experienced discomfort. Age and analgosedation were the two most important variables involved with a high degree of discomfort. Clinical care practices must consider these factors and try to plan activities designed to relieve discomfort in all critically ill paediatric patients.

COMFORT Behavior Scale instrument: validity and reliability test for critically ill pediatric patients in Indonesia.

The COMFORT Behavior Scale (CBS) is an instrument that has been validated in several languages to assess the levels of sedation in children. This project was implemented to identify the validity and reliability of CBS. The design used was an analytic descriptive cross-sectional approach. Fifty-one children aged 1 month to 18 years who received analgesic and/or sedation therapy were purposively selected and assessed for their sedation levels using CBS and the Nurse Interpretation of Sedation Score (NISS). The data were analyzed using the Mann-Whitney U test to measure the concurrent validity; each item was analyzed using Pearson correlation; inter-rater reliability was measured by the Kappa coefficient; and the internal consistency was measured by Cronbach’s alpha. The results showed there was no significant correlation between the levels of sedation assessed using CBS and NISS (P= 0.118; α= 0.05). Six items in the CBS instrument were found to be valid (r= 0.348–0.813). The Cronbach’s alpha for CBS was 0.873. Thus, the Indonesian version of CBS is valid and reliable in assessing sedation levels in children.