Stressful Procedures Research Articles

Leukocyte Coping Capacity: An Integrative Parameter for Wildlife Welfare Within Conservation Interventions.

Wildlife management, conservation interventions and wildlife research programs often involve capture, manipulation and transport of wild animals. Widespread empirical evidence across various vertebrate taxa shows that handling wildlife generally induces a severe stress response resulting in increased stress levels. The inability of individuals to appropriately respond to rapidly changing environmental conditions during and after manipulations may have deleterious and long-lasting implications on animal welfare. Therefore, mitigating stress responses in the frame of conservation interventions is a key animal welfare factor. However, we have a poor understanding of the metrics to adequately assess and monitor the dynamic physiological changes that animals undergo when subjected to stressful procedures in wild or captive conditions. A growing number of studies provide good evidence for reciprocal interactions between immune processes and stress. Here, we review the existing literature on a relatively new technique—Leukocyte Coping Capacity (LCC), a proxy for stress quantifying oxygen radical production by leukocytes. We discuss the strength and weaknesses of this immunological approach to evaluate stress, the individual capacity to cope with stress and the resulting potential implications for animal welfare. Additionally we present new data on LCC in captive roe deer (Capreolus capreolus) under long-time anesthesia and free-ranging Asiatic wild asses (Kulan; Equus hemionus kulan) were LCC was used to assess stress levels in animals captured for a reintroduction project.

Pain, Parental Involvement, and Oxytocin in the Neonatal Intensive Care Unit.

Preterm infants (PTI) typically experience many painful and stressful procedures or events during their first weeks of life in a neonatal intensive care unit, and these can profoundly impact subsequent brain development and function. Several protective interventions during this sensitive period stimulate the oxytocin system, reduce pain and stress, and improve brain development. This review provides an overview of the environmental risk factors experienced by PTI during hospitalization, with a focus on the effects of pain, and early maternal separation. We also describe the long-term adverse effects of the simultaneous experiences of pain and maternal separation, and the potential beneficial effects of maternal vocalizations, parental contact, and several related processes, which appear to be mediated by the oxytocin system.

Clinical Ultrasound in Inflammatory Bowel Disease.

Ultrasound should be the first-line imaging method in the medical care of patients with inflammatory bowel disease. It can be used to differentiate between Crohn's disease and ulcerative colitis and to detect numerous complications like stenoses, fistulas, and abscesses. As the method is also highly suitable for follow-up, stressful endoscopic procedures and examinations involving radiation are less necessary. Comparison studies with MRI and CT show that ultrasound is not an inferior method and it is therefore included in all guidelines. Intensifying physician training in this method will help to ensure its comprehensive use.

Effects of commercial hatchery processing on short- and long-term stress responses in laying hens

In commercial egg production, chicks are exposed to a potentially stressful procedure during their first day of life. Here, we investigated how this procedure affects the chickens in a short- as well as long-term perspective by conducting two behaviour tests and measuring corticosterone (CORT) and sex hormone levels at different time points. These results were compared with a group of control chickens from the same hatchery and incubator that did not go through the commercial hatchery routine. Chickens were continuously weighed, egg production data was collected and feather scoring was performed. We found that chicks have a significant increase in CORT during the hatchery process, which implies they are exposed to stress. During first weeks of life, these chicks were more fearful, had a higher CORT reactivity during restraint and weighed more than control chicks. Later in life, hatchery treated chickens had more feather damages and injuries on combs and wattles, a faster onset of egg laying and higher levels of estradiol. We conclude that processing at the commercial hatchery was a stressful event with short- and long-term effects on behaviour and stress reactivity, and potentially also positive effects on production. The results are relevant for a large number of individuals, since the chicken is by far the globally most common farm animal.

Burrowing and nest building activity in mice after exposure to grid floor, isoflurane or ip injections

Burrowing and nest building are examples of highly motivated innate behaviours in rodents. Assessments based on these behaviours can be used as non-invasive indicators of pain, distress and suffering. In this study, we investigated the effect of three stressful procedures, namely grid floor housing for 24 h, 15 min of isoflurane anaesthesia and an intraperitoneal saline injection daily for three days, on nest building and burrowing in female C57BL/6NTac mice. For burrowing, we also investigated the effect of the presence of a shelter and nesting material (standard home cage enrichment) versus no shelter and nesting material, and whether the test can be performed during normal working hours. Alongside this, we investigated the effect of grid floor, isoflurane anaesthesia and intraperitoneal injections on stress hormone level, body weight, fur status and sucrose preference. The burrowing test was found to be sensitive to 24 h grid floor housing when no shelter but only a cardboard tube was present during testing. The mice burrowed a mean of 21 g less after grid floor housing (P < .01). This change was accompanied by decreased sucrose preference (P < .01) and body weight (P < .01). 15 min of anaesthesia with isoflurane induced changes in the nest building activity test. After exposure to isoflurane the mice built less complex nests (P = .04). This was accompanied by a decrease in sucrose preference (P < .01), a decrease in body weight (P < .01), and elevated stress hormone levels (P < .01). One daily intraperitoneal injection of saline for three days did not result in changes in nest building activity (P > .01). We also found that the mice burrowed equal amount during normal working hours and prior to the dark phase, indicating that the burrowing test can be performed during normal working hours instead of prior to the dark phase (P = .62).

Flaws in design, execution and interpretation limit CLARITY-BPA's value for risk assessments of bisphenol A.

The Consortium Linking Academic and Regulatory Insights on BPA Toxicity (CLARITY-BPA) involved the Food and Drug Administration, the National Toxicology Program and 14 academic investigators funded by the National Institute of Environmental Health Sciences. Two key questions to be answered by CLARITY-BPA were as follows: (1) Would the academic investigator studies show effects at low doses of bisphenol A (BPA) while the core guideline study conducted by the FDA only showed toxic effects at high doses? (2) Would the academic investigators be able to replicate their numerous prior studies with animals raised and treated in the FDA's toxicology centre? Several flaws in the design and execution of CLARITY-BPA biased the experiment towards not finding significant results (Type 2 error): (1) use of the oestrogen-insensitive NCTR CD-SD rat, (2) use of a stressful daily gavage BPA administration procedure throughout life, (3) lack of inclusion of non-gavaged negative controls and (4) lack of a comprehensive examination of animals for BPA contamination. In spite of these flaws, in some of the experiments conducted by CLARITY-BPA academic investigators, and also in the FDA's core study, there were significant low-dose effects, but these were ignored by the FDA. Thus, immediately after releasing the results from their core portion of CLARITY-BPA, the FDA issued a statement concluding BPA was "safe," and they ignored non-monotonic dose-response relationships. The FDA should not base its BPA risk assessment only on outdated guideline studies, but instead on the vast (~8000) number of publications documenting the similar health hazards BPA poses to animals and humans.

Projecting the economic impact of silver diamine fluoride on caries treatment expenditures and outcomes in young U.S. children.

To quantify the economic impact of using silver diamine fluoride (SDF) to arrest the progression of dental caries in Medicaid-enrolled children (aged 1-5 years) relative to the standard restorative treatment from the Medicaid programs' perspective. We used Monte Carlo simulation to estimate averted restorative visits and associated expenditures for varying SDF effectiveness and intervention penetration levels. We compared the current standard of care for treating caries to applying SDF. We estimated expenditures from the 2010-2012 Medicaid Analytic Extract files for seven US states and the incremental cost effectiveness ratio for SDF application on averted restorative visits. Across the seven states, averted restorative visits ranged from 2,049 (Vermont) to 60,542 (North Carolina), assuming an SDF penetration level of 50%. Averted per-restorative visit costs ranged from $100 to $350 per-visit. There were higher averted per-restorative visit costs in nonmetropolitan counties than metropolitan counties. Providing SDF as a caries management strategy can reduce Medicaid program dental care expenditures by averting expensive caries treatment options. It could also prevent stressful restorative procedures. State Medicaid programs should consider reimbursing for SDF to arrest the progression of dental caries in young children.

Fecal microbiota changes associated with dehorning and castration stress primarily affects light-weight dairy calves.

Gastrointestinal tract (GIT) microbiota and stress can impact animal health. Studies have shown that perturbations in the GIT microbiota can influence host health and productivity by affecting physiological homeostasis, metabolism, hematopoiesis and inflammation. The present study aimed to evaluate possible effects of dehorning and castration stress on the GIT microbiota of dairy calves. Dehorning and castration are routinely performed on over 90% of dairy farms, and analgesics like flunixin meglumine (FLU) are given at the time of these procedures to reduce pain. We analyzed fecal microbiota of 24 weaned male dairy calves at two different stages in their life (at 10 weeks for dehorning and 36 weeks age for castration) to determine any GIT microbiota changes due to these stressful procedures and the FLU treatment. Dehorning was performed using an electrocautery dehorner applied to the horn for 10 seconds, and surgical castration was used as the castration method. Our analysis showed that the Shannon diversity index was significantly higher in animals that were not dehorned compared to dehorned animals. Castration stress also resulted in a significant decrease in Shannon diversity index, which was more pronounced in lower weight calves. Body weight and stress had significant effects on the taxonomic profiles of the GIT microbiota. There was a significant difference in the GIT bacterial community structure between heavy- and light-weight calves at Day 3 after castration but not at Day 0 (prior to castration). Our results indicate that dehorning and castration stress reduced microbial diversity of the GIT microbiota, but only in light-weight calves. This work is important for elucidating biological effects of stress on dairy calves and identifying potential modulation points in the microbiota of these food-producing animals to improve animal health and production.

Low-dose Oral Ketamine as a Procedural Analgesia in Pediatric Cancer Patients Undergoing Bone Marrow Aspirations at a Resource-limited Cancer Hospital in India.

Aim:Many pediatric cancer patients undergo repeated bone marrow aspirations (BMAs) for diagnostic and treatment evaluation purposes. Full anesthesia is the standard of care during this procedure in high-income countries. At hospitals with low resources in low/middle-income countries many children undergo these painful procedures without sufficient pain relief. This study aimed to evaluate the usefulness of low-dose oral ketamine as a procedural analgesic in a low-resource pediatric cancer care department.Materials and Methods:Pediatric patients, 4–15 years of age, who underwent BMAs between September 31 and November 30, 2018, were invited to participate. The study was designed as a placebo-controlled, single-blinded trial with three trial groups. Group K received 1.0 mg/kg of ketamine and Group KM received 1.0 mg/kg ketamine with an addition of 0.2 mg/kg midazolam, mixed in juice 30 min before procedures. Group P received placebo consisting of plain juice. All three groups also received the hospital's current standard treatment for procedural pain in BMAs. Patients and caregivers assessed the procedural pain, as did the performing doctors. For the patients, Faces Pain Scale – Revised was used and the Numeric Rating Scale-11 for caregivers and doctors.Results:A total of 87 patients were included in the study distributed with 29 in Group K, 29 in Group KM, and 29 in Group P. Seven patients were excluded, one patient denied participation and the remaining did not meet the inclusion criteria. There was no significant difference between the pain reported by the groups. A total of 69% patients in Group KM and 35% in Group K had somnolence reported as a side effect compared to 14% in Group P.Conclusion:We found no significant effects on the procedural pain in any of the treatment groups compared to placebo. There were only mild side effects. The doses of ketamine might be insufficient for this painful and stressful procedure.

Effect of music therapy on anxiety levels on patient undergoing dental extractions.

Background and Aims:Dental anxiety has been found to be a significant problem faced by patients undergoing extractions. Anxious patients tend to avoid dental care ultimately leading to complications. Treatment of anxious patients can be very challenging to the dentists, prolonging the treatment duration. There has been various methods to reduce anxiety of which non pharmacological ways include music and aroma therapy. Music has been known to reduce fear, stress and is a form of meditation and relaxation. Hence effect of music on the reduction of anxiety levels for patients undergoing extractions were assessed. The aim of this study is to assess the effect of music therapy on dental anxiety levels of patients undergoing extractions.Methods:50 patients visiting the outpatient department of Saveetha Dental College for dental extractions were randomly selected and allocated to Test group and Control group. The test group (N = 25) were subjected to music during extractions and Control (N = 25) were not exposed. Dental anxiety levels and hemodynamic changes namely systolic pressure, diastolic pressure and heart rate were assessed before and after extraction. The data was collected and analyzed using SPSS software with Paired t Test.Results:The study showed that the control population had elevated hemodynamic changes with regard to systolic, diastolic blood pressure and heart rate, of which the diastolic pressure rise was significant. In the test population, there was fall in the hemodynamic changes with respect to systolic diastolic blood pressure and heart rate, all of which were statistically significant. This was evident in the modified dental anxiety scale as well.Conclusion:Music seems to be a psychological and spiritual way to calm oneself down. Hence music therapy can be used as an anxiolytic agent for stressful dental procedures.

Pharmacological and nonpharmacological measures of pain management and treatment among neonates.

ObjectiveThis study sought to describe and quantify the pharmacological and nonpharmacological strategies used to relieve the pain/stress of neonates during hospitalization in neonatal intensive care units.MethodsThis quantitative, longitudinal, and descriptive study examined 50 neonates from neonatal intensive care unit admission to discharge.ResultsA total of 9,948 painful/stressful procedures were recorded (mean = 11.25 ± 6.3) per day per neonate. A total of 11,722 pain-management and relief interventions were performed, of which 11,495 (98.1%) were nonpharmacological strategies, and 227 (1.9%) were pharmacological interventions. On average, each neonate received 235 pain-management and treatment interventions during hospitalization, 13 nonpharmacological interventions per day, and one pharmacological intervention every 2 days.ConclusionNeonates receive few specific measures for pain relief given the high number of painful and stressful procedures performed during hospitalization. Thus, it is essential to implement effective pain-relief protocols.

Reducing toxic stress in the neonatal intensive care unit to improve infant outcomes

In 2011, the American Academy of Pediatrics (AAP) published a technical report on the lifelong effects of early toxic stress on human development, and included a new framework for promoting pediatric health: the Ecobiodevelopmental Framework for Early Childhood Policies and Programs. We believe that hospitalization is a specific form of toxic stress for the neonatal patient, and that toxic stress must be addressed by the nursing profession in order to substantially improve outcomes for the critically ill neonate. Approximately 4% of normal birthweight newborns and 85% of low birthweight newborns are hospitalized each year in the highly technological neonatal intensive care unit (NICU). Neonates are exposed to roughly 70 stressful procedures a day during hospitalization, which can permanently and negatively alter the infant's developing brain. Neurologic deficits can be partly attributed to the frequent, toxic, and cumulative exposure to stressors during NICU hospitalization. However, the AAP report does not provide specific action steps necessary to address toxic stress in the NICU and realize the new vision for pediatric health care outlined therein. Therefore, this paper applies the concepts and vision laid out in the AAP report to the care of the hospitalized neonate and provides action steps for true transformative change in neonatal intensive care. We review how the environment of the NICU is a significant source of toxic stress for hospitalized infants. We provide recommendations for caregiving practices that could significantly buffer the toxic stress experienced by hospitalized infants. We also identify areas of research inquiry that are needed to address gaps in nursing knowledge and to propel nursing science forward. Finally, we advocate for several public policies that are not fully addressed in the AAP technical report, but are vital to the health and development of all newborns.

What's in a fragrance? Scenting healthcare environments

When people imagine the scent of a clinic, they might think of disinfectant and alcohol—sterile smells that many people associate with bad memories or stressful procedures. But this doesn't have to be the case. In this article, Prettpal Somel discusses how utilising the power of fragrance in your clinic could help to make your patients feel more relaxed, making the whole experience more enjoyable

Chronic Sleep Deprivation in Mouse Pups by Means of Gentle Handling.

Sleep is critical for proper development and neural plasticity. Moreover, abnormal sleep patterns are characteristic of many neurodevelopmental disorders. Studying how chronic sleep restriction during development can affect adult behavior may add to our understanding of the emergence of behavioral symptoms of neurodevelopmental disorders. While there are many methods that can be used to restrict sleep in rodents including forced locomotion, constant disruption, presentation of an aversive stimulus, or electric shock, many of these methods are very stressful and cannot be used in neonatal mice. Here, we describe gentle handling, a sleep deprivation technique that can be used chronically throughout development and into adulthood to achieve sleep restriction. Gentle handling involves close observation of the mice throughout the sleep deprivation period and requires the researcher to gently prod the animals whenever they are inactive or display behaviors associated with sleep. Coupled with EEG recordings, gentle handling could be used to selectively disrupt a specific phase of sleep such as rapid eye movement (REM) sleep. The technique of gentle handling is a powerful tool for the study of the effects of chronic sleep restriction even in neonatal mice that circumvents many of the more stressful procedures used for sleep deprivation.

Apulo-Calabrese and Crossbreed Pigs Show Different Physiological Response and Meat Quality Traits after Short Distance Transport.

Simple SummaryTransport is a stressful procedure that can affect adversely the welfare of pigs and pork quality. It is well known that response to the journey is influenced by the genetic type. However, very little is known on the response of local breeds to the transport procedures despite the increasing interest in the welfare of animals during transport. The objective of this study was to investigate the effect of short distance transport on behaviour, blood parameters and meat quality traits of Apulo-Calabrese (local Italian pig breed) and crossbreed [Duroc × (Landrace × Large White)] pigs. Statistical analyses were done using univariate and multivariate approaches. Both approaches showed that glucose, albumin/globulin, urea, and aspartate aminotransferase concentrations were influenced by the genetic type. Despite at loading Apulo-Calabrese pigs were less reluctant to move and showed a lower vocalization, physiological response to the short distance transport was more intense in this breed when compared with crossbreeds. With regards to meat quality, higher a* and lower L* coordinates were found in Apulo-Calabrese which indicates darker and more reddish meat than crossbreeds. The results from this study may provide insight into the response of local breeds to the transport procedures.Despite the increasing interest in the welfare of animals during transport, very little is known on the response of local pig breeds to the transport procedures. This study aims to compare the effect of short journey on behaviour, blood parameters, and meat quality traits in 51 Apulo-Calabrese and 52 crossbreed [Duroc × (Landrace × Large White)] pigs. All the animals were blood sampled five days before delivery (basal condition) and at exsanguination for the analysis of creatine kinase, cortisol, glucose, lactate, albumin, albumin/globulin, total protein, urea, creatinine, aspartate aminotransferase (AST), alanine aminotransferase, alkaline phosphate, sodium, and potassium. Post mortem pH, color, drip loss, cooking loss, and Warner-Bratzler shear force were measured at different times in longissimus thoracis samples. Univariate and multivariate analyses showed that glucose, albumin/globulin, urea, and AST at exsanguination were influenced by the genetic type. Apulo-Calabrese showed the highest increase in blood values of lactate, creatinine, sodium and potassium after the short distance transport. Behavioural occurrences were similar in both genetic types during unloading and lairage. Small differences were observed for meat quality although significantly higher a* and lower L* were found in Apulo-Calabrese pigs, showing meat with a deeper red colour than crossbreeds.

Effect of an audience on trainee stress and performance during simulated neonatal intubation: a randomized crossover trial

BackgroundNeonatal intubation is a stressful procedure taught to trainees. This procedure can attract additional observers. The impact of observers on neonatal intubation performance by trainees has not been studied. Our objective was to evaluate if additional observers present during neonatal mannequin endotracheal intubation (NMEI) by junior trainees, affects their performance and their stress levels.MethodsA randomized cross over trial was conducted. First year residents with no experience in neonatal intubation were assigned to NMEI condition A or B randomly on day 1. Subjects were crossed over to the other condition on day 2.Condition A: Only one audience member was present Condition B: Presence of an audience of 5 health care providers.Differences in the time to successful NMEI was recorded and compared between conditions. A portable heart rate monitor was used to measure peak heart rate above baseline during NMEI under both conditions.ResultsForty nine residents were recruited. 72% were female with a median age of 25 years (IQR: 24–27). Time to successful intubation was comparable under both conditions with a mean difference of − 3.94 s (95% CI: -8.2,0.4). Peak heart rate was significantly lower under condition A (mean difference − 11.9 beats/min, 95% CI -15.98 to − 7.78).ConclusionAlthough the time required to NMEI did not increase, our results suggest that presence of observers significantly increases trainee stress. The addition of extraneous observers during simulation training may better equip residents to deal with such stressors.Trial registrationDate of registration: March 2016, NCT 02726724.

Improving Care in the Pediatric Emergency Department With Virtual Reality

Background: Emergency departments (EDs) are often perceived as scary and have been shown to induce anxiety in children. Some hospitals utilize Certified Child Life Specialists (CCLS), hospital staff trained to meet the psychosocial needs of children, to assist when children show signs of anxiety and/or pain during treatment. The CCLS will distract the child, such as with an iPad; however, the child may still watch the IV start, which could result in a failure of the distraction. Digital distraction, distracting a child with technology during stressful procedures, has shown to reduce pain and anxiety better than medications or no distraction at all. Virtual reality (VR) is one form of digital distraction and is increasingly being used in hospitals, as both vision and hearing are blocked by the headset. Previous research shows that the more senses used in the distraction, the less likely the patient will experience pain and anxiety.

Painful procedures and analgesia in hospitalized newborns: A prospective longitudinal study

ObjectiveTo identify the type and frequency of stressful and painful procedures, the use of pharmacological and non-pharmacological strategies; to identify relationships between demographic and clinical variables with frequency of procedures and pain management. DesignA prospective longitudinal study was conducted in neonatal intensive care units (NICU) of two hospitals in the city of Belo Horizonte, Brazil. 140 newborns admitted to the NICU between June 2014 and January 2015 were included. ResultsA total of 21,291 procedures were documented, 18,131 (85.2%) stressful procedures and 3,160 (14.8%) invasive skin-breaking painful procedures. Each day of hospitalization increased by 10.9 the number of stressful procedures and by 2.2 the number of painful procedures. Furthermore, for each day of hospitalization, non-pharmacological strategies registered increased by 3.4% and pharmacological strategies, increased by 9.3%. ConclusionNeonates underwent a high number of stressful and painful procedures and with infrequent use of pharmacological and non-pharmacological strategies during the entire hospitalization.

Physical medical aspects of early rehabilitation after proximal femoral fractures

Proximal femoral fractures in old age are known as fragility fractures. They are the sequelae of osteoporosis and an expression of a general reduced capacity and an increase in sensory and functional deficits against the background of multimorbidity. They are often caused by reduced compensation strategies. Simultaneously, for many older people they represent alife event. Despite modern osteosynthesis techniques and less stressful anesthesia procedures, the occurrence of a proximal femoral fracture shakes the labile equilibrium of those affected. Proximal femoral fractures are associated with a high risk of mortality. Only some 50% of those affected achieve the pretraumatic functional level again. Therefore, a comprehensive, multiprofessional and interdisciplinary management of these patients is required. The rehabilitation has to start at the time of diagnosis and at the latest after the operation with a comprehensive interdisciplinary management. Pain and complaints during the rehabilitation have to be clarified and targeted, mostly multimodal interventions, must be included.

Serum Cyclosporine Levels: The Influence of the Time Interval Between Interrupting the Infusion and Obtaining the Samples: A Randomized Clinical Trial.

There are controversies regarding the best way to collect blood samples for cyclosporine A (CsA) serum levels when this immunosuppressant is administered continuously through a silicone central venous catheter (CVC) to hematopoietic stem cell transplant recipients. The aim of this study was to verify the effect of the time elapsed between the interruption of a continuous intravenous CsA infusion and the collection of blood samples on CsA serum levels. This randomized 2-group clinical trial involved 32 adults. In group A, blood samples were collected immediately after interrupting the medication from peripheral vein and CVC lines. In group B, the same procedures were performed 5 minutes after interrupting the infusion. We did not observe influence of the time elapsed between interruption of the infusion and collection of the samples, independent of the collection mode and the volume discarded (P > .05). The line used for the infusion maintained a constant high level when compared with different moments of collection (P > .05), whereas in the other lines, there was a significant increase when compared with the levels obtained at 24 hours and 7 days after CsA start (P = .00). The CVC line free from cyclosporine can safely be used to collect blood. The procedure can be performed immediately after interrupting the infusion, and discarding 5 mL is sufficient to obtain accurate levels. The results can help nurses choose how to collect blood samples through the CVC, thus preventing patients from having a painful and stressful procedure such as peripheral venipuncture.