2,927 research outputs found
Pain Level Detection From Facial Image Captured by Smartphone
Accurate symptom of cancer patient in regular basis is highly concern to the medical service provider for clinical decision making such as adjustment of medication. Since patients have limitations to provide self-reported symptoms, we have investigated how mobile phone application can play the vital role to help the patients in this case. We have used facial images captured by smart phone to detect pain level accurately. In this pain detection process, existing algorithms and infrastructure are used for cancer patients to make cost low and user-friendly. The pain management solution is the first mobile-based study as far as we found today. The proposed algorithm has been used to classify faces, which is represented as a weighted combination of Eigenfaces. Here, angular distance, and support vector machines (SVMs) are used for the classification system. In this study, longitudinal data was collected for six months in Bangladesh. Again, cross-sectional pain images were collected from three different countries: Bangladesh, Nepal and the United States. In this study, we found that personalized model for pain assessment performs better for automatic pain assessment. We also got that the training set should contain varying levels of pain in each group: low, medium and high
Individual contextual factors in the validation of the Bernese pain scale for neonates: protocol for a prospective observational study
Background: The Bernese Pain Scale for Neonates (BPSN) is a multidimensional pain assessment tool that is already
widely used in clinical settings in the German speaking areas of Europe. Recent findings indicate that pain
responses in preterm neonates are influenced by individual contextual factors, such as gestational age (GA), gender
and the number of painful procedures experienced. Currently, the BPSN does not consider individual contextual
factors. Therefore, the aim of this study is the validation of the BPSN using a large sample of neonates with
different GAs. Furthermore, the influence of individual contextual factors on the variability in pain reactions across
GA groups will be explored. The results will be used for a modification of the BPSN to account for individual
contextual factors in future clinical pain assessment in neonates.
Methods and design: This prospective multisite validation study with a repeated measures design will take place
in three university hospital neonatal intensive care units (NICUs) in Switzerland (Bern, Basel and Zurich). To examine
the impact of GA on pain responses and their variability, the infants will be stratified into six GA groups ranging
from 24 0/7 to 42 0/7. Among preterm infants, 2–5 routine capillary heel sticks within the first 14 days of life, and
among full-term infants, two heel sticks during the first days of life will be documented. For each heel stick,
measurements will be video recorded for each of three phases: baseline, heel stick, and recovery. The infants’ pain
responses will be rated according to the BPSN by five nurses who are blinded as to the number of each heel stick
and as to the measurement phases. Individual contextual factors of interest will be extracted from patient charts.
Discussion: Understanding and considering the influence of individual contextual factors on pain responses in a
revised version of the BPSN will help the clinical staff to more appropriately assess pain in neonates, particularly
preterm neonates hospitalized in NICUs. Pain assessment is a first step toward appropriate and efficient pain
management, which itself is an important factor in later motor and cognitive development in this vulnerable
patient population.
Trial registration: The study is registered in the database of Clinical Trial gov. Study ID-number: NCT 02749461.
Registration date: 12 April 2016.
Keywords: Pain assessment, Premature infants, Contextual factors, Diagnosti
The consideration of individual contextual factors in neonatal pain assessment : validation and revision of the Bernese Pain Scale for Neonates
Neonates are dependent on a caregiver to discover that they are in pain and to manage it. Numerous pain assessment scales have been developed, but pain assessment is challenging because neonates of different gestational ages (GAs) have widely varied pain responses. Individual contextual factors such as GA or health status may account for this variability in pain response. The aim of the present dissertation was the validation and revision of the Bernese Pain Scale for Neonates (BPSN) by testing its psychometric properties and analyzing the influence of individual contextual factors on the variability in pain response. The BPSN is a pain assessment tool that is widely used in Swiss neonatal intensive care units. In this prospective multisite validation study, 154 neonates between 24 2/7 and 41 4/7 weeks of gestation were videotaped during 1-5 routine capillary heel sticks in their first 14 days of life. For each heel stick, three video sequences were produced: baseline, heel stick, and recovery. Comprehensive psychometric testing was conducted to examine the BPSN’s underlying factor structure, interrater reliability, concurrent and construct validity, sensitivity and specificity. Single and multiple linear mixed effects analyses were used to examine the influence of individual contextual factors on variability in pain response. The results of the psychometric testing indicated a significant reduction of the scale from nine to four items: crying, facial expression, posture and heart rate. This modified BPSN showed promising reliability and validity, especially when the cut-off that discriminates between no or low pain and moderate to severe pain is adjusted to increase with increasing GA. Apart from the GA, baseline behavioral state and ventilation status were the individual contextual factors which the revised BPSN should account for. The BPSN-Revised is a promising tool for acute procedural pain assessment in full-term and preterm neonates with different GAs. Future studies should test its validity, feasibility and clinical utility
Acute Pain Assessment in Prematurely Born Infants Below 29 Weeks A Long Way to Go
Objectives: Neonates born extremely prematurely are at high risk of
acute and prolonged pain. Effective treatment requires reliable pain
assessment, which is currently missing. Our study explored whether
existing pain assessment tools and physiological indicators measure
pain and comfort accurately in this population.
Materials and Methods: We prospectively collected data in 16
neonates born at less than 29 weeks’ gestational age during 3 conditions: skin-to-skin care, rest, and heelstick procedure for capillary
blood sampling in the incubator. The neonates were video recorded
in these situations, and recordings were coded using 5 observational
pain assessment tools and numeric rating scales for pain and distress. We simultaneously collected heart rate, respiratory rate,
arterial oxygen saturation, regional cerebral oxygenation, and the
number of skin conductance peaks. All measures across the 3 conditions were compared using general linear modeling.
Results: The median gestational age was 27.1 weeks (range: 24.1 to
28.7). Forty measurement periods across the 3 conditions were
analyzed. Heart rate was significantly higher during heelstick procedures compared with during rest, with a mean difference of 10.7
beats/min (95% confidence interval [CI]: 2.7-18.6). Oxygen saturation was significantly higher during skin-to-skin care compared
with during heelstick procedures with a mean difference of 5.5%
(95% CI: 0.2-10.8). The Premature Infant Pain Profile-revised
(PIPP-R) score was significantly higher during heelstick procedures
compared with skin-to-skin care with a mean difference of 3.2
points (95% CI: 1.6-5.0).
Discussion: Pain measurement in clinical practice in prematurely
born infants below 29 weeks remains challenging. The included
behavioral and physiological indicators did not adequately distinguish between a painful situation, rest, and skin-to-skin care in
premature neonates
AuE-IPA: An AU Engagement Based Infant Pain Assessment Method
Recent studies have found that pain in infancy has a significant impact on
infant development, including psychological problems, possible brain injury,
and pain sensitivity in adulthood. However, due to the lack of specialists and
the fact that infants are unable to express verbally their experience of pain,
it is difficult to assess infant pain. Most existing infant pain assessment
systems directly apply adult methods to infants ignoring the differences
between infant expressions and adult expressions. Meanwhile, as the study of
facial action coding system continues to advance, the use of action units (AUs)
opens up new possibilities for expression recognition and pain assessment. In
this paper, a novel AuE-IPA method is proposed for assessing infant pain by
leveraging different engagement levels of AUs. First, different engagement
levels of AUs in infant pain are revealed, by analyzing the class activation
map of an end-to-end pain assessment model. The intensities of top-engaged AUs
are then used in a regression model for achieving automatic infant pain
assessment. The model proposed is trained and experimented on YouTube
Immunization dataset, YouTube Blood Test dataset, and iCOPEVid dataset. The
experimental results show that our AuE-IPA method is more applicable to infants
and possesses stronger generalization ability than end-to-end assessment model
and the classic PSPI metric
Multi-Channel Neural Network for Assessing Neonatal Pain from Videos
Neonates do not have the ability to either articulate pain or communicate it
non-verbally by pointing. The current clinical standard for assessing neonatal
pain is intermittent and highly subjective. This discontinuity and subjectivity
can lead to inconsistent assessment, and therefore, inadequate treatment. In
this paper, we propose a multi-channel deep learning framework for assessing
neonatal pain from videos. The proposed framework integrates information from
two pain indicators or channels, namely facial expression and body movement,
using convolutional neural network (CNN). It also integrates temporal
information using a recurrent neural network (LSTM). The experimental results
prove the efficiency and superiority of the proposed temporal and multi-channel
framework as compared to existing similar methods.Comment: Accepted to IEEE SMC 201
How effective is tetracaine 4% gel, before a peripherally inserted central catheter, in reducing procedural pain in infants: a randomized double-blind placebo controlled trial [ISRCTN75884221]
BACKGROUND: Procedural pain relief is sub-optimal in infants, especially small and vulnerable ones. Tetracaine gel 4% (Ametop(®), Smith-Nephew) provides pain relief in children and larger infants, but its efficacy in smaller infants and for peripherally inserted central catheters (PICC) remains uncertain. The objective of this trial was to assess the safety and efficacy of tetracaine gel on the pain response of very low birth weight (VLBW) infants during insertion of a PICC. METHODS: Medically stable infants greater than or equal to 24 weeks gestation, requiring a non-urgent PICC, were included. Following randomization and double blinding, 1.1 g of tetracaine or placebo was applied to the skin for 30 minutes. The PICC was inserted according to a standard protocol. Pain was assessed using the Premature Infant Pain Profile (PIPP). A 3-point change in the pain score was considered clinically significant, leading to a sample size of 54 infants, with 90% statistical power. Local skin reactions and immediate adverse cardiorespiratory events were noted. The primary outcome, PIPP score at 1 minute, was analysed using an independent Student's t-test. RESULTS: Fifty-four infants were included, 27 +/- 2 weeks gestation, 916 +/- 292 grams and 6.5 +/- 3.2 days of age. Baseline characteristics were similar between groups. The mean PIPP score in the first minute was 10.88 in the treatment group as compared to 11.74 in the placebo group (difference 0.86, 95% CI -1.86, 3.58). Median duration of crying in non-intubated infants was 181 seconds in the tetracaine group compared to 68 seconds in the placebo group (difference -78, 95% CI -539, 117). Local skin erythema was observed transiently in 4 infants (3 in the treatment and 1 in the placebo group). No serious harms were observed. CONCLUSION: Tetracaine 4% when applied for 30 minutes was not beneficial in decreasing procedural pain associated with a PICC in very small infants
How effective is tetracaine 4% gel, before a venipuncture, in reducing procedural pain in infants: a randomized double-blind placebo controlled trial
BACKGROUND: Procedural pain relief is sub-optimal in neonates. Topical tetracaine provides pain relief in children. Evidence of its efficacy and safety in neonates is limited. The objective of this study was to assess the efficacy and safety of topical tetracaine on the pain response of neonates during a venipuncture. METHODS: Medically stable infants greater than or equal to 24 weeks gestation, requiring a venipuncture, were included. Following randomization and double blinding, 1.1 g of tetracaine or placebo was applied to the skin for 30 minutes. Participants received oral sucrose if they met local eligibility criteria. The venipuncture was performed according to a standard protocol. A medium effect size in the pain score (corresponding to about 2 point difference in the PIPP score) was considered clinically significant, leading to a sample size of 142 infants, with 80% statistical power. Local skin reactions and immediate adverse cardiorespiratory events were noted. The primary outcome, PIPP score at 1 minute, was analysed using an independent Student's t-test. RESULTS: One hundred and forty two infants were included, 33 +/- 4 weeks gestation, 2100 +/- 900 grams and 6 +/- 3 days of age. There was almost no difference in PIPP scores at 1 minute between groups (mean difference -0.09; 95% confidence interval [CI]: -1.68 to 1.50; P = . 91). Similarly, there were no differences in PIPP scores during the 2(nd), 3(rd )and 4th minute. Duration of cry did not differ between the groups (median difference, 0; 95% CI, -3 to 0; P = . 84). The majority of infants in both groups received sucrose 24%. Sucrose had a significant effect on the PIPP score, as assessed by an ANOVA model (p = 0.0026). Local skin erythema was observed transiently in 11 infants (7 in the tetracaine and 4 in the placebo group). No serious side effect was observed. CONCLUSION: Tetracaine did not significantly decrease procedural pain in infants undergoing a venipuncture, when used in combination with routine sucrose administration
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