Omalizumab in middle-aged or older patients with severe allergic asthma-COPD overlap.

Introduction: Biological therapies used for severe asthma may be useful even for middle-aged or older patients who have a history of severe allergic asthma with a chronic obstructive pulmonary disease (COPD) overlap phenotype. Aim: To show omalizumab efficacy in severe allergic asthma-COPD overlap disease.Material and methods: We report our data of a retrospective study on 11 patients (mean age: 67.18 years) with a positive history of severe allergic asthma treated with omalizumab. They all presented limited reversibility of airway obstruction and signs of chronic bronchitis at radiological examinations, as in asthma-COPD overlap. Omalizumab improved conditions in terms of reduced exacerbations as well as asthma control test (ACT) and Asthma Quality of Life Questionnaire (AQLQ) scores. Results: Clinical improvement was seen already in the first year with significantly increased ACT scores (p < 0.0001) and a significantly decreased number of exacerbations (p < 0.001). Furthermore, our data showed a significant inverse correlation over time between the number of exacerbations and ACT (r = -0.83, p < 0.0001), AQLQ symptoms (r = -0.87, p < 0.0001), forced expiratory volume in 1 s (FEV1) (r = -0.71, p < 0.001) and FEV1/forced vital capacity (FVC) (r = -0.43, p = 0.04). There also was a positive correlation between ACT and FEV1 (r = 0.74, p < 0.0001), ACT and AQLQ symptoms (r = 0.93, p < 0.0001), FEV1 and AQLQ symptoms (r = 0.67, p < 0.001). All parameters continued to improve during the second year of treatment. Conclusions: Omalizumab may be relevant as a therapeutic option even in middle-aged and older patients with severe asthma.

The ST2/Interleukin-33 Axis in Hematologic Malignancies: The IL-33 Paradox.

Interleukin (IL)-33 is a chromatin-related nuclear interleukin that is a component of IL-1 family. IL-33 production augments the course of inflammation after cell damage or death. It is discharged into the extracellular space. IL-33 is regarded as an "alarmin" able to stimulate several effectors of the immune system, regulating numerous immune responses comprising cancer immune reactions. IL-33 has been demonstrated to influence tumorigenesis. However, as far as this cytokine is concerned, we are faced with what has sometimes been defined as the IL-33 paradox. Several studies have demonstrated a relevant role of IL-33 to numerous malignancies, where it may have pro- and-less frequently-antitumorigenic actions. In the field of hematological malignancies, the role of IL-33 seems even more complex. Although we can affirm the existence of a negative role of IL-33 in Chronic myelogenos leukemia (CML) and in lymphoproliferative diseases and a positive role in pathologies such as Acute myeloid leukemia (AML), the action of IL-33 seems to be multiple and sometimes contradictory within the same pathology. In the future, we will have to learn to govern the negative aspects of activating the IL-33/ST2 axis and exploit the positive ones.

A Personal Decision Support System for Heart Failure Management (HeartMan): study protocol of the HeartMan randomized controlled trial.

BACKGROUND: Heart failure (HF) is a highly prevalent chronic disease, for which there is no cure available. Therefore, improving disease management is crucial, with mobile health (mHealth) being a promising technology. The aim of the HeartMan study is to evaluate the effect of a personal mHealth system on top of standard care on disease management and health-related quality of life (HRQoL) in HF. METHODS: HeartMan is a randomized controlled 1:2 (control:intervention) proof-of-concept trial, which will enrol 120 stable ambulatory HF patients with reduced ejection fraction across two European countries. Participants in the intervention group are equipped with a multi-monitoring health platform with the HeartMan wristband sensor as the main component. HeartMan provides guidance through a decision support system on four domains of disease management (exercise, nutrition, medication adherence and mental support), adapted to the patient's medical and psychological profile. The primary endpoint of the study is improvement in self-care and HRQoL after a six-months intervention. Secondary endpoints are the effects of HeartMan on: behavioural outcomes, illness perception, clinical outcomes and mental state. DISCUSSION: HeartMan is technologically the most innovative HF self-management support system to date. This trial will provide evidence whether modern mHealth technology, when used to its full extent, can improve HRQoL in HF. TRIAL REGISTRATION: This trial has been registered on https://clinicaltrials.gov/ct2/show/NCT03497871 , on April 13 2018 with registration number NCT03497871.

The soft computing-based approach to investigate allergic diseases: a systematic review.

BACKGROUND: Early recognition of inflammatory markers and their relation to asthma, adverse drug reactions, allergic rhinitis, atopic dermatitis and other allergic diseases is an important goal in allergy. The vast majority of studies in the literature are based on classic statistical methods; however, developments in computational techniques such as soft computing-based approaches hold new promise in this field. OBJECTIVE: The aim of this manuscript is to systematically review the main soft computing-based techniques such as artificial neural networks, support vector machines, bayesian networks and fuzzy logic to investigate their performances in the field of allergic diseases. METHODS: The review was conducted following PRISMA guidelines and the protocol was registered within PROSPERO database (CRD42016038894). The research was performed on PubMed and ScienceDirect, covering the period starting from September 1, 1990 through April 19, 2016. RESULTS: The review included 27 studies related to allergic diseases and soft computing performances. We observed promising results with an overall accuracy of 86.5%, mainly focused on asthmatic disease. The review reveals that soft computing-based approaches are suitable for big data analysis and can be very powerful, especially when dealing with uncertainty and poorly characterized parameters. Furthermore, they can provide valuable support in case of lack of data and entangled cause-effect relationships, which make it difficult to assess the evolution of disease. CONCLUSIONS: Although most works deal with asthma, we believe the soft computing approach could be a real breakthrough and foster new insights into other allergic diseases as well.

A systematic review of the association between allergic asthma and autism.

INTRODUCTION: Autism Spectrum Disorder represents a burdensome condition in early childhood, with a number of risk factors proposed to explain its pathogenesis, most of which without a reliable scientific basis. Allergic asthma is likely to be one of the possible comorbilities of autism. EVIDENCE ACQUISITION: In this paper, the relationship between autism and allergic asthma was analyzed through a systematic literature review, conducted according to the PRISMA Guidelines. The review was performed on PubMed and Science Direct database and covered the period January 1, 2004-July 9, 2016. The search was limited to articles published in peer-reviewed journals. The obtained results were sorted by relevance and the most significant case-control, epidemiological and nationwide-based works associating autism and allergic asthma in humans were selected. EVIDENCE SYNTHESIS: A slight correlation between these conditions has been found in more than a half studies selected, suggesting a possible association between the two diseases. Small sample sizes of some works and some methodological limitations rise uncertainty about this link. CONCLUSIONS: Autism Spectrum Disorder and asthma could be associated conditions, as evidenced by the higher prevalence of asthma in autistic children with respect to typically developed controls, with also a verisimilar biological basis. Despite that, future studies are required to provide more reliable data, also by employing animal models, to better clarify this, still unsure, relationship. Methods for study selection and inclusion criteria were specified in advance and documented in PROSPERO protocol #CRD42014012851.

A Novel Application for Cognitive Evaluation in Mountain Ultramarathons: Olfactory Assessment.

OBJECTIVE: Olfactory function, a cognitive impairment biomarker, was evaluated in mountain ultramarathon (MUM) runners during the Tor des Géants race (332.5 km with an overall altitude gain of 24,000 m; altitude range 330-3296 m above the sea). METHODS: An Odor Identification Test was administered before (T0; n = 53), at 148.7 kms (T1; n = 32) and after the race (T2; n = 28). The effect of dehydration and sleep deprivation on olfactory function was assessed. Olfactory function was also assessed in non-MUM athletes and sedentary controls (C) at rest. RESULTS: A majority of the athletes completed the olfactory test at all time intervals. Olfactory function decreased throughout the race (T0: 13.8 ± 1.9, T1: 13.7 ± 1.6, T2: 13.1 ± 1.8; T0 vs T2 P = .01). There was no relationship with race time or sleep deprivation on the sense of smell throughout the competition. However, there was a combined effect with decreased olfaction during the second half of the race, while a poor relationship was seen between olfaction and total body water at midterm (T1: rs = -0.427; P = .019), but not at baseline or after the race. MUM athletes had similar olfactory scores to C (13.8 ± 1.9 vs 13.7 ± 1.4) and non-MUM (13.8 ± 1.9 vs 13.9 ± 1.6) athletes. CONCLUSIONS: This pilot study showed the feasibility of olfactory evaluation as a minimally invasive cognitive impairment assessment. The test can be used in logistically difficult environments, adding scientific value to this promising method. Although olfaction decreased after prolonged physical activity, further studies are warranted to make the relationship between cognition and external factors (eg, sleep deprivation, dehydration) more clear.

The role of wearable sensors and wireless technologies for the assessment of heart rate variability in anorexia nervosa.

PURPOSE: Bradycardia and abnormal cardiac autonomic function are related to increased mortality in anorexia nervosa (AN). The aim of this study was to assess heart rate (HR) and HR variability of young adolescents with AN as compared to controls by means of wearable sensors and wireless technologies. METHOD: The ECG signal was recorded in 27 AN girls and 15 healthy girls at rest using a wearable chest strap. The tachogram, the mean intervals between R peaks (meanRR), the root mean square of successive differences (RMSSD), the power of low-frequency (LF) and high-frequency (HF) bands and the LF/HF ratio were assessed. RESULTS: All AN girls showed a reduced HR and an increased meanRR and RMSSD. An HF increase, a LF decrease, and a LF/HF reduction indicated a prevalence of the parasympathetic on sympathetic activity. CONCLUSIONS: The instruments used in this pilot study were feasible, unobtrusive and extremely suitable in AN subjects who are burdened by high incidence of cardiovascular mortality; their application could open to new approaches of vital signs monitoring in hospitals as well as in home settings.

Experiential virtual scenarios with real-time monitoring (interreality) for the management of psychological stress: a block randomized controlled trial.

BACKGROUND: The recent convergence between technology and medicine is offering innovative methods and tools for behavioral health care. Among these, an emerging approach is the use of virtual reality (VR) within exposure-based protocols for anxiety disorders, and in particular posttraumatic stress disorder. However, no systematically tested VR protocols are available for the management of psychological stress. OBJECTIVE: Our goal was to evaluate the efficacy of a new technological paradigm, Interreality, for the management and prevention of psychological stress. The main feature of Interreality is a twofold link between the virtual and the real world achieved through experiential virtual scenarios (fully controlled by the therapist, used to learn coping skills and improve self-efficacy) with real-time monitoring and support (identifying critical situations and assessing clinical change) using advanced technologies (virtual worlds, wearable biosensors, and smartphones). METHODS: The study was designed as a block randomized controlled trial involving 121 participants recruited from two different worker populations-teachers and nurses-that are highly exposed to psychological stress. Participants were a sample of teachers recruited in Milan (Block 1: n=61) and a sample of nurses recruited in Messina, Italy (Block 2: n=60). Participants within each block were randomly assigned to the (1) Experimental Group (EG): n=40; B1=20, B2=20, which received a 5-week treatment based on the Interreality paradigm; (2) Control Group (CG): n=42; B1=22, B2=20, which received a 5-week traditional stress management training based on cognitive behavioral therapy (CBT); and (3) the Wait-List group (WL): n=39, B1=19, B2=20, which was reassessed and compared with the two other groups 5 weeks after the initial evaluation. RESULTS: Although both treatments were able to significantly reduce perceived stress better than WL, only EG participants reported a significant reduction (EG=12% vs. CG=0.5%) in chronic "trait" anxiety. A similar pattern was found for coping skills: both treatments were able to significantly increase most coping skills, but only EG participants reported a significant increase (EG=14% vs CG=0.3%) in the Emotional Support skill. CONCLUSIONS: Our findings provide initial evidence that the Interreality protocol yields better outcomes than the traditionally accepted gold standard for psychological stress treatment: CBT. Consequently, these findings constitute a sound foundation and rationale for the importance of continuing future research in technology-enhanced protocols for psychological stress management. TRIAL REGISTRATION: ClinicalTrials.gov: NCT01683617; http://clinicaltrials.gov/show/NCT01683617 (Archived by WebCite at http://www.webcitation.org/6QnziHv3h).

[Telemedicine and wireless devices in heart failure]. / Telemedicina e sistemi wireless nello scompenso cardiaco.

Telemedicine has the potential to constitute the central element of the future primary care and become an effective means of prevention and early warning of acute exacerbation of chronic diseases. Up to now, the application of telemedicine has found a variety of difficulties, regarding the types and methods of acquisition and transmission of biological signals, the acceptance and cooperation of the patient, etc. The latest technological developments involve the combined use of wireless technologies and smartphones, for the collection and the transmission of data, and specific softwares for their automatic analysis. This paper examines some of the critical aspects in the application of new technologies for heart failure remote management.

Exploring ChatGPT's potential in the clinical stream of neurorehabilitation.

In several medical fields, generative AI tools such as ChatGPT have achieved optimal performance in identifying correct diagnoses only by evaluating narrative clinical descriptions of cases. The most active fields of application include oncology and COVID-19-related symptoms, with preliminary relevant results also in psychiatric and neurological domains. This scoping review aims to introduce the arrival of ChatGPT applications in neurorehabilitation practice, where such AI-driven solutions have the potential to revolutionize patient care and assistance. First, a comprehensive overview of ChatGPT, including its design, and potential applications in medicine is provided. Second, the remarkable natural language processing skills and limitations of these models are examined with a focus on their use in neurorehabilitation. In this context, we present two case scenarios to evaluate ChatGPT ability to resolve higher-order clinical reasoning. Overall, we provide support to the first evidence that generative AI can meaningfully integrate as a facilitator into neurorehabilitation practice, aiding physicians in defining increasingly efficacious diagnostic and personalized prognostic plans.

"BrainHeart": Pilot Study on a Novel Application for Elderly Well-Being Based on Mindfulness Acceptance and Commitment Therapy.

The rising prevalence of mental illness is straining global mental health systems, particularly affecting older adults who often face deteriorating physical health and decreased autonomy and quality of life. Early detection and targeted rehabilitation are crucial in mitigating these challenges. Mindfulness acceptance and commitment therapy (ACT) holds promise for enhancing motivation and well-being among the elderly, although delivering such psychological interventions is hindered by limited access to services, prompting exploration of remote delivery options like mobile applications. In this paper, we introduce the BrainHeart App (v.1.1.8), a mobile application tailored to improve physical and mental well-being in seniors. The app features a 10-day ACT program and other sections promoting healthy lifestyle. In a pilot study involving twenty participants, individuals engaged in daily mental exercises for 10 days using the app. Clinical evaluations, including assessments of psychological flexibility, overall cognitive profile, mindfulness disposition, cognitive fusion, and heart rate collected with Polar H10, were conducted at baseline (T0) and one month post-intervention (T1). Analysis revealed significant improvements in almost all neuropsychological scores, with high usability reported (system usability scale average score: 82.3 ± 9.31). Additionally, a negative correlation was found between usability and experiential avoidance (r = -0.51; p = 0.026), and a notable difference in heart rate was observed between baseline and post-intervention (F-value = 3.06; p-value = 0.09). These findings suggest that mindfulness-ACT exercises delivered via the BrainHeart App can enhance the well-being of elderly individuals, highlighting the potential of remote interventions in addressing mental health needs in this population.

Rapid diagnosis of primary ciliary dyskinesia: cell culture and soft computing analysis.

Diagnosis of primary ciliary dyskinesia (PCD) sometimes requires repeated nasal brushing to exclude secondary ciliary alterations. Our aim was to evaluate whether the use of a new method of nasal epithelial cell culture can speed PCD diagnosis in doubtful cases and to identify which are the most informative parameters by means of a multilayer artificial neural network (ANN). A cross-sectional study was performed in patients with suspected PCD. All patients underwent nasal brushing for ciliary motion analysis, ultrastructural assessment and evaluation of ciliary function after ciliogenesis in culture by ANN. 151 subjects were studied. A diagnostic suspension cell culture was obtained in 117 nasal brushings. A diagnosis of PCD was made in 36 subjects (29 of whom were children). In nine out of the 36 patients the diagnosis was made only after a second brushing, because of equivocal results of both tests at first examination. In each of these subjects diagnosis of PCD was confirmed by cell culture results. Cell culture in suspension evaluated by means of ANN allows the separation of PCD from secondary ciliary dyskinesia patients after only 5 days of culture and allows diagnosis to be reached in doubtful cases, thus avoiding the necessity of a second sample.

TeleRehabilitation of Social-Pragmatic Skills in Children with Autism Spectrum Disorder: A Principal Component Analysis.

In many therapeutic settings, remote health services are becoming increasingly a viable strategy for behavior management interventions in children with autism spectrum disorder (ASD). However, there is a paucity of tools for recovering social-pragmatic skills. In this study, we sought to demonstrate the effectiveness of a new online behavioral training, comparing the performance of an ASD group carrying out an online treatment (n°8) with respect to a control group of demographically-/clinically matched ASD children (n°8) engaged in a traditional in-presence intervention (face-to-face). After a 4-month behavioral treatment, the pragmatic skills language (APL test) abilities detected in the experimental group were almost similar to the control group. However, principal component analysis (PCA) demonstrated that the overall improvement in socio-pragmatic skills was higher for ASD children who underwent in-presence training. In fact, dimensions defined by merging APL subscale scores are clearly separated in ASD children who underwent in-presence training with respect to those performing the online approach. Our findings support the effectiveness of remote healthcare systems in managing the social skills of children with ASD, but more approaches and resources are required to enhance remote services.

Multiparametric Evaluation of Geriatric Patients Admitted to Intermediate Care: Impact on Geriatric Rehabilitation.

Optimizing the functional status of patients of any age is a major global public health goal. Rehabilitation is a process in which a person with disabilities is accompanied to achieve the best possible physical, functional, social, intellectual, and relational outcomes. The Intermediate Care Unit within the O.U. of Geriatrics and Gerontology of the San Martino Hospital in Genoa is focused on the treatment and motor reactivation of patients with geriatric pathologies. The objective of this study was to identify which factor, among the characteristics related to the patient and those identified by the geriatric evaluation, had the greatest impact on rehabilitation outcomes. Our findings revealed significant correlations between the Barthel Index delta, the 4AT Screening Test, and the number of drugs taken. This association highlights the potential benefits of medication management in enhancing the overall well-being and functional abilities of frail older adults, despite the literature suggesting that polypharmacotherapy is associated with a reduction in functional status and an increase in mortality. These findings underscore the significance of a multidimensional geriatric assessment. Refining and optimising these multidisciplinary approaches is the objective of a more effective geriatric rehabilitation strategy.

Application of Machine Learning Algorithms for Prognostic Assessment in Rotator Cuff Pathologies: A Clinical Data-Based Approach.

AIM: The overall aim of this proposal is to ameliorate the care of rotator cuff (RC) tear patients by applying an innovative machine learning approach for outcome prediction after arthroscopic repair. MATERIALS AND METHODS: We applied state-of-the-art machine learning algorithms to evaluate the best predictors of the outcome, and 100 RC patients were evaluated at baseline (T0), after 1 month (T1), 3 months (T2), 6 months (T3), and 1 year (T4) from surgical intervention. The outcome measure was the Costant-Murley Shoulder Score, whereas age, sex, BMI, the 36-Item Short-Form Survey, the Simple Shoulder Test, the Hospital Anxiety and Depression Scale, the American Shoulder and Elbow Surgeons Score, the Oxford Shoulder Score, and the Shoulder Pain and Disability Index were considered as predictive factors. Support vector machine (SVM), k-nearest neighbors (k-NN), naïve Bayes (NB), and random forest (RF) algorithms were employed. RESULTS: Across all sessions, the classifiers demonstrated suboptimal performance when using both the complete and shrunken sets of features. Specifically, the logistic regression (LR) classifier achieved a mean accuracy of 46.5% ± 6%, while the random forest (RF) classifier achieved 51.25% ± 4%. For the shrunken set of features, LR obtained a mean accuracy of 48.5% ± 6%, and RF achieved 45.5% ± 4.5%. No statistical differences were found when comparing the performance metrics of ML algorithms. CONCLUSIONS: This study underlines the importance of extending the application of AI methods to new predictors, such as neuroimaging and kinematic data, in order to better record significant shifts in RC patients' prognosis. LIMITATIONS: The data quality within the cohort could represent a limitation, since certain variables, such as smoking, diabetes, and work injury, are known to have an impact on the outcome.

Evaluation of pulmonary disease using static lung volumes in primary ciliary dyskinesia.

BACKGROUND: In primary ciliary dyskinesia (PCD) lung damage is usually evaluated by high-resolution CT (HRCT). OBJECTIVE: To evaluate whether HRCT abnormalities and Pseudomonas aeruginosa infection were better predicted by spirometry or plethysmography. METHODS: A cross-sectional study performed in consecutive patients with PCD who underwent sputum culture, spirometry, plethysmography and HRCT within 48 h. Principal component analysis and soft computing were used for data evaluation. RESULTS: Fifty patients (26 children) were studied. P aeruginosa infection was found in 40% of the patients and bronchiectasis in 88%. There was a correlation between infection with P aeruginosa and extent of bronchiectasis (p=0.009; r =0.367) and air-trapping (p=0.03; r =0.315). Moreover, there was an association between infection with P aeruginosa and residual volume (RV) values >150% (p=0.04) and RV/total lung capacity (TLC) ratio >140% (p=0.001), but not between infection with P aeruginosa and forced expiratory volume in 1 s (FEV(1))<80%, or forced expiratory flow between 25% and 75% of forced vital capacity (FVC) (FEF(25-75%))<70% or FEV(1)/FVC<70% (<80% in children). Severity of the total lung impairment on chest HRCT directly correlated with RV when expressed as per cent predicted (p=0.003; r =0.423), and RV/TLC (p<0.001; r =0.513) or when expressed as z scores (p=0.002, r =0.451 and p<0.001, r =0.536 respectively). Principal component analysis on plethysmographic but not on spirometry data allowed recognition of different severities of focal air trapping, atelectasis and extent of bronchiectasis. CONCLUSIONS: Plethysmography better predicts HRCT abnormalities than spirometry. Whether it might be a useful test to define populations of patients with PCD who should or should not have HRCT scans requires further longitudinal studies.

An open source mobile platform for psychophysiological self tracking.

Self tracking is a recent trend in e-health that refers to the collection, elaboration and visualization of personal health data through ubiquitous computing tools such as mobile devices and wearable sensors. Here, we describe the design of a mobile self-tracking platform that has been specifically designed for clinical and research applications in the field of mental health. The smartphone-based application allows collecting a) self-reported feelings and activities from pre-programmed questionnaires; b) electrocardiographic (ECG) data from a wireless sensor platform worn by the user; c) movement activity information obtained from a tri-axis accelerometer embedded in the wearable platform. Physiological signals are further processed by the application and stored on the smartphone's memory. The mobile data collection platform is free and released under an open source licence to allow wider adoption by the research community (download at: http://sourceforge.net/projects/psychlog/).

A system for automatic detection of momentary stress in naturalistic settings.

Prolonged exposure to stressful environments can lead to serious health problems. Therefore, measuring stress in daily life situations through non-invasive procedures has become a significant research challenge. In this paper, we describe a system for the automatic detection of momentary stress from behavioral and physiological measures collected through wearable sensors. The system's architecture consists of two key components: a) a mobile acquisition module; b) an analysis and decision module. The mobile acquisition module is a smartphone application coupled with a newly developed sensor platform (Personal Biomonitoring System, PBS). The PBS acquires behavioral (motion activity, posture) and physiological (hearth rate) variables, performs low-level, real-time signal preprocessing, and wirelessly communicates with the smartphone application, which in turn connects to a remote server for further signal processing and storage. The decision module is realized on a knowledge basis, using neural network and fuzzy logic algorithms able to combine as input the physiological and behavioral features extracted by the PBS and to classify the level of stress, after previous knowledge acquired during a training phase. The training is based on labeling of physiological and behavioral data through self-reports of stress collected via the smartphone application. After training, the smartphone application can be configured to poll the stress analysis report at fixed time steps or at the request of the user. Preliminary testing of the system is ongoing.

Binaural beats reduce feeling of pain and discomfort during colonoscopy procedure in not-sedated patients: A randomized control trial.

BACKGROUND AND PURPOSE: This study aimed to determine the effect of Binaural Beats(BB)on feeling of pain, and patient comfort during colonoscopy without sedation. MATERIALS AND METHODS: It is a randomized, controlled, double-blind procedural study of 115 patients that underwent colonoscopy without sedation. The patients were randomly assigned into the experimental group (n = 42) and the control group (n = 48) that were given BB starting 5 min before and continuing until the end of the colonoscopy procedure without any intervention other than routine nursing care. Measures of the state of anxiety (VAS-Anxiety scale) administered before the procedure, and measures of feeling of pain (Visual Analogue scale VAS-pain), Satisfactory and Willingness to repeat the procedure as Likert scales were also collected soon after the colonoscopy procedure. RESULTS: Feeling of pain was lower and scores of the level of comfort were higher in the experimental group when compared to the control group (p < 0.05). CONCLUSIONS: BB is an effective and safe method for reducing pain and improving patient comfort in cases undergoing colonoscopy without sedation. Since BB method is a non-pharmacological, non-invasive, inexpensive and simple method without any side effects, it may be used to reduce the feeling of pain and discomfort for non-sedated patients undergoing colonoscopy.