1
|
D'Auria D, Bettini F, Tognarelli S, Calvanese D, Menciassi A. Technologies and main functionalities of the telemonitoring application reCOVeryaID. Front Big Data 2024; 7:1360092. [PMID: 39104732 PMCID: PMC11298383 DOI: 10.3389/fdata.2024.1360092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 07/08/2024] [Indexed: 08/07/2024] Open
Abstract
The COVID-19 pandemic has highlighted the need to take advantage of specific and effective patient telemonitoring platforms, with specific reference to the constant monitoring of vital parameters of patients most at risk. Among the various applications developed in Italy, certainly there is reCOVeryaID, a web application aimed at remotely monitoring patients potentially, currently or no longer infected with COVID-19. Therefore, in this paper we present a system model, consisting of a multi-platform intelligent telemonitoring application, that enables remote monitoring and provision of integrated home care to both patients symptomatic, asymptomatic and pre-symptomatic with severe acute respiratory infectious disease or syndrome caused by viruses belonging to the Coronavirus family, as well as simply to people with respiratory problems and/or related diseases (chronic obstructive pulmonary disease or asthma). In fact, in this paper we focus on exposing the technologies and various functionalities offered by the system, which constitute the practical implementation of the theoretical framework described in detail in another paper. Specifically, the reCOVeryaID telemonitoring application is a stand-alone, knowledge base-supported application that can promptly react and inform physicians if dangerous trends in a patient's short- and long-term vital signs are detected, thus enabling them to be monitored continuously, both in the hospital and at home. The paper also reports an evaluation of user satisfaction, carried out by actual patients and medical doctors.
Collapse
Affiliation(s)
- Daniela D'Auria
- Faculty of Engineering, Free University of Bozen-Bolzano, Bolzano, Italy
| | - Fabio Bettini
- Faculty of Engineering, Free University of Bozen-Bolzano, Bolzano, Italy
| | | | - Diego Calvanese
- Faculty of Engineering, Free University of Bozen-Bolzano, Bolzano, Italy
- Department of Computing Science, Umeå University, Umeå, Sweden
| | | |
Collapse
|
2
|
García-Marichal C, Aguilar-Jerez MF, Delgado-Plasencia LJ, Pérez-Hernández O, Armas-González JF, Pelazas-González R, Martín-González C. A Primary Health Care Program and COVID-19. Impact in Hospital Admissions and Mortality. J Gen Intern Med 2024:10.1007/s11606-024-08912-6. [PMID: 39023662 DOI: 10.1007/s11606-024-08912-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Accepted: 06/25/2024] [Indexed: 07/20/2024]
Abstract
BACKGROUND Most patients with mild or moderate COVID infection did not require hospital admission, but depending on their personal history, they needed medical supervision. In monitoring these patients in primary care, the design of specific surveillance programs was of great help. Between February 2021 and March 2022, EDCO program was designed in Tenerife, Spain, to telemonitor patients with COVID infection who had at least one vulnerability factor to reduce hospital admissions and mortality. OBJECTIVE The aim of this study is to describe the clinical course of patients included in the EDCO program and to analyze which factors were associated with a higher probability of hospital admission and mortality. DESIGN Retrospective cohort study. PATIENTS We included 3848 patients with a COVID-19 infection age over 60 years old or age over 18 years and at least one vulnerability factor previously reported in medical history. MAIN MEASURES Primary outcome was to assess risk of admission or mortality. KEY RESULTS 278 (7.2%) patients required hospital admission. Relative risks (RR) of hospital admission were oxygen saturation ≤ 92% (RR: 90.91 (58.82-142.86)), respiratory rate ≥ 22 breaths per minute (RR: 20.41 (1.19-34.48), obesity (RR: 1.53 (1.12-2.10), chronic kidney disease (RR:2.31 (1.23-4.35), ≥ 60 years of age (RR: 1.44 (1.04-1.99). Mortality rate was 0.7% (27 patients). Relative risks of mortality were respiratory rate ≥ 22 breaths per minute (RR: 24.85 (11.15-55.38), patients with three or more vulnerability factors (RR: 4.10 (1.62-10.38), oxygen saturation ≤ 92% (RR: 4.69 (1.70-15.15), chronic respiratory disease (RR: 3.32 (1.43-7.69) and active malignancy (RR: 4.00 (1.42-11.23). CONCLUSIONS Vulnerable patients followed by a primary care programme had admission rates of 7.2% and mortality rates of 0.7%. Supervision of vulnerable patients by a Primary Care team was effective in the follow-up of these patients with complete resolution of symptoms in 91.7% of the cases.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Candelaria Martín-González
- Hospital Universitario de Canarias, San Cristóbal De La Laguna, Spain.
- Universidad de La Laguna, San Cristóbal De La Laguna, Spain.
- Departamento de Medicina Interna, Dermatología y Psiquiatría, Universidad de La Laguna, Servicio de Medicina Interna, Hospital Universitario de Canarias, Canary Islands, Tenerife, Spain.
| |
Collapse
|
3
|
Shah N. A Randomized Controlled Trial of the Safety and Efficacy of Systemic Enzyme Supplementation on Symptoms and Quality of Life in Patients with Idiopathic Pulmonary Fibrosis. Diseases 2024; 12:155. [PMID: 39057126 PMCID: PMC11276359 DOI: 10.3390/diseases12070155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2024] [Revised: 07/02/2024] [Accepted: 07/12/2024] [Indexed: 07/28/2024] Open
Abstract
Idiopathic pulmonary fibrosis (IPF) imposes a substantial symptom burden that adversely impacts patients' quality of life. Current anti-fibrotic treatments for IPF provide limited symptomatic relief, necessitating the implementation of complementary disease management strategies to enhance health-related quality of life (HRQOL). Serracor-NK® and Serra Rx260, systemic enzyme supplements, improved symptoms and HRQOL with favorable safety profiles in a proof-of-concept study in PF patients. This prospective, double-blind randomized placebo-controlled trial enrolled 100 IPF patients from six institutions. The supplement group (n = 50) received the oral systemic enzyme supplements Serracor-NK® and Serra Rx260 in addition to standard care for 6 months, while the placebo group (n = 50) received standard care alone. The primary objective was to evaluate the regimen's impact on symptoms, QOL, and well-being using the UCSD shortness of breath (UCSD-SOB) questionnaire, St. George's respiratory questionnaire (SGRQ), and WHO well-being index (WHO-5). Safety evaluation was a secondary objective. A significantly higher proportion of patients in the supplement group demonstrated meaningful improvement in symptoms as compared to the placebo group, as assessed by the UCSD-SOB (p < 0.05) and SGRQ questionnaires (p < 0.05). Additionally, a significantly greater proportion of patients in the supplement group showed improved QOL and well-being (p < 0.05) and reduced health impairment (p < 0.05), as assessed by SGRQ. Mental well-being (WHO-5) and physical activity (SGRQ activity domain) did not differ significantly between the groups. Safety assessments, including liver function tests and vital signs, indicated that the supplement regimen was well tolerated. To conclude, Serracor-NK® and Serra Rx260 alleviate symptoms and enhance HRQOL in IPF patients with a favorable safety profile (Clinical Trials Registry India registration number: CTRI/2020/05/025374).
Collapse
Affiliation(s)
- Neha Shah
- Pulmonary Fibrosis NOW, Chino, CA 91710, USA
| |
Collapse
|
4
|
Cabanas AM, Fuentes-Guajardo M, Sáez N, Catalán DD, Collao-Caiconte PO, Martín-Escudero P. Exploring the Hidden Complexity: Entropy Analysis in Pulse Oximetry of Female Athletes. BIOSENSORS 2024; 14:52. [PMID: 38275305 PMCID: PMC11154467 DOI: 10.3390/bios14010052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 01/06/2024] [Accepted: 01/12/2024] [Indexed: 01/27/2024]
Abstract
This study examines the relationship between physiological complexity, as measured by Approximate Entropy (ApEn) and Sample Entropy (SampEn), and fitness levels in female athletes. Our focus is on their association with maximal oxygen consumption (VO2,max). Our findings reveal a complex relationship between entropy metrics and fitness levels, indicating that higher fitness typically, though not invariably, correlates with greater entropy in physiological time series data; however, this is not consistent for all individuals. For Heart Rate (HR), entropy measures suggest stable patterns across fitness categories, while pulse oximetry (SpO2) data shows greater variability. For instance, the medium fitness group displayed an ApEn(HR) = 0.57±0.13 with a coefficient of variation (CV) of 22.17 and ApEn(SpO2) = 0.96±0.49 with a CV of 46.08%, compared to the excellent fitness group with ApEn(HR) = 0.60±0.09 with a CV of 15.19% and ApEn(SpO2) =0.85±0.42 with a CV of 49.46%, suggesting broader physiological responses among more fit individuals. The larger standard deviations and CVs for SpO2 entropy may indicate the body's proficient oxygen utilization at higher levels of physical demand. Our findings advocate for combining entropy metrics with wearable sensor technology for improved biomedical analysis and personalized healthcare.
Collapse
Affiliation(s)
- Ana M. Cabanas
- Departamento de Física, Universidad de Tarapacá, Arica 1010069, Chile; (N.S.); (D.D.C.)
| | | | - Nicolas Sáez
- Departamento de Física, Universidad de Tarapacá, Arica 1010069, Chile; (N.S.); (D.D.C.)
| | - Davidson D. Catalán
- Departamento de Física, Universidad de Tarapacá, Arica 1010069, Chile; (N.S.); (D.D.C.)
| | | | - Pilar Martín-Escudero
- Medical School of Sport Medicine, Faculty of Medicine, Universidad Complutense de Madrid, 28040 Madrid, Spain;
| |
Collapse
|
5
|
D'Auria D, Russo R, Fedele A, Addabbo F, Calvanese D. An intelligent telemonitoring application for coronavirus patients: reCOVeryaID. Front Big Data 2023; 6:1205766. [PMID: 37790086 PMCID: PMC10543687 DOI: 10.3389/fdata.2023.1205766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 08/29/2023] [Indexed: 10/05/2023] Open
Abstract
The COVID-19 emergency underscored the importance of resolving crucial issues of territorial health monitoring, such as overloaded phone lines, doctors exposed to infection, chronically ill patients unable to access hospitals, etc. In fact, it often happened that people would call doctors/hospitals just out of anxiety, not realizing that they were clogging up communications, thus causing problems for those who needed them most; such people, often elderly, have often felt lonely and abandoned by the health care system because of poor telemedicine. In addition, doctors were unable to follow up on the most serious cases or make sure that others did not worsen. Thus, uring the first pandemic wave we had the idea to design a system that could help people alleviate their fears and be constantly monitored by doctors both in hospitals and at home; consequently, we developed reCOVeryaID, a telemonitoring application for coronavirus patients. It is an autonomous application supported by a knowledge base that can react promptly and inform medical doctors if dangerous trends in the patient's short- and long-term vital signs are detected. In this paper, we also validate the knowledge-base rules in real-world settings by testing them on data from real patients infected with COVID-19.
Collapse
Affiliation(s)
- Daniela D'Auria
- Faculty of Engineering, Free University of Bozen-Bolzano, Bolzano, Italy
| | | | | | | | - Diego Calvanese
- Faculty of Engineering, Free University of Bozen-Bolzano, Bolzano, Italy
- Department of Computing Science, Umeå University, Umeå, Sweden
| |
Collapse
|
6
|
Kayser SA, Williamson R, Siefert G, Roberts D, Murray A. Respiratory rate monitoring and early detection of deterioration practices. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2023; 32:620-627. [PMID: 37410682 DOI: 10.12968/bjon.2023.32.13.620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/08/2023]
Abstract
BACKGROUND Growing evidence points to respiratory rate (RR) being the most important vital sign for early detection of patient deterioration. However, RR is the vital sign most likely to be inaccurate or missed. AIMS To measure prevalence of early detection of deterioration protocols, examine whether RR was perceived as the leading indicator of deterioration, and understand RR monitoring practices used by nurses around the world. METHODS A double-blinded survey of nurses in Asia Pacific, Middle East, and Western Europe. FINDINGS 161 nurses responded. Most (80%) reported having an initiative for early detection of patient deterioration; 12% indicated RR was the most important indicator of deterioration, 27% captured RR for all medical/surgical patients, and 56% take 60 seconds or longer to measure RR. CONCLUSION Nurses across all regions generally underestimated the importance of capturing an accurate RR for all patients' multiple times per day. This study reinforces the need to enhance international nursing education regarding the importance of RR.
Collapse
Affiliation(s)
- Susan A Kayser
- Health Economist, Baxter International, Batesville, Indiana, USA
| | - Rachel Williamson
- Director, Global Strategic Marketing, Baxter International, Batesville, Indiana, USA
| | - Gabriela Siefert
- Associate Director of Strategy, Baxter International, Omaha, Nebraska, USA
| | - Dan Roberts
- Health Economist, Baxter International, Scottsville, Virginia, USA
| | - Angela Murray
- Senior Director of Health Economics, Baxter International, Chicago, Illinois, USA
| |
Collapse
|
7
|
Palmer JH, James S, Wadsworth D, Gordon CJ, Craft J. How registered nurses are measuring respiratory rates in adult acute care health settings: An integrative review. J Clin Nurs 2022. [PMID: 36097417 DOI: 10.1111/jocn.16522] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 07/06/2022] [Accepted: 08/17/2022] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES This integrative review aimed to draw conclusions from evidence on how registered nurses are measuring respiratory rates for acute care patients. BACKGROUND Despite the growing research supporting respiratory rate as an early indicator for clinical deterioration, respiratory rate has consistently been the least frequently measured and accurately documented vital sign. DESIGN An integrative review. METHODS A systematic literature search was conducted in June 2022 in four databases: CINAHL, PubMed, Medline and Scopus. Quality appraisal was undertaken using the Joanna Briggs Institute's Checklist. PRISMA guidelines were followed to ensure explicit reporting and reported in the PRISMA checklist. RESULTS Overall, 9915 records were identified, and 19 met the inclusion criteria. Of these 19 articles, seven themes emerged: estimation and digit preference, lack of understanding and knowledge, not valuing the clinical significance of respiratory rate, oxygen saturation substitute, interobserver agreement, subjective concern and count duration. A high prevalence of bias, estimation and incorrect technique was evident. A total of 15 articles reported specifically on how registered nurses are measuring respiratory rates on general medical and surgical wards. CONCLUSIONS Despite its importance, this integrative review has determined that respiratory rates are not being assessed correctly by nursing staff in the acute care environment. Evidence of using estimation, value bias or quick count and multiply techniques are emerging themes which urgently require further research. No patient or public contribution.
Collapse
Affiliation(s)
- Jennifer H Palmer
- School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast, Caboolture, Queensland, Australia.,Critical Care and Support Services, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Steven James
- School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast, Caboolture, Queensland, Australia
| | - Daniel Wadsworth
- School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast, Caboolture, Queensland, Australia.,Sunshine Coast Health Institute, Birtinya, Queensland, Australia
| | - Christopher J Gordon
- Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia.,CIRUS Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, Sydney, New South Wales, Australia
| | - Judy Craft
- School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast, Caboolture, Queensland, Australia
| |
Collapse
|
8
|
Halverson CC, Bailey C, Ennis JA, Cox EE. Nursing surveillance of respiratory adverse events among hospitalized adults: A systematic review to guide evidence-based practice. Worldviews Evid Based Nurs 2022; 19:260-266. [PMID: 35638706 DOI: 10.1111/wvn.12581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Revised: 12/03/2021] [Accepted: 02/10/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Nursing surveillance (NS) involves the purposeful, ongoing acquisition, interpretation, and synthesis of patient data for clinical decision-making. Surveillance is used to identify patients with early signs of distress and prevent adverse events. The processes that support and measure the outcomes of nursing surveillance are not clearly specified. AIM The aim of this systematic review was to describe the impact of NS on respiratory adverse events for adult hospitalized patients. METHODS The PRISMA model guided this systematic search of Academic Search Complete (EBSCOhost), CINAHL Complete (EBSCOhost), Nursing & Allied Health (ProQuest), and PubMed databases for articles published between 1990 and 2019. Search terms included nursing surveillance, data points typically attributed to nursing surveillance, adult hospitalized patients, and adverse respiratory events. The protocol for this review was registered as PROSPERO: CRD42020147557. RESULTS Of the 2907 references screened, 67 full-text articles were reviewed and 10 were eligible for inclusion. Research on nursing surveillance in the presence of respiratory deterioration is limited. Six studies used assessment tools that were generated from early warning scores, and four used research or institutionally designed trigger criteria. Surveillance, like other types of nursing care, was difficult to isolate and measure. Although components of surveillance were described in the selected studies, the nurse's role was not explicitly identified. Further research is required to highlight the role nursing surveillance plays in clinical decision-making to keep patients safe. LINKING EVIDENCE TO ACTION The attributes of NS provide a useful intervention guide for the hospitalized patient at risk of deterioration. Early warning score techniques provide empirical evidence for identifying patients at risk of deterioration. The findings of this study provide evidence of the significance for research focused on the attributes of NS relative to responding to patients at risk of deterioration.
Collapse
Affiliation(s)
- Colleen C Halverson
- The Houston J and Florence A Doswell, Dallas, Texas, USA.,College of Nursing, Texas Woman's University, Dallas, Texas, USA
| | - Catherine Bailey
- The Houston J and Florence A Doswell, Dallas, Texas, USA.,College of Nursing, Texas Woman's University, Dallas, Texas, USA
| | - Joyce Arlene Ennis
- The Houston J and Florence A Doswell, Dallas, Texas, USA.,College of Nursing, Texas Woman's University, Dallas, Texas, USA
| | - E Elaine Cox
- Mary Evelyn Blagg-Huey Library, Texas Woman's University, Denton, Texas, USA
| |
Collapse
|
9
|
Takayama A, Takeshima T, Nagamine T. Factors associated with the frequency of respiratory rate measurement by hospital nurses: a multicentre cross-sectional study. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2022; 31:495-501. [PMID: 35559695 DOI: 10.12968/bjon.2022.31.9.495] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Although the respiratory rate (RR) is a sensitive predictor of patient deterioration, it is often neglected. Moreover, only a few studies have investigated the factors that cause health professionals to disregard RR. AIMS This cross-sectional study aimed to elucidate the factors affecting the frequency of RR measurement by the nurses. METHODS An original questionnaire, comprising 18 factors extracted from previous studies, was administered to nurses from nine hospitals. FINDINGS Of the 644 eligible nurses, 592 (92%) completed the questionnaire. The adjusted odds ratios and 95% confidence intervals of the factors of importance, educational experiences, shortened-count method use, negative experiences, and inconvenience were 2.24 (1.13-4.45), 2.26 (1.20-4.26), 0.61 (0.42-0.91), 0.45 (0.29-0.70), and 0.41 (0.26-0.65), respectively. CONCLUSION Education, feedback systems, and automation are the primary issues that need attention. Prioritising these factors could provide a practical guide for optimising the frequency of RR measurement.
Collapse
Affiliation(s)
- Atsushi Takayama
- Research Fellow, Center for Innovative Research for Communities and Clinical Excellence (CiRC2LE), Fukushima Medical University Hospital, Fukushima, Japan
| | - Taro Takeshima
- Professor, Center for Innovative Research for Communities and Clinical Excellence (CiRC2LE), Fukushima Medical University Hospital, Fukushima, Japan; Professor, Department of General Medicine, Shirakawa Satellite for Teaching And Research, Fukushima Medical University Hospital, Fukushima, Japan
| | - Takahiko Nagamine
- Representative Director, Sunlight Brain Research Center, Hofu, Yamagushi Japan
| |
Collapse
|
10
|
Iwashita Y, Nebuya S. Evaluation of a Novel Contactless Electrical Impedance Device for Measuring Respiratory and Heart Rates: A Pilot Study. Cureus 2021; 13:e18622. [PMID: 34786226 PMCID: PMC8580114 DOI: 10.7759/cureus.18622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/09/2021] [Indexed: 11/30/2022] Open
Abstract
Although the respiratory rate is an important vital sign, it is rarely recorded in hospitals given the lack of convenient measurement devices. Posh Wellness Laboratory Inc. (Tokyo, Japan) developed a novel contactless card-type respiratory/heart rate monitoring device that measures electrical impedance variations on the human chest. This study was aimed to test and validate the accuracy of the proposed device compared with conventional medical monitors. To evaluate the card-type monitoring device, we compared the measurements from the device with those from the mechanical ventilators and electrocardiogram monitors. Patients who were hospitalized in the Emergency Department of Shimane University Hospital from April 5 to 30, 2021 were included in this study. A card-type sensor was attached to five patients who agreed to participate in this study. Four of the five patients were receiving mechanical ventilation. The respiratory rate error provided by the card-type sensor remained within 15% compared with the measurements of the conventional medical monitor. In contrast, the heart rate counts were largely different from the measurements. Thus, the proposed device can successfully measure the respiratory rate, whereas heart rate measurements require further improvement. Our small, lightweight, radiation-free, and contactless monitoring device can conveniently measure the respiratory rate of patients. With the improvement of measuring the heart rate, we would like to assess a larger number and a wider range of patients.
Collapse
Affiliation(s)
- Yoshiaki Iwashita
- Department of Emergency and Critical Care Medicine, Shimane University, Izumo, JPN
| | - Satoru Nebuya
- Collaborative Research Programs of Advanced Medical Electromagnetic Engineering, Shimane University, Izumo, JPN
| |
Collapse
|
11
|
Peelen RV, Eddahchouri Y, Koeneman M, van de Belt TH, van Goor H, Bredie SJ. Algorithms for Prediction of Clinical Deterioration on the General Wards: A Scoping Review. J Hosp Med 2021; 16:612-619. [PMID: 34197299 DOI: 10.12788/jhm.3630] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 03/30/2021] [Indexed: 11/20/2022]
Abstract
OBJECTIVE The primary objective of this scoping review was to identify and describe state-of-the-art models that use vital sign monitoring to predict clinical deterioration on the general ward. The secondary objective was to identify facilitators, barriers, and effects of implementing these models. DATA SOURCES PubMed, Embase, and CINAHL databases until November 2020. STUDY SELECTION We selected studies that compared vital signs-based automated real-time predictive algorithms to current track-and-trace protocols in regard to the outcome of clinical deterioration in a general ward population. DATA EXTRACTION Study characteristics, predictive characteristics and barriers, facilitators, and effects. RESULTS We identified 1741 publications, 21 of which were included in our review. Two of the these were clinical trials, 2 were prospective observational studies, and the remaining 17 were retrospective studies. All of the studies focused on hospitalized adult patients. The reported area under the receiver operating characteristic curves ranged between 0.65 and 0.95 for the outcome of clinical deterioration. Positive predictive value and sensitivity ranged between 0.223 and 0.773 and from 7.2% to 84.0%, respectively. Input variables differed widely, and predicted endpoints were inconsistently defined. We identified 57 facilitators and 48 barriers to the implementation of these models. We found 68 reported effects, 57 of which were positive. CONCLUSION Predictive algorithms can detect clinical deterioration on the general ward earlier and more accurately than conventional protocols, which in one recent study led to lower mortality. Consensus is needed on input variables, predictive time horizons, and definitions of endpoints to better facilitate comparative research.
Collapse
Affiliation(s)
- Roel V Peelen
- Radboud University Medical Center, Department of Internal Medicine, Nijmegen, The Netherlands
| | - Yassin Eddahchouri
- Radboud University Medical Center, Department of Surgery, Nijmegen, The Netherlands
| | - Mats Koeneman
- Radboud University Medical Center, REshape and Innovation Center, Nijmegen, The Netherlands
| | - Tom H van de Belt
- Radboud University Medical Center, REshape and Innovation Center, Nijmegen, The Netherlands
| | - Harry van Goor
- Radboud University Medical Center, Department of Surgery, Nijmegen, The Netherlands
| | - Sebastian Jh Bredie
- Radboud University Medical Center, Department of Internal Medicine, Nijmegen, The Netherlands
- Radboud University Medical Center, REshape and Innovation Center, Nijmegen, The Netherlands
| |
Collapse
|
12
|
Abstract
The registered nurse (RN) on a medical-surgical nursing unit may be the first health care professional to encounter a patient with the signs of impending respiratory failure. Importantly, the RN must recognize the signs of respiratory compromise and possess the competence and confidence to intervene without delay. Signs of respiratory deterioration, physical assessment, and respiratory laboratory studies are reviewed. Modes of oxygen therapy, basic airway management techniques, including bag mask ventilation, and use of oropharyngeal and nasopharyngeal airways are discussed. The assembly of equipment and medications frequently used for intubation are also outlined.
Collapse
Affiliation(s)
- Denise H Tola
- Nurse Anesthesia Program, Duke University School of Nursing, 307 Trent Drive, Durham, NC 27710, USA.
| | - Alyssa Rojo
- American Association of Nurse Anesthetists, 222 South Prospect Avenue, Park Ridge, IL 60068, USA
| | - Brett Morgan
- American Association of Nurse Anesthetists, 222 South Prospect Avenue, Park Ridge, IL 60068, USA
| |
Collapse
|