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Kolben Y, Gork I, Peled D, Amitay S, Moshel P, Goldstein N, Ben Ishay A, Fons M, Tabi M, Eisenkraft A, Gepner Y, Nachman D. Continuous Monitoring of Advanced Hemodynamic Parameters during Hemodialysis Demonstrated Early Variations in Patients Experiencing Intradialytic Hypotension. Biomedicines 2024; 12:1177. [PMID: 38927384 PMCID: PMC11200556 DOI: 10.3390/biomedicines12061177] [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: 04/03/2024] [Revised: 05/18/2024] [Accepted: 05/23/2024] [Indexed: 06/28/2024] Open
Abstract
Intradialytic hypotension (IDH) is a severe complication of hemodialysis (HD) with a significant impact on morbidity and mortality. In this study, we used a wearable device for the continuous monitoring of hemodynamic vitals to detect hemodynamic changes during HD and attempted to identify IDH. End-stage kidney disease patients were continuously monitored 15 min before starting the session and until 15 min after completion of the session, measuring heart rate (HR), noninvasive cuffless systolic and diastolic blood pressure (SBP and DBP), stroke volume (SV), cardiac output (CO), and systemic vascular resistance (SVR). Data were analyzed retrospectively and included comparing BP measured by the wearable devices (recorded continuously every 5 s) and the cuff-based devices. A total of 98 dialysis sessions were included in the final analysis, and IDH was identified in 22 sessions (22.5%). Both SBP and DBP were highly correlated (r > 0.62, p < 0.001 for all) between the wearable device and the cuff-based measurements. Based on the continuous monitoring, patients with IDH had earlier and more profound reductions in SBP and DBP during the HD treatment. In addition, nearly all of the advanced vitals differed between groups. Further studies should be conducted in order to fully understand the potential of noninvasive advanced continuous monitoring in the prediction and prevention of IDH events.
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Affiliation(s)
- Yotam Kolben
- Heart Institute, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9112001, Israel; (Y.K.); (S.A.); (P.M.); (D.N.)
| | - Ittamar Gork
- Department of Nephrology and Hypertension, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9112001, Israel;
| | - David Peled
- Department of Health Promotion, School of Public Health, Faculty of Medicine and Health, Sylvan Adams Sports Institute, Tel Aviv University, Tel Aviv 6997801, Israel; (D.P.); (Y.G.)
| | - Shani Amitay
- Heart Institute, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9112001, Israel; (Y.K.); (S.A.); (P.M.); (D.N.)
| | - Peleg Moshel
- Heart Institute, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9112001, Israel; (Y.K.); (S.A.); (P.M.); (D.N.)
| | - Nir Goldstein
- Biobeat Technologies Ltd., Petah Tikva 4937213, Israel; (N.G.); (A.B.I.); (M.F.); (M.T.)
| | - Arik Ben Ishay
- Biobeat Technologies Ltd., Petah Tikva 4937213, Israel; (N.G.); (A.B.I.); (M.F.); (M.T.)
| | - Meir Fons
- Biobeat Technologies Ltd., Petah Tikva 4937213, Israel; (N.G.); (A.B.I.); (M.F.); (M.T.)
| | - Michael Tabi
- Biobeat Technologies Ltd., Petah Tikva 4937213, Israel; (N.G.); (A.B.I.); (M.F.); (M.T.)
| | - Arik Eisenkraft
- Biobeat Technologies Ltd., Petah Tikva 4937213, Israel; (N.G.); (A.B.I.); (M.F.); (M.T.)
- Institute for Research in Military Medicine, Faculty of Medicine, The Hebrew University of Jerusalem and the Israel Defense Force Medical Corps, Jerusalem 9112102, Israel
| | - Yftach Gepner
- Department of Health Promotion, School of Public Health, Faculty of Medicine and Health, Sylvan Adams Sports Institute, Tel Aviv University, Tel Aviv 6997801, Israel; (D.P.); (Y.G.)
| | - Dean Nachman
- Heart Institute, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9112001, Israel; (Y.K.); (S.A.); (P.M.); (D.N.)
- Institute for Research in Military Medicine, Faculty of Medicine, The Hebrew University of Jerusalem and the Israel Defense Force Medical Corps, Jerusalem 9112102, Israel
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Morgan S. Nurse productivity: using evidence to enhance nurses' use of time. Nurs Stand 2024; 39:30-34. [PMID: 38343375 DOI: 10.7748/ns.2024.e12251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2023] [Indexed: 05/02/2024]
Abstract
The UK is experiencing a nursing shortage, making it challenging to maintain the staffing levels required to deliver effective patient care. One way of enhancing the care delivered by the existing workforce could be to optimise nurse productivity; however, previous efforts to do this have been largely ineffective, due in part to a focus on the processes of care delivery rather than the nursing activities within these processes. In this article, the author explores the concept of nurse productivity and suggests that enhancing productivity requires the identification of nursing activities and consideration of how these may be undertaken in a more time-efficient manner - or removed altogether. The author discusses two such activities: intentional (hourly) rounding, and fixed-time manual vital signs for patients on general wards. The author also considers the potential of using automatic continuous remote monitoring on general hospital wards to free up nurses' time for other care activities.
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Eisenkraft A. Threat Agnostic Approach to Epidemic Management Using Continuous Remote Patient Monitoring. Health Secur 2024; 22:156-158. [PMID: 38483338 PMCID: PMC11044856 DOI: 10.1089/hs.2023.0061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2024] Open
Affiliation(s)
- Arik Eisenkraft
- Arik Eisenkraft, MD, MHA, is a Senior Researcher, The Institute for Research in Military Medicine, The Department of Military Medicine, The Hebrew University Faculty of Medicine and the IDF Medical Corps, Jerusalem, Israel
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Bailey M, Linden D, Earley O, Guo Parke H, McAuley DF, Peto T, Taggart C, Kidney J. Inhibition of bradykinin in SARS-CoV-2 infection: a randomised, double-blind trial of icatibant compared with placebo (ICASARS). BMJ Open 2023; 13:e074726. [PMID: 38035747 PMCID: PMC10689398 DOI: 10.1136/bmjopen-2023-074726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 07/19/2023] [Indexed: 12/02/2023] Open
Abstract
SARS-CoV-2 binds to ACE2 receptors and enters cells. The symptoms are cough, breathlessness, loss of taste/smell and X-ray evidence of infiltrates on chest imaging initially caused by oedema, and subsequently by a lymphocytic pneumonitis. Coagulopathy, thrombosis and hypotension occur. Worse disease occurs with age, obesity, ischaemic heart disease, hypertension and diabetes.These features may be due to abnormal activation of the contact system. This triggers coagulation and the kallikrein-kinin system, leading to accumulation of bradykinin and its derivatives, which act on receptors B1R and B2R. Receptor activation causes cough, hypotension, oedema and release of the cytokine interleukin-6 (IL-6) which recruits lymphocytes. These effects are core features seen in early SARS CoV-2 infection. METHODS AND ANALYSIS In this study, hypoxic patients with COVID-19 with symptom onset ≤7 days will be randomised to either a bradykinin inhibitor (icatibant) or placebo. Patients and investigators will be blinded. The primary outcome will be blood oxygenation, measured by arterial blood sampling. The secondary outcome will be cardiovascular status. Retinal imaging will be performed to assess vessel size. Blood samples will be taken for measurement of inflammatory analyses including IL-6. As a separate substudy, we will also take comparator blood inflammatory samples from a COVID-19-negative cohort. ETHICS AND DISSEMINATION The study has received the following approvals: West Midlands-Edgbaston Research Ethics Committee. Medicines and Healthcare products Regulatory Agency has issued a clinical trial authorisation. Belfast Health and Social Care Trust is the study sponsor. Results will be made available to participants upon request and findings will be presented and published. TRIAL REGISTRATION NUMBER NCT05407597.
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Affiliation(s)
- Melanie Bailey
- Mater Hospital, Belfast Health and Social Care Trust, Belfast, UK
| | - Dermot Linden
- Mater Hospital, Belfast Health and Social Care Trust, Belfast, UK
- Centre for Experimental Medicine, Queen's University Belfast, Belfast, UK
| | - Olivia Earley
- Mater Hospital, Belfast Health and Social Care Trust, Belfast, UK
| | - Hong Guo Parke
- Centre for Experimental Medicine, Queen's University Belfast, Belfast, UK
| | | | - Tunde Peto
- Mater Hospital, Belfast Health and Social Care Trust, Belfast, UK
- Faculty of Medicine, Health and Life Sciences, Queen's University Belfast, Belfast, UK
| | - Cliff Taggart
- Centre for Experimental Medicine, Queen's University Belfast, Belfast, UK
| | - Joe Kidney
- Mater Hospital, Belfast Health and Social Care Trust, Belfast, UK
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Nicolosi GL. Artificial Intelligence in Cardiology: Why So Many Great Promises and Expectations, but Still a Limited Clinical Impact? J Clin Med 2023; 12:jcm12072734. [PMID: 37048817 PMCID: PMC10095331 DOI: 10.3390/jcm12072734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 04/01/2023] [Indexed: 04/14/2023] Open
Abstract
Looking at the extremely large amount of literature, as summarized in two recent reviews on applications of Artificial Intelligence in Cardiology, both in the adult and pediatric age groups, published in the Journal of Clinical Medicine [...].
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Eisenkraft A, Goldstein N, Merin R, Fons M, Ishay AB, Nachman D, Gepner Y. Developing a real-time detection tool and an early warning score using a continuous wearable multi-parameter monitor. Front Physiol 2023; 14:1138647. [PMID: 37064911 PMCID: PMC10090377 DOI: 10.3389/fphys.2023.1138647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 03/20/2023] [Indexed: 03/31/2023] Open
Abstract
Background: Currently-used tools for early recognition of clinical deterioration have high sensitivity, but with low specificity and are based on infrequent measurements. We aimed to develop a pre-symptomatic and real-time detection and warning tool for potential patients’ deterioration based on multi-parameter real-time warning score (MPRT-WS).Methods: A total of more than 2 million measurements were collected, pooled, and analyzed from 521 participants, of which 361 were patients in general wards defined at high-risk for deterioration and 160 were healthy participants allocation as controls. The risk score stratification was based on cutoffs of multiple physiological parameters predefined by a panel of specialists, and included heart rate, blood oxygen saturation (SpO2), respiratory rate, cuffless systolic and diastolic blood pressure (SBP and DBP), body temperature, stroke volume (SV), cardiac output, and systemic vascular resistance (SVR), recorded every 5 min for a period of up to 72 h. The data was used to define the various risk levels of a real-time detection and warning tool, comparing it with the clinically-used National Early Warning Score (NEWS).Results: When comparing risk levels among patients using both tools, 92.6%, 6.1%, and 1.3% of the readings were defined as “Low”, “Medium”, and “High” risk with NEWS, and 92.9%, 6.4%, and 0.7%, respectively, with MPRT-WS (p = 0.863 between tools). Among the 39 patients that deteriorated, 30 patients received ‘High’ or ‘Urgent’ using the MPRT-WS (42.7 ± 49.1 h before they deteriorated), and only 6 received ‘High’ score using the NEWS. The main abnormal vitals for the MPRT-WS were SpO2, SBP, and SV for the “Urgent” risk level, DBP, SVR, and SBP for the “High” risk level, and DBP, SpO2, and SVR for the “Medium” risk level.Conclusion: As the new detection and warning tool is based on highly-frequent monitoring capabilities, it provides medical teams with timely alerts of pre-symptomatic and real-time deterioration.
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Affiliation(s)
- Arik Eisenkraft
- Biobeat Technologies Ltd., Petach Tikva, Israel
- Faculty of Medicine, Institute for Research in Military Medicine, The Hebrew University of Jerusalem, Israel Defense Force Medical Corps, Jerusalem, Israel
| | | | - Roei Merin
- Biobeat Technologies Ltd., Petach Tikva, Israel
| | - Meir Fons
- Biobeat Technologies Ltd., Petach Tikva, Israel
| | | | - Dean Nachman
- Faculty of Medicine, Institute for Research in Military Medicine, The Hebrew University of Jerusalem, Israel Defense Force Medical Corps, Jerusalem, Israel
- Heart Institute, Hadassah Medical Center, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Yftach Gepner
- Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine and Sylvan Adams Sports Institute, Tel Aviv University, Tel Aviv, Israel
- *Correspondence: Yftach Gepner,
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Circadian patterns of heart rate, respiratory rate and skin temperature in hospitalized COVID-19 patients. PLoS One 2022; 17:e0268065. [PMID: 35797369 PMCID: PMC9262173 DOI: 10.1371/journal.pone.0268065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 04/22/2022] [Indexed: 12/15/2022] Open
Abstract
Rationale
Vital signs follow circadian patterns in both healthy volunteers and critically ill patients, which seem to be influenced by disease severity in the latter. In this study we explored the existence of circadian patterns in heart rate, respiratory rate and skin temperature of hospitalized COVID-19 patients, and aimed to explore differences in circadian rhythm amplitude during patient deterioration.
Methods
We performed a retrospective study of COVID-19 patients admitted to the general ward of a tertiary hospital between April 2020 and March 2021. Patients were continuously monitored using a wireless sensor and fingertip pulse oximeter. Data was divided into three cohorts: patients who recovered, patients who developed respiratory insufficiency and patients who died. For each cohort, a population mean cosinor model was fitted to detect rhythmicity. To assess changes in amplitude, a mixed-effect cosinor model was fitted.
Results
A total of 429 patients were monitored. Rhythmicity was observed in heartrate for the recovery cohort (p<0.001), respiratory insufficiency cohort (p<0.001 and mortality cohort (p = 0.002). Respiratory rate showed rhythmicity in the recovery cohort (p<0.001), but not in the other cohorts (p = 0.18 and p = 0.51). Skin temperature also showed rhythmicity in the recovery cohort (p<0.001), but not in the other cohorts (p = 0.22 and p = 0.12). For respiratory insufficiency, only the amplitude of heart rate circadian pattern increased slightly the day before (1.2 (99%CI 0.16–2.2, p = 0.002)). In the mortality cohort, the amplitude of heart rate decreased (-1.5 (99%CI -2.6- -0.42, p<0.001)) and respiratory rate amplitude increased (0.72 (99%CI 0.27–1.3, p = 0.002) the days before death.
Conclusion
A circadian rhythm is present in heart rate of COVID-19 patients admitted to the general ward. For respiratory rate and skin temperature, rhythmicity was only found in patients who recover, but not in patients developing respiratory insufficiency or death. We found no consistent changes in circadian rhythm amplitude accompanying patient deterioration.
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Itelman E, Shlomai G, Leibowitz A, Weinstein S, Yakir M, Tamir I, Sagiv M, Muhsen A, Perelman M, Kant D, Zilber E, Segal G. Assessing the Usability of a Novel Wearable Remote Patient Monitoring Device for the Early Detection of In-Hospital Patient Deterioration: Observational Study. JMIR Form Res 2022; 6:e36066. [PMID: 35679119 PMCID: PMC9227660 DOI: 10.2196/36066] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 03/13/2022] [Accepted: 05/01/2022] [Indexed: 12/24/2022] Open
Abstract
Background Patients admitted to general wards are inherently at risk of deterioration. Thus, tools that can provide early detection of deterioration may be lifesaving. Frequent remote patient monitoring (RPM) has the potential to allow such early detection, leading to a timely intervention by health care providers. Objective This study aimed to assess the potential of a novel wearable RPM device to provide timely alerts in patients at high risk for deterioration. Methods This prospective observational study was conducted in two general wards of a large tertiary medical center. Patients determined to be at high risk to deteriorate upon admission and assigned to a telemetry bed were included. On top of the standard monitoring equipment, a wearable monitor was attached to each patient, and monitoring was conducted in parallel. The data gathered by the wearable monitors were analyzed retrospectively, with the medical staff being blinded to them in real time. Several early warning scores of the risk for deterioration were used, all calculated from frequent data collected by the wearable RPM device: these included (1) the National Early Warning Score (NEWS), (2) Airway, Breathing, Circulation, Neurology, and Other (ABCNO) score, and (3) deterioration criteria defined by the clinical team as a “wish list” score. In all three systems, the risk scores were calculated every 5 minutes using the data frequently collected by the wearable RPM device. Data generated by the early warning scores were compared with those obtained from the clinical records of actual deterioration among these patients. Results In total, 410 patients were recruited and 217 were included in the final analysis. The median age was 71 (IQR 62-78) years and 130 (59.9%) of them were male. Actual clinical deterioration occurred in 24 patients. The NEWS indicated high alert in 16 of these 24 (67%) patients, preceding actual clinical deterioration by 29 hours on average. The ABCNO score indicated high alert in 18 (75%) of these patients, preceding actual clinical deterioration by 38 hours on average. Early warning based on wish list scoring criteria was observed for all 24 patients 40 hours on average before clinical deterioration was detected by the medical staff. Importantly, early warning based on the wish list scoring criteria was also observed among all other patients who did not deteriorate. Conclusions Frequent remote patient monitoring has the potential for early detection of a high risk to deteriorate among hospitalized patients, using both grouped signal-based scores and algorithm-based prediction. In this study, we show the ability to formulate scores for early warning by using RPM. Nevertheless, early warning scores compiled on the basis of these data failed to deliver reasonable specificity. Further efforts should be directed at improving the specificity and sensitivity of such tools. Trial Registration ClinicalTrials.gov NCT04220359; https://clinicaltrials.gov/ct2/show/NCT04220359
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Affiliation(s)
- Edward Itelman
- Chaim Sheba Medical Center, Sheba Beyond, Virtual Hospital, Ramat Gan, Israel
| | - Gadi Shlomai
- Chaim Sheba Medical Center, Sheba Beyond, Virtual Hospital, Ramat Gan, Israel
| | - Avshalom Leibowitz
- Chaim Sheba Medical Center, Sheba Beyond, Virtual Hospital, Ramat Gan, Israel
| | - Shiri Weinstein
- Chaim Sheba Medical Center, Sheba Beyond, Virtual Hospital, Ramat Gan, Israel
| | - Maya Yakir
- Chaim Sheba Medical Center, Sheba Beyond, Virtual Hospital, Ramat Gan, Israel
| | - Idan Tamir
- Chaim Sheba Medical Center, Sheba Beyond, Virtual Hospital, Ramat Gan, Israel
| | - Michal Sagiv
- Chaim Sheba Medical Center, Sheba Beyond, Virtual Hospital, Ramat Gan, Israel
| | - Aia Muhsen
- Chaim Sheba Medical Center, Sheba Beyond, Virtual Hospital, Ramat Gan, Israel
| | - Maxim Perelman
- Chaim Sheba Medical Center, Sheba Beyond, Virtual Hospital, Ramat Gan, Israel
| | - Daniella Kant
- Chaim Sheba Medical Center, Sheba Beyond, Virtual Hospital, Ramat Gan, Israel
| | - Eyal Zilber
- Chaim Sheba Medical Center, Sheba Beyond, Virtual Hospital, Ramat Gan, Israel
| | - Gad Segal
- Chaim Sheba Medical Center, Sheba Beyond, Virtual Hospital, Ramat Gan, Israel
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